Recommended Treatment for Bilateral Hernia
The recommended treatment for bilateral hernia is a laparoscopic approach (either TEP or TAPP) as it offers shorter recovery time, lower risk of chronic pain, and is cost-effective compared to open repair techniques. 1, 2, 3
Surgical Approach Selection
- For stable patients with bilateral hernias, a minimally invasive laparoscopic approach is recommended as it provides shorter convalescence time, quicker return to work (average 17.9 days vs 56.4 days for open repair), and lower chronic pain risk 3, 1
- In unstable patients or those with signs of strangulation or perforation, an abdominal approach (laparotomy) is recommended as the primary surgical approach 1, 4
- For patients over 65 years of age, there is a higher likelihood of receiving open repair (4.18 times higher odds), though this appears to be based on practice patterns rather than evidence-based recommendations 2
- Patients on anticoagulants have significantly higher odds (38.8 times) of receiving open rather than minimally invasive repair 2
Technical Considerations
- Mesh repair is strongly recommended as the first choice for bilateral hernias, regardless of whether an open or laparoscopic approach is used 1, 5
- During TAPP (transabdominal preperitoneal) laparoscopic repair, inspection of the contralateral side is recommended after obtaining patient consent 5
- For larger defects (>8 cm or area >20 cm²), mesh should overlap the defect edge by 1.5-2.5 cm 1
- Primary repair with non-absorbable sutures should always be attempted when possible before considering mesh placement 1
Specific Benefits of Laparoscopic Repair for Bilateral Hernias
- Laparoscopic repair allows simultaneous treatment of both hernias through the same access ports, minimizing tissue trauma 6, 3
- The total extraperitoneal (TEP) approach is commonly used (82% of cases in one large series) with excellent outcomes 6
- Laparoscopic repair shows lower recurrence rates (1.3% vs 5.1% for open repair) in bilateral hernia cases 3
- Minimally invasive approaches demonstrate lower morbidity (5-6%) compared to open approaches (17-18%) 7
Potential Complications and Management
- Complications after bilateral hernia repair include atelectasia, surgical site infection, bleeding, respiratory insufficiency, ileus, gastroesophageal reflux, chronic pain, hernia recurrence, and cardiac injury 7
- Recurrence may be related to use of absorbable sutures, suture tension, inadequate fixation of prosthetic material, increased intra-abdominal pressure, poor thoracic cleaning, and intra-abdominal sepsis 7
- For patients with bilateral hernias who develop recurrence after anterior repair, a posterior approach is recommended; conversely, anterior repair is recommended after failed posterior repair 5
Special Considerations
- For women with bilateral groin hernias, laparoscopic repair is particularly recommended to decrease chronic pain risk and avoid missing femoral hernias 5
- In patients with right-sided diaphragmatic hernia as part of bilateral presentation, repair can be more difficult due to the presence of the liver, potentially requiring a combined or thoracic approach 1
- Day surgery is recommended for most bilateral groin hernia repairs, provided appropriate aftercare is organized 5
- Patients should be encouraged to resume normal activities without restrictions as soon as they feel comfortable 5