Long-term outcomes after bilateral transabdominal preperitoneal (TAPP) repair for asymptomatic contralateral inguinal hernia.

Abstract

Surgical management of an asymptomatic inguinal hernia is controversial but given that most of the patients will develop symptoms, the hernioplasty seems to be a reasonable option. We aimed to compare postoperative outcomes after transabdominal preperitoneal (TAPP) repair between patients with symptomatic bilateral hernia (SBH) and patients with one symptomatic hernia and an asymptomatic contralateral hernia (ACH). A consecutive series of patients undergoing bilateral laparoscopic TAPP from July 2014 to June 2018 were included. Symptomatic hernia was defined as a groin bulge associated to pain and altered patient's daily activities. Patients were divided into two groups, those with SBH and those with one symptomatic hernia in whom an ACH was diagnosed by physical examination or ultrasound when clinical assessment was inconclusive. Demographics, operative, and postoperative outcomes were compared. Quality of life (QoL) was assessed before and after surgery in both groups. A total of 305 bilateral TAPP repairs were included; 102 (33, 4%) patients had SBH and 203 (66, 6%) had ACH. There were no significant differences between groups regarding age, gender, body mass index, active smoking, and comorbidities. Operative time (SBH: 125 vs. ACH: 132min, p = 0.13) and overall 30-day morbidity were similar between groups (SBH: 14, 7% vs. ACH: 13, 8%, p = 0.82). After a mean follow-up of 30 (10-48) months, the recurrence rate was 1, 4% and 2, 2% in SBH and ACH, respectively (p = 0.53). QoL after surgery improved significantly and similarly in both groups. Bilateral laparoscopic TAPP in the setting of an asymptomatic hernia did not increase morbidity and had similar outcomes when compared to patients with bilateral symptoms. A comprehensive preoperative evaluation of the contralateral groin should be routinely performed, mainly by physical examination, and a bilateral repair may be proposed if an asymptomatic contralateral hernia is detected.