Bilateral and Unilateral Total Extraperitoneal Inguinal Hernia Repair (TEP) have Equivalent Early Outcomes: Analysis of 9395 Cases.

F Köckerling,A Kuthe,C Schug‐Pass,T Keller,D Adolf

doi:10.1007/s00268-015-3055-z

Abstract

IntroductionTo date, no randomized controlled trials have been carried out to compare the perioperative outcome of unilateral and bilateral inguinal hernia repair using an endoscopic technique. In a Swiss registry study comparing unilateral with bilateral inguinal hernias, no further details were given regarding the nature of the intra- and postoperative complications. In addition, some authors have raised the issue of prophylactic repair of a clinically healthy other groin side.Patients and methodsIn the Herniamed Registry, in total 9395 patients with a TEP were enrolled. These comprised 6700 patients with unilateral (71.31 %) and 2695 patients (28.69 %) with bilateral inguinal hernia repair. The outcome variables, analyzed in a multivariable model, were the intra- and postoperative as well as general complication rates, reoperation rate, duration of operation, and length of hospital stay.ResultsWhile no significant difference was found in the overall number of intraoperative complications between the unilateral and bilateral group (p = 0.310), a significantly higher number of urinary bladder injuries in the bilateral TEP operation of 0.28 % compared with 0.04 % for unilateral TEP (p = 0,008) were noted. The greater probability of reoperation (0.82 % for unilateral vs. 1.78 % for bilateral TEP; p < 0,001) in the unadjusted analysis was confirmed in the multivariable model [OR 2.35 (1.504; 3.322); p = 0.001].SummaryA significantly higher intraoperative urinary bladder injury rate and reoperation rate because of postoperative surgical complications constitute a difference in the perioperative outcome between unilateral and bilateral TEP which that warrants attention. Based on these results, prophylactic operation of the healthy other groin should not be recommended.Electronic supplementary materialThe online version of this article (doi:10.1007/s00268-015-3055-z) contains supplementary material, which is available to authorized users.

Highlights

To date, no randomized controlled trials have been carried out to compare the perioperative outcome of unilateral and bilateral inguinal hernia repair using an endoscopic technique
While no significant difference was found in the overall number of intraoperative complications between the unilateral and bilateral group (p = 0.310), a significantly higher number of urinary bladder injuries in the bilateral total extraperitoneal patch plasty (TEP) operation of 0.28 % compared with 0.04 % for unilateral TEP (p = 0,008) were noted
Summary A significantly higher intraoperative urinary bladder injury rate and reoperation rate because of postoperative surgical complications constitute a difference in the perioperative outcome between unilateral and bilateral TEP which that warrants attention

Summary

Introduction

No randomized controlled trials have been carried out to compare the perioperative outcome of unilateral and bilateral inguinal hernia repair using an endoscopic technique. In a Swiss registry study comparing unilateral with bilateral inguinal hernias, no further details were given regarding the nature of the intra- and postoperative complications. Some authors have raised the issue of prophylactic repair of a clinically healthy other groin side. Patients and methods In the Herniamed Registry, in total 9395 patients with a TEP were enrolled These comprised 6700 patients with unilateral (71.31 %) and 2695 patients (28.69 %) with bilateral inguinal hernia repair. A Swiss registry study compared 3457 unilateral with 3048 bilateral inguinal hernia repairs using total extraperitoneal patch plasty (TEP) technique [6]. The authors concluded that the absolute difference between intra- and postoperative complications of unilateral versus bilateral inguinal hernia repair in TEP technique was small and of minor clinical relevance. Some authors have raised the issue of prophylactic repair of a clinically healthy other side to avoid the second inguinal hernia repair in the future [7–9]

Methods

Results

Conclusion