Inguinal hernia is one of the most common surgical conditions worldwide, and while open repair has been practiced for decades, recurrence remains a challenge, particularly when the hernia is bilateral and recurrent. Bilateral recurrent inguinal hernia refers to the reappearance of hernia defects on both sides of the groin after a previous repair. Managing these cases is often technically demanding because of distorted anatomy, scar tissue formation, and limited options for traditional repair. Laparoscopic repair, with its minimally invasive advantages, has emerged as a preferred approach for such complex hernias.

Understanding Bilateral Recurrent Inguinal Hernia

Inguinal hernia occurs when intra-abdominal contents protrude through a weakened area of the abdominal wall in the groin. Recurrence may result from several factors such as:

Inadequate initial repair

Poor mesh placement or fixation

Chronic cough, constipation, or obesity causing increased intra-abdominal pressure

Wound infection or poor healing

Patient-related risk factors like smoking or diabetes

When the recurrence occurs on both sides, patients often experience significant discomfort, impaired mobility, and reduced quality of life. Pain, swelling, and a visible bulge in the groin are common symptoms. Recurrent cases are particularly concerning because each additional repair becomes more difficult due to scarring and anatomical distortion.

Advantages of Laparoscopic Repair

For recurrent bilateral inguinal hernia, laparoscopic repair offers several advantages over open re-repair:

Access to Virgin Tissue Planes
Laparoscopy allows the surgeon to approach the hernia from the posterior aspect, avoiding scar tissue created during the previous anterior open repairs. This reduces the risk of injury to vital structures.

Simultaneous Bilateral Repair
Both sides of the groin can be addressed in the same procedure without additional incisions, making it highly efficient for bilateral cases.

Reduced Postoperative Pain
Minimally invasive surgery causes less trauma to the tissues, which translates to faster recovery and less discomfort.

Lower Recurrence Rates
With proper technique and mesh placement, the recurrence rates are significantly lower compared to repeat open repairs.

Quick Return to Daily Activities
Patients usually experience an early return to work, mobility, and normal lifestyle.

Surgical Techniques

Two main laparoscopic techniques are used for recurrent inguinal hernia repair:

Transabdominal Preperitoneal (TAPP) Repair

In this method, the surgeon enters the abdominal cavity and creates a peritoneal flap to access the preperitoneal space. The hernia sac is reduced, and a large mesh is placed to cover all potential hernia sites. The peritoneum is then closed over the mesh.

Advantages:

Wide view of the anatomy

Easier identification of bilateral defects

Secure mesh placement covering direct, indirect, and femoral hernia sites

Totally Extraperitoneal (TEP) Repair

Here, the surgeon works exclusively in the preperitoneal space without entering the abdominal cavity. A balloon dissector or blunt dissection is used to create space for mesh placement.

Advantages:

No breach of the peritoneal cavity

Reduced risk of intra-abdominal adhesions and complications

Shorter hospital stay

For bilateral recurrent cases, both TEP and TAPP are effective. However, TAPP is often favored in complex recurrences because it provides better visualization of scarred tissues and allows for easier dissection.

Mesh Placement and Fixation

A large synthetic mesh is used to reinforce the weakened abdominal wall and prevent further recurrence. The mesh should be wide enough to cover the myopectineal orifice comprehensively. Fixation can be done with tacks, fibrin glue, or even left without fixation in some cases, depending on the surgeon’s preference and patient anatomy. Care is taken to avoid nerve entrapment, which may cause chronic postoperative pain.

Postoperative Recovery

Recovery after laparoscopic repair of bilateral recurrent inguinal hernia is generally smooth. Most patients can start walking within hours of surgery and are discharged within 24 to 48 hours. Mild discomfort and groin stiffness may persist for a few days, but pain is usually well-controlled with oral medications. Patients are advised to avoid heavy lifting for a few weeks, but normal daily activities can resume much earlier compared to open re-repair.

Complications and Risks

Although laparoscopic repair is safe, certain complications can occur, especially in recurrent cases:

Injury to blood vessels, bladder, or intestines

Seroma or hematoma formation

Chronic groin pain due to nerve irritation

Mesh infection (rare but serious)

Risk of another recurrence if technique or mesh coverage is inadequate

Experienced surgeons and careful technique significantly minimize these risks.

Conclusion

Laparoscopic repair of bilateral recurrent inguinal hernia is considered the gold standard for complex hernia recurrences. By offering access to unscarred tissue planes, the ability to repair both sides simultaneously, reduced pain, and faster recovery, it surpasses conventional open re-repair techniques. With advances in mesh technology and laparoscopic expertise, patient outcomes continue to improve, making this minimally invasive procedure the preferred approach for patients suffering from recurrent bilateral inguinal hernias.