Inguinal hernia repair is one of the most frequently performed procedures in general surgery. The advent of laparoscopic techniques has significantly improved outcomes by minimizing postoperative pain, reducing recovery time, and lowering recurrence rates. Among these minimally invasive methods, Transabdominal Preperitoneal (TAPP) repair is widely adopted, especially for bilateral inguinal hernias, where both sides of the groin are affected. Dr. R.K. Mishra and other surgical experts advocate TAPP for its precision, safety, and reproducibility, particularly in bilateral cases.

Introduction to Bilateral Inguinal Hernia

An inguinal hernia occurs when abdominal contents protrude through a weakness in the inguinal canal. Bilateral inguinal hernias affect both sides of the groin and may be symptomatic or detected during physical examination. Patients often experience groin swelling, discomfort, or pain, which may worsen with activity or straining. Bilateral hernias require careful surgical planning because simultaneous repair can present technical challenges and increase operative time.

Why TAPP for Bilateral Hernias?

The TAPP technique involves entering the peritoneal cavity laparoscopically, creating a preperitoneal space, and placing a mesh to cover the hernia defects. Its advantages for bilateral inguinal hernias include:

Single Surgical Session: Both hernias can be repaired in one procedure, reducing anesthesia exposure and hospital visits.

Minimal Invasiveness: Small laparoscopic incisions reduce postoperative pain and allow faster recovery.

Enhanced Visualization: The laparoscope provides magnified views of the myopectineal orifice, allowing precise dissection and mesh placement on both sides.

Lower Recurrence Rates: Mesh placement in the preperitoneal space ensures tension-free repair, minimizing the risk of recurrence.

Early Return to Daily Activities: Patients typically resume normal activities within days, compared to weeks after open surgery.

Preoperative Considerations

Dr. R.K. Mishra emphasizes thorough preoperative assessment:

Clinical Evaluation: Confirmation of bilateral hernia through physical examination, sometimes supplemented with imaging like ultrasound or CT scan.

Comorbidities Assessment: Patients with cardiovascular, respiratory, or metabolic conditions should be optimized preoperatively.

Informed Consent: Patients must understand the procedure, benefits, potential complications, and recovery expectations.

Surgical Technique: Stepwise Approach

The TAPP procedure for bilateral inguinal hernia involves the following steps:

Anesthesia and Patient Positioning: General anesthesia is administered. The patient is placed supine with slight Trendelenburg tilt to allow abdominal contents to move away from the operative field.

Port Placement: A camera port (usually 10 mm) is placed at the umbilicus, with two additional 5 mm working ports in the lower abdomen. Proper placement is crucial to provide ergonomic access to both groin areas.

Peritoneal Incision: The peritoneum is incised above the hernia defect to create a flap, exposing the preperitoneal space.

Dissection: Careful dissection identifies critical structures, including the inferior epigastric vessels, spermatic cord, and vas deferens. Hernial sacs are reduced, and the preperitoneal space is cleared on both sides.

Mesh Placement: A synthetic mesh is placed over both myopectineal orifices, ensuring coverage of all potential hernia sites. Mesh fixation may be achieved with tacks, sutures, or self-fixating meshes.

Peritoneal Closure: The peritoneal flap is closed over the mesh to prevent adhesions and exposure to intra-abdominal contents.

Final Inspection: Surgeons verify hemostasis and proper mesh placement before desufflating the abdomen and closing the ports.

Advantages of Bilateral TAPP

Simultaneous Repair: Avoids the need for two separate surgeries.

Reduced Postoperative Pain: Less trauma to the groin muscles and nerves.

Early Mobilization: Encourages faster recovery and lower risk of complications like deep vein thrombosis.

Cosmetic Benefit: Minimal scarring due to small port incisions.

Potential Risks and Complications

While TAPP is generally safe, complications can occur:

Bleeding from inferior epigastric or other vessels

Injury to vas deferens or spermatic cord structures

Seroma or hematoma formation

Mesh infection or migration (rare)

Conversion to open surgery in case of dense adhesions or technical difficulties

Postoperative Care

Patients are usually discharged within 24–48 hours. Mild discomfort is managed with analgesics, and early ambulation is encouraged. Strenuous activity is typically restricted for 2–3 weeks. Follow-up visits ensure proper healing and monitor for complications.

Conclusion

Bilateral TAPP inguinal hernia repair represents a safe, effective, and minimally invasive option for patients with hernias on both sides of the groin. By combining advanced laparoscopic techniques, magnified visualization, and tension-free mesh placement, this approach offers excellent functional and cosmetic outcomes. Surgeons like Dr. R.K. Mishra highlight that meticulous technique, proper patient selection, and adherence to surgical principles are essential for success.

Bilateral TAPP not only addresses both hernias simultaneously but also enhances recovery, reduces pain, and minimizes recurrence, making it a preferred choice for modern hernia surgery.