Research Supports Single-Session Laparoscopic Repair For Bilateral Inguinal Hernias

A recent study co-authored by Associate Professor Adam Bartlett has demonstrated that repairing bilateral inguinal hernias—weaknesses in the abdominal wall causing bulges in the groin on both sides—can be safely and effectively performed in a single laparoscopic (keyhole) operation. This approach offers significant advantages, including reduced hospital visits and recovery time, though risks should be discussed in light of the study's findings compared to unilateral repairs.

The research, published in the journal Hernia in 2023, compared outcomes for patients undergoing bilateral versus unilateral total extra-peritoneal (TEP) inguinal hernia repairs. The systematic review and meta-analysis found no significant difference in most complications such as seroma, hematoma, or urinary retention when both sides were addressed simultaneously, though there was an increased rate of hernia recurrence in bilateral repairs. Recovery metrics, including length of hospital stay, were comparable between the groups. Notably, the bilateral procedure required only a slightly longer operation time but eliminated the need for a second anesthesia and recovery period. The authors noted the low quality of evidence and recommended further study via randomized controlled trials.

"This study provides reassuring evidence for patients facing bilateral hernias," said A/Prof Bartlett, a specialist in general, laparoscopic, and hepatopancreatobiliary surgery based in Auckland. "For most individuals, a single-sitting repair streamlines treatment and enhances convenience, aligning with modern surgical best practices."

Key findings from the research include:

• Safety Profile: Bilateral repairs did not elevate most complication rates, though hernia recurrence was higher, affirming the procedure's viability for suitable candidates while warranting further study via RCTs.
• Recovery Similarity: Patients experienced similar lengths of hospital stay as those with single-side repairs.
• Efficiency Gains: Avoiding a second surgery reduces overall healthcare burden, including fewer anesthetics and hospital admissions.

These results are supported by international guidelines from leading organisations:

• The HerniaSurge international guidelines (2018, updated 2023) endorse laparoscopic repair as a standard for groin hernias, explicitly supporting bilateral procedures in one session with a trained team.
• The European Hernia Society (EHS) strongly recommends laparoscopic approaches for primary bilateral inguinal hernias under experienced surgeons.
• The UK's National Institute for Health and Care Excellence (NICE) advocates laparoscopic surgery for bilateral cases and recurrent hernias post-open repair.
• The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) highlights laparoscopic repair as ideal for bilateral hernias due to its efficiency and recovery benefits.

While the single-session approach is recommended for most patients eligible for laparoscopic surgery, separate operations may be preferable in cases involving complex hernias, significant comorbidities that limit longer procedures, or when open surgery is required.

This study reinforces guideline recommendations, offering practical insights for surgeons and patients alike. Individuals considering hernia repair are encouraged to discuss personalised options with their healthcare provider, factoring in overall health, lifestyle, and preferences.

About A/Professor Adam Bartlett Associate Professor Adam Bartlett is a leading surgeon specialising in hepatopancreatobiliary and general surgery, with expertise in laparoscopic techniques. He practices in Auckland and contributes to medical education and pro bono initiatives.

For more information, visit https://www.hpbsurgery.co.nz/hernia-repair-surgery/

Read more on Recent Publications by Adam Bartlett on This Topic: 

• "Comparison of bilateral to unilateral total extra-peritoneal (TEP) inguinal hernia repair: a systematic review and meta-analysis" (Hernia, April 2023). https://pubmed.ncbi.nlm.nih.gov/37010657/
• "Totally extraperitoneal laparoscopic inguinal hernia repair post-radical prostatectomy" (Surgical Endoscopy, May 2022). https://pubmed.ncbi.nlm.nih.gov/35579700/

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