From the Guidelines
The recommended surgical treatment for bilateral inguinal hernias is typically a bilateral laparoscopic repair, either using the totally extraperitoneal (TEP) or transabdominal preperitoneal (TAPP) approach. This approach allows for both hernias to be repaired during a single operation with minimal incisions, reducing postoperative pain and recovery time compared to sequential open repairs 1. The procedure involves placing synthetic mesh over both hernia defects to reinforce the weakened areas.
Key Considerations
- For patients who are poor candidates for laparoscopy due to previous abdominal surgery or other contraindications, bilateral open repair using the Lichtenstein tension-free technique is an acceptable alternative 1.
- The decision between laparoscopic and open approaches should consider the patient's medical history, hernia characteristics, and surgeon expertise, but addressing both hernias in a single procedure is generally preferred to minimize overall recovery time and reduce costs 1.
- Postoperative pain management typically includes acetaminophen and NSAIDs, with limited opioids for breakthrough pain.
Surgical Approach
- The TEP and TAPP approaches are both effective for bilateral inguinal hernia repair, with the choice between them depending on the surgeon's preference and the patient's anatomy 1.
- Laparoscopic repair has been shown to have lower recurrence rates and reduced postoperative pain compared to open repair 1.
Mesh Selection
- Synthetic mesh is commonly used for inguinal hernia repair, but biological mesh may be considered in cases where there is a high risk of infection or contamination 1.
- The choice of mesh type should be based on the patient's individual needs and the surgeon's preference.
Recovery and Follow-up
- Most patients can return to light activities within 1-2 weeks and full activities within 4-6 weeks after laparoscopic repair 1.
- Follow-up appointments should be scheduled to monitor for any complications or recurrence of the hernia.
From the Research
Surgical Treatment for Bilateral Inguinal Hernias
The recommended surgical treatment for bilateral inguinal hernias is a topic of interest, with various studies comparing different approaches.
- Laparoscopic total extraperitoneal (TEP) approach is considered a feasible and advantageous method for bilateral inguinal hernia treatment, with low rates of complications, conversion, and recurrence 2.
- A comparison between laparoscopic TEP and Lichtenstein tension-free open mesh repair (LMR) showed that TEP has added advantages like less postoperative pain, early resumption of normal activities, and less chronic groin pain, although it has a longer operative time 3.
- A study comparing TEP and transabdominal preperitoneal (TAPP) techniques in bilateral inguinal hernias found similar outcomes, with no significant differences in postoperative complications, chronic inguinal pain, or recurrence 4.
- Another study found that TAPP repairs had a higher recurrence rate compared to TEP repairs, although the overall complication rate was similar between the two approaches 5.
- A systematic review with a network meta-analysis found that TEP and TAPP are equivalent in terms of operative time, postoperative complications, postoperative pain, time to return to work, and recurrences, although TAPP was associated with a slightly longer hospital stay 6.
Key Findings
- Laparoscopic TEP approach is a recommended method for bilateral inguinal hernia treatment.
- TEP and TAPP techniques have similar outcomes in terms of postoperative complications, chronic inguinal pain, and recurrence.
- The choice of surgical technique (TEP or TAPP) depends on the surgeon's expertise and the patient's specific condition.
- Laparoscopic hernia repair offers advantages over open hernia repair, including less pain and shorter convalescence.