Evidence-based medicine and special aspects in bilateral inguinal hernia repair

Fischer, Steven Roger; Cassivi, S.D.; Paul, Andreas; Troidl, H.

doi:10.1007/bf01194613

Cited by 16 publications

(10 citation statements)

References 50 publications

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“…Prophylactic repair is therefore performed when a patient has a contralateral inguinal hernia. However, Fischer et al 1 have pointed out that it is not yet known whether repair of the contralateral hernia prevents future complications or traumatizes the abdominal wall unnecessarily and increases the risk for surgical morbidity. At present, the prophylactic repair of an incidentally found contralateral hernia appears unjustified.…”

Section: Discussionmentioning

confidence: 99%

“…P ATIENTS WITH BILATERAL INGUINAL HERNIA account for about 15% of all inguinal hernia surgical procedures. 1 Although sequential open repair of bilateral inguinal hernia has been the traditional school of thought, simultaneous bilateral repair, irrespective of the technique, has been gaining in popularity during the past two decades. 2 Simultaneous repair confers the advantage of a single anesthesia, avoids another operation, shortens the length of hospitalization, reduces costs, and averts the risk for strangulation of the contralateral hernia before the patient undergoes the second surgery.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

A Comparative Outcome Analysis of Bilateral versus Unilateral Endoscopic Extraperitoneal Inguinal Hernioplastics

Lau

Patil

Yuen

2003

Journal of Laparoendoscopic & Advanced Surgical Techniques

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

A Comparative Outcome Analysis of Bilateral versus Unilateral Endoscopic Extraperitoneal Inguinal Hernioplastics

Lau

Patil

Yuen

2003

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…In terms of evidence-based practice, specific data on bilateral inguinal hernias are sparse, and therefore many of the principles used to manage bilateral hernias rely on information obtained from the treatment of unilateral inguinal hernias. 16 …”

Section: Discussionmentioning

confidence: 99%

“…Currently, hernia surgeons focus on feasibility, costs, safety, recovery, and postoperative pain, rather than on recurrence rate. 16 In the scenario, no mesh fixation appears to have important advantages over fixation methods. The challenge may be greater for bilateral inguinal hernias.…”

Section: Discussionmentioning

confidence: 99%

Mesh Displacement After Bilateral Inguinal Hernia Repair With No Fixation

Claus

Rocha

Campos

et al. 2017

JSLS

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Background and Objectives:About 20% of patients with inguinal hernia present bilateral hernias in the diagnosis. In these cases, laparoscopic procedure is considered gold standard approach. Mesh fixation is considered important step toward avoiding recurrence. However, because of cost and risk of pain, real need for mesh fixation has been debated. For bilateral inguinal hernias, there are few specific data about non fixation and mesh displacement. We assessed mesh movement in patients who had undergone laparoscopic bilateral inguinal hernia repair without mesh fixation and compared the results with those obtained in patients with unilateral hernia.Methods:From January 2012 through May 2014, 20 consecutive patients with bilateral inguinal hernia underwent TEP repair with no mesh fixation. Results were compared with 50 consecutive patients with unilateral inguinal hernia surgically repaired with similar technique. Mesh was marked with 3 clips. Mesh movements were measured by comparing initial radiography performed at the end of surgery, with a second radiographic scan performed 30 days later.Results:Mean movements of all 3 clips in bilateral nonfixation (NF) group were 0.15–0.4 cm compared with 0.1–0.3 cm in unilateral NF group. Overall displacement of bilateral and unilateral NF groups did not show significant difference. Mean overall displacement was 1.9 cm versus 1.8 cm in the bilateral and unilateral NF groups, respectively (P = .78).Conclusions:TEP with no mesh fixation is safe in bilateral inguinal repairs. Early mesh displacement is minimal. This technique can be safely used in most patients with inguinal hernia.

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“…Indeed, more than 800,000 groin hernia repairs are performed in the United States each year [3]. Approximately 15% of all inguinal hernias are bilateral [4]. The debate continues as to whether bilateral hernias should be repaired simultaneously or sequentially [5,6].…”

mentioning

confidence: 99%

Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes similar to those for unilateral TEP: population-based analysis of prospective data of 6,505 patients

et al. 2011

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Background Whether bilateral total extraperitoneal (TEP) inguinal hernia repair is associated with worse outcomes than unilateral TEP continues to be a matter of debate. This study aimed to compare different outcomes of large cohorts of patients undergoing bilateral versus unilateral TEP. Methods Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS), all patients undergoing elective unilateral or bilateral TEP from 1995 to 2006 were included in the study. The outcomes compared included conversion rates; intraoperative, surgical, and general postoperative complications; duration of operation; and length of hospital stay (LOS). Unadjusted and risk-adjusted multivariable analyses were performed. Results Data for 6,505 patients undergoing unilateral (n = 3,457) and bilateral (n = 3,048) TEP were prospectively collected. The average age and the American Society of Anesthesiologists (ASA) score were similar in the two groups. The patients undergoing bilateral TEP repair had a slightly increased rate of intraoperative complications (bilateral, 3.1% vs. unilateral, 1.9%) and surgical postoperative complications (bilateral, 3.2% vs. unilateral, 2.3%). The operation time was longer for bilateral TEP repair (86 vs. 67 min). No significant differences in postoperative LOS, general postoperative complications, or conversion rates were found. Conclusions This is the first population-based analysis in the literature to compare different outcomes in a prospective cohort of more than 6,500 patients undergoing bilateral versus unilateral TEP. Although the rates for intraoperative and surgical postoperative complications were slightly higher for the patients undergoing bilateral TEP repair, the absolute differences were small and of minor clinical relevance. Bilateral TEP repair is associated with a minimal increase in operating time and similar LOS, general postoperative complications, and conversion rates. Therefore, for patients with bilateral inguinal hernia, a simultaneous endoscopic approach represents an excellent therapeutic option.Keywords Bilateral vs. unilateral inguinal hernia repair Á Inguinal hernia Á Population-based analysis Á TEP Á Total extraperitoneal inguinal hernia repair Symptomatic inguinal hernia is a common surgical problem, and inguinal hernia repair is among the most frequently performed operations in general surgery [1,2]. Indeed, more than 800,000 groin hernia repairs are performed in the United States each year [3]. Approximately 15% of all inguinal hernias are bilateral [4]. The debate continues as to whether bilateral hernias should be repaired simultaneously or sequentially [5,6].

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Evidence-based medicine and special aspects in bilateral inguinal hernia repair

Cited by 16 publications

References 50 publications

A Comparative Outcome Analysis of Bilateral versus Unilateral Endoscopic Extraperitoneal Inguinal Hernioplastics

A Comparative Outcome Analysis of Bilateral versus Unilateral Endoscopic Extraperitoneal Inguinal Hernioplastics

Mesh Displacement After Bilateral Inguinal Hernia Repair With No Fixation

Bilateral total extraperitoneal inguinal hernia repair (TEP) has outcomes similar to those for unilateral TEP: population-based analysis of prospective data of 6,505 patients

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