title: Endoscopic totally extraperitoneal repair of bilateral inguinal hernias.
abstract: BACKGROUND
  Recurrence rates associated with bilateral inguinal hernia repair with a giant prosthesis (Stoppa procedure) are low. Endoscopic totally extraperitoneal bilateral inguinal hernia repair with a giant prosthesis combines the low recurrence rate of the Stoppa repair and the advantages of minimally invasive surgery. The aim of this retrospective study was to investigate whether extraperitoneal bilateral inguinal hernia repair could be performed by the minimally invasive, totally extraperitoneal approach.
  
  
  METHODS
  From February 1993 to January 1998, 98 patients with bilateral inguinal hernias underwent surgery. A polypropylene 30 x 10 cm rectangular mesh or a 30 x 10/15 cm 'slipmesh' was used. Follow-up, including a physical examination, of 96 per cent of patients was performed.
  
  
  RESULTS
  Median operative time was 60 min. Mostly minor intraoperative complications occurred. Conversion was required for two patients. Apart from one patient with a necrotic fasciitis who died from respiratory failure, only minor postoperative complications (10 per cent) occurred. Median hospital stay was 1 (range 1-21) days. Median recuperation time was 5 (range 1-22) days. Median follow-up (96 per cent) was 32 (range 7-57) months; there were six recurrences among 34 hernias in the group of 17 patients treated with 10 x 30 cm mesh and two (1 per cent) in the group that received 30 x 10/15 cm mesh (162 hernias in 81 patients).
  
  
  CONCLUSIONS
  The endoscopic approach for the Stoppa procedure for bilateral inguinal hernia repair is a reliable method with minor complications. It ensures a short recuperation time and the recurrence rate is low owing to adequate overlap of the hernial defect when a 'slipmesh' is used.
authors.affiliation: Department of Surgery, University Hospital Dijkzigt, Rotterdam, The Netherlands.
authors.forename: M T
authors.initials: MT
authors.lastname: Knook
authors.forename: W F
authors.initials: WF
authors.lastname: Weidema
authors.forename: L P
authors.initials: LP
authors.lastname: Stassen
authors.forename: R U
authors.initials: RU
authors.lastname: Boelhouwer
authors.forename: C J
authors.initials: CJ
authors.lastname: van Steensel
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004724:Endoscopy / Q000379:methods*; D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019919:Prosthesis Implantation / Q000379:methods*; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome