Inguinal hernia is one of the most common surgical conditions encountered worldwide, affecting both men and women. Bilateral inguinal hernias, where hernias occur on both sides of the groin, present a unique challenge to surgeons. Traditionally repaired via open surgery, the advent of laparoscopic techniques has transformed hernia management, offering advantages such as reduced postoperative pain, faster recovery, and improved cosmetic outcomes. Laparoscopic bilateral inguinal hernia repair is now widely accepted as a safe and effective minimally invasive approach, particularly suitable for patients with simultaneous bilateral hernias.

Indications for Laparoscopic Bilateral Repair

Laparoscopic repair is indicated in patients with:

Bilateral Inguinal Hernias: Patients presenting with hernias on both sides of the groin.

Recurrent Hernias: Patients who have undergone prior open repair and now present with recurrence.

Straining Risk Factors: Patients with conditions that increase intra-abdominal pressure, such as chronic cough or obesity, where minimally invasive repair may reduce complications.

Patient Preference: Individuals seeking minimal scarring, quicker return to normal activities, or reduced postoperative pain.

Preoperative evaluation includes a thorough history, physical examination, and imaging such as ultrasound or CT scan if hernia diagnosis is uncertain. Assessment of comorbidities, anesthesia fitness, and informed patient consent are essential.

Surgical Techniques

Laparoscopic bilateral inguinal hernia repair can be performed using two main approaches:

Transabdominal Preperitoneal (TAPP) Repair: In this technique, the surgeon enters the peritoneal cavity, creates a peritoneal flap, and places mesh in the preperitoneal space to cover the hernia defects.

Totally Extraperitoneal (TEP) Repair: Here, the surgeon works entirely in the preperitoneal space without entering the peritoneal cavity, reducing the risk of intra-abdominal complications.

Both techniques aim to provide tension-free repair with mesh reinforcement, minimizing recurrence. The choice between TAPP and TEP depends on surgeon expertise, patient anatomy, and previous abdominal surgeries.

Operative Procedure (TEP Approach)

Patient Positioning and Port Placement: The patient is placed in the supine position with a slight Trendelenburg tilt. Typically, three ports are inserted: a 10 mm infraumbilical port for the laparoscope and two 5 mm ports in the lower abdomen for instruments. Pneumoperitoneum is established, and the preperitoneal space is created using blunt dissection and CO₂ insufflation.

Hernia Sac Identification: Both inguinal regions are carefully inspected. The hernia sac is dissected from the surrounding tissues, preserving the spermatic cord in males or the round ligament in females. Adhesions are released to allow proper mesh placement.

Mesh Placement: A pre-shaped synthetic mesh, typically measuring 10×15 cm, is introduced into the preperitoneal space. The mesh covers the direct, indirect, and femoral hernia defects on both sides. The mesh is secured using tackers or glue as required, though many surgeons prefer a self-fixating or wide overlap technique to reduce fixation.

Closure and Inspection: The preperitoneal space is inspected for bleeding or hernia sac reduction. Ports are removed, and the fascial and skin layers are closed with absorbable sutures or subcuticular techniques.

Postoperative Care

Postoperative recovery after laparoscopic bilateral inguinal hernia repair is typically rapid. Patients experience minimal pain due to the minimally invasive nature of the procedure. Early ambulation is encouraged, and oral intake can be resumed within a few hours. Analgesics are provided for pain control, and patients are advised to avoid heavy lifting for at least 4–6 weeks. Follow-up includes monitoring for complications, ensuring wound healing, and assessing the return to normal activities.

Outcomes and Complications

Laparoscopic bilateral inguinal hernia repair has demonstrated excellent outcomes. Recurrence rates are low, comparable to or better than open repair. Postoperative pain, wound infections, and hospital stay are significantly reduced. Potential complications, though rare, include seroma or hematoma formation, mesh infection, injury to blood vessels, bladder or bowel injury, and chronic groin pain. Careful surgical technique, proper patient selection, and adherence to guidelines minimize these risks.

Advantages of Laparoscopic Bilateral Repair

Minimal Pain: Reduced tissue trauma results in less postoperative discomfort.

Faster Recovery: Most patients resume normal activities within 1–2 weeks.

Cosmetic Benefits: Smaller incisions result in minimal visible scarring.

Simultaneous Repair: Bilateral hernias can be repaired in a single procedure, avoiding multiple surgeries.

Lower Recurrence: Tension-free mesh placement reduces the risk of recurrence compared to traditional suture repair.

Conclusion

Laparoscopic bilateral inguinal hernia repair represents a significant advancement in hernia surgery, combining the benefits of minimally invasive techniques with effective, durable repair. With careful patient selection, meticulous surgical technique, and proper postoperative care, this approach offers superior outcomes, minimal postoperative pain, rapid recovery, and excellent cosmetic results. As laparoscopic expertise continues to grow, it is likely to become the standard of care for bilateral inguinal hernia management.