What are the treatment options for bilateral inguinal (groin area) hernias?

From the Guidelines

Bilateral inguinal hernias should be treated with prompt surgical consultation, preferably using a laparoscopic approach, to minimize the risk of complications such as incarceration or strangulation, as recommended by the 2017 update of the WSES guidelines for emergency repair of complicated abdominal wall hernias 1.

Treatment Approach

The treatment of bilateral inguinal hernias involves surgical repair, which can be performed laparoscopically or openly, with mesh reinforcement.

• The laparoscopic approach is preferred for its lower wound infection rate and reduced postoperative complications, as seen in a retrospective 4-year analysis of 188 patients who underwent emergency surgical repair of strangulated groin hernias 1.
• The use of mesh in clean surgical fields is associated with a lower recurrence rate, without an increase in wound infection rate, as stated in the 2017 WSES guidelines 1.

Preoperative Care

While awaiting surgery, patients should:

• Avoid heavy lifting (nothing over 10-15 pounds)
• Use proper body mechanics when coughing or straining
• Consider wearing a supportive truss if recommended by their physician
• Manage pain with acetaminophen 650mg every 6 hours or ibuprofen 400-600mg every 6-8 hours as needed, unless contraindicated

Postoperative Care

Bilateral repairs are typically performed during the same operation, with recovery requiring:

• 1-2 weeks for desk jobs
• 4-6 weeks before returning to heavy physical activity The choice of surgical approach and postoperative care should be individualized based on the patient's condition and the surgeon's expertise, as recommended by the 2017 WSES guidelines 1.

From the Research

Diagnosis and Treatment of Bilateral Inguinal Hernias

• Bilateral inguinal hernias can be diagnosed by physical examination, and in some cases, ultrasonography or magnetic resonance imaging may be necessary for diagnosis 2.
• The treatment of bilateral inguinal hernias often involves surgical repair, with laparoscopic or endoscopic procedures being preferable to open procedures 3, 4, 5.
• Laparoscopic repair offers significant advantages over open techniques, including lower recurrence risk, less pain, and faster recovery 4, 5.

Surgical Techniques for Bilateral Inguinal Hernias

• The totally extraperitoneal patch plasty (TEP) and transabdominal preperitoneal patch plasty (TAPP) are recommended techniques for laparoscopic repair of bilateral inguinal hernias 6.
• The Lichtenstein technique is also a recommended open mesh repair technique for inguinal hernias 6.
• Surgeons should be proficient in both open and laparoscopic/endoscopic techniques to provide the best treatment options for patients with bilateral inguinal hernias 3, 6.

Outcomes and Complications of Bilateral Inguinal Hernia Repair

• Laparoscopic repair of bilateral inguinal hernias has been shown to have low recurrence rates and minimal complications 5.
• The use of mesh-based repair is generally recommended, as it seems reasonable in view of the pathogenesis of the condition, which involves an abnormality of the extracellular matrix 3.
• Patients treated by laparoscopy/endoscopy develop chronic pain less often than those treated by open surgery 3.