Inguinal hernia is one of the most common surgical conditions, occurring when abdominal contents protrude through a weakened area in the groin region. While unilateral hernias are more frequent, many patients present with hernias on both sides, known as bilateral inguinal hernias. Traditionally, open surgical repair required two separate incisions, which often led to longer recovery times, increased postoperative pain, and higher chances of complications. With advancements in minimally invasive surgery, bilateral laparoscopic inguinal hernia repair has emerged as a safe, efficient, and patient-friendly technique.

Understanding Bilateral Inguinal Hernia

An inguinal hernia occurs when a part of the intestine or fatty tissue pushes through the inguinal canal. When hernias develop on both the left and right groin, the condition is termed bilateral. This is particularly common in elderly patients, those with chronic coughing, heavy lifting habits, or a genetic predisposition to weak abdominal walls. If untreated, hernias may enlarge, cause discomfort, or even lead to complications like strangulation of bowel loops.

Why Laparoscopic Approach?

The laparoscopic technique has gained wide acceptance due to its minimally invasive nature. Instead of large incisions, the surgeon uses small keyhole cuts through which specialized instruments and a camera are introduced. This allows direct visualization of both groins simultaneously, making it especially beneficial for bilateral cases.

Compared to traditional open repair, laparoscopic surgery offers:

Less postoperative pain

Shorter hospital stay

Faster recovery and return to activities

Better cosmetic results

Reduced risk of wound infections

Simultaneous repair of both hernias without additional incisions

Types of Laparoscopic Hernia Repair

Two main laparoscopic techniques are commonly performed:

Transabdominal Preperitoneal Repair (TAPP) – The surgeon enters the peritoneal cavity, creates a space, and places a mesh in the preperitoneal region.

Totally Extraperitoneal Repair (TEP) – The peritoneal cavity is not entered; instead, a preperitoneal space is directly created to insert the mesh.

Both methods are effective, though the choice depends on surgeon expertise and patient factors.

The Surgical Procedure

Anesthesia and Positioning

The patient is placed under general anesthesia and positioned supine. Both groins are prepped and draped.

Port Placement

Small incisions are made, usually one near the umbilicus and two in the lower abdomen. A laparoscope (camera) provides magnified visualization.

Dissection

The hernia sac and surrounding structures are carefully dissected. Key anatomical landmarks such as the inferior epigastric vessels, spermatic cord structures, and Cooper’s ligament are identified to avoid injury.

Mesh Placement

A synthetic mesh is placed over the weakened area of the abdominal wall to reinforce the defect. For bilateral cases, a separate mesh is used for each side. The mesh is usually fixed with tacks, glue, or left in place by intra-abdominal pressure, depending on the surgeon’s preference.

Closure

The peritoneum is closed in TAPP to cover the mesh. Ports are removed, and small skin incisions are closed with sutures or surgical glue.

Postoperative Care

Most patients undergoing bilateral laparoscopic inguinal hernia surgery are discharged within 24 hours. Postoperative pain is generally mild and managed with oral analgesics. Patients are advised to avoid heavy lifting for a few weeks but can resume light activities within days. Recovery is significantly faster compared to open surgery, with many patients returning to work within 1–2 weeks.

Advantages Over Open Bilateral Repair

Single anesthesia and short operative time for both sides

Fewer incisions leading to better cosmetic outcomes

Early mobilization reducing risks of deep vein thrombosis and pulmonary issues

Lower recurrence rates when mesh is properly placed

Ability to detect and repair occult (hidden) hernias that may not be apparent preoperatively

Potential Risks and Complications

Like any surgical procedure, bilateral laparoscopic inguinal hernia repair carries some risks, though the incidence is relatively low. Possible complications include:

Bleeding or infection

Injury to blood vessels or nerves in the groin

Urinary retention

Seroma (fluid collection)

Mesh-related complications (rare)

Hernia recurrence if mesh placement is inadequate

Careful surgical technique and proper patient selection help minimize these risks.

Patient Selection

Not all patients are ideal candidates for laparoscopic repair. Contraindications may include:

Severe cardiopulmonary disease making general anesthesia risky

Previous extensive lower abdominal surgery causing adhesions

Inability to tolerate pneumoperitoneum (gas inflation of abdomen)

For suitable patients, however, the benefits far outweigh the risks.

Conclusion

Bilateral laparoscopic inguinal hernia surgery represents a modern, effective, and minimally invasive solution for patients suffering from hernias on both sides of the groin. It allows simultaneous repair through small incisions, provides faster recovery, and significantly improves quality of life compared to open techniques. With growing expertise and advancements in surgical instruments, laparoscopic bilateral hernia repair has become the gold standard in many centers worldwide. Patients can expect reduced pain, minimal scarring, and a quicker return to normal activities, making it a preferred option for bilateral inguinal hernia management.