Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair

Abstract

In the present study bilateral TEP was performed in three types of patients: those with clinically bilateral hernias, those with clinically unilateral hernia but with an OCH, and in truly unilateral hernias. All of these were compared with unilateral TEPs in clinically unilateral hernias, and we found no significant increase in morbidity, pain, recurrence or complications in bilateral repairs. Convalescence from surgery, as determined by return to activities of daily living and return to work parameters, was also comparable. Surgeons experienced in laparoscopic TEP, in high-volume centers, can provide bilateral repairs in patients with inguinal hernia, bearing in mind its advantages and comparable morbidity. We also feel that, in elective repair of inguinal hernia, the patient should be given the option of bilateral repair. Bilateral repair does not add to the risk of surgery in experienced hands and we strongly feel that unilateral TEP is actually a job half done.

Early pain after laparoscopic inguinal hernia repair. A qualitative systematic review

“…Operation of bilateral hernia ( n = 217) compared with unilateral hernia ( n = 545) may not lead to higher pain intensity after TAPP during the first post‐operative week . Similar results were found with the TEP technique . However, two of these prospective studies with patients undergoing TEP found significantly higher pain intensity after unilateral compared with bilateral repair at 12 h and on day 2–3, but findings may be due to informative bias in the bilateral group or mass significance due to multiple testing …”

“…After laparoscopic groin hernia repair, pain intensity peaks on day 0 [13–58 mm, range of median values in the papers, visual analogue scale (VAS), 0–100 mm] with moderate to severe pain in half of the patients and decreases during the following days . Most studies did not evaluate pre‐operative pain, but some studies found that pain intensity at day 3 was comparable to pre‐operative levels, although findings are not consistent because pain in several studies persisted until day 7 or longer .…”

The experience and awareness of laparoendoscopic procedures among Polish surgeons in everyday clinical practice.

“…As a result, two thirds of the surveyed surgeons opt for a two-stage approach, managing one side at a time. The available literature confirms improved cost-effectiveness of a single-stage bilateral inguinal hernia repair [11]. This improved cost-effectiveness was demonstrated even in cases of intraoperative finding of an asymptomatic hernia on the contralateral side, which should be repaired at the same time, provided that the patient has given their informed consent to such intervention [12].…”

A Literature Review on the Role of Totally Extraperitoneal Repairs for Groin Pain in Athletes

“…14,24,26 Furthermore, should a TEP repair be performed prophylactically in patients with asymptomatic contralateral groins? 38 A paucity of studies exists regarding TEP repair and sports hernias. The current evidence would suggest a short trial of conservative treatment followed by surgery, provided no other pathology requiring other interventions is identified on imaging studies.…”