title: Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature.
abstract: BACKGROUND
  Advantages and disadvantages of open and endoscopic hernia surgery are still being discussed. Until now there has been no study that evaluated the advantages and disadvantages of bilateral hernia repair in a large number of patients.
  
  
  METHODS
  Our prospectively collected database was analyzed to compare the results of laparoscopic bilateral with laparoscopic unilateral hernia repair. We then compared these results with the results of a literature review regarding open and laparoscopic bilateral hernia repair.
  
  
  RESULTS
  From April 1993 to December 2007 there were 7240 patients with unilateral primary hernia (PH) and 2880 patients with bilateral hernia (5760 hernias) who underwent laparoscopic transabdominal preperitoneal patch plastic (TAPP). Of the 10,120 patients, 28.5% had bilateral hernias. Adjusted for the number of patients operated on, the mean duration of surgery for unilateral hernia repair was shorter than that for bilateral repair (45 vs. 70 min), but period of disability (14 vs. 14 days) was the same. Adjusted for the number of hernias repaired, morbidity (1.9 vs. 1.4%), reoperation (0.5 vs. 0.43%), and recurrence rate (0.63 vs. 0.42%) were similar for unilateral versus bilateral repair, respectively. The review of the literature shows a significantly shorter time out of work after laparoscopic bilateral repair than after the bilateral open approach.
  
  
  CONCLUSIONS
  Simultaneous laparoscopic repair of bilateral inguinal hernias does not increase the risk for the patient and has an equal length of down time compared with unilateral repair. According to literature, recovery after laparoscopic repair is faster than after open simultaneous repair. Laparoscopic/endoscopic inguinal hernia repair of bilateral hernias should be recommended as the gold standard.
authors.affiliation: Department for General, Visceral and Thoracic Surgery, Marienhospital Stuttgart, Boeheimstrasse 37, 70199, Stuttgart, Germany. constantin.aurel@wauschkuhn.de
authors.forename: Constantin Aurel
authors.initials: CA
authors.lastname: Wauschkuhn
authors.forename: Jochen
authors.initials: J
authors.lastname: Schwarz
authors.forename: Ulf
authors.initials: U
authors.lastname: Boekeler
authors.forename: Reinhard
authors.initials: R
authors.lastname: Bittner
mesh_terms: D006552:Hernia, Inguinal / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D011446:Prospective Studies
references.citation: Surg Laparosc Endosc. 1998 Aug;8(4):313-8
references.pmid: 9703609
references.citation: Am J Surg. 2007 Apr;193(4):466-70
references.pmid: 17368290
references.citation: Int Surg. 1994 Oct-Dec;79(4):300-3
references.pmid: 7713695
references.citation: Chirurg. 1990 Dec;61(12):874-9
references.pmid: 2286105
references.citation: Chirurgie. 1992;118(1-2):83-5
references.pmid: 1306431
references.citation: J Laparoendosc Surg. 1995 Feb;5(1):27-9
references.pmid: 7766925
references.citation: Int Surg. 1995 Jan-Mar;80(1):18-25
references.pmid: 7657484
references.citation: Surg Endosc. 2002 Feb;16(2):240-4
references.pmid: 11967671
references.citation: Surg Laparosc Endosc Percutan Tech. 2001 Aug;11(4):262-7
references.pmid: 11525372
references.citation: Hernia. 2006 Aug;10(4):309-15
references.pmid: 16721504
references.citation: Ann Surg. 1995 Jan;221(1):3-13
references.pmid: 7826159
references.citation: Surg Endosc. 1996 Feb;10(2):122-7
references.pmid: 8932612
references.citation: Surg Laparosc Endosc. 1992 Mar;2(1):53-8
references.pmid: 1341501
references.citation: Surg Endosc. 2003 Dec;17(12):2021-4
references.pmid: 14577028
references.citation: Hernia. 2007 Feb;11(1):47-9
references.pmid: 17006623
references.citation: Langenbecks Arch Surg. 2005 Apr;390(2):77-82
references.pmid: 15711997
references.citation: Ann Chir. 2000 Jul;125(6):560-5
references.pmid: 10986768
references.citation: Surg Endosc. 1993 Jan-Feb;7(1):26-8
references.pmid: 8424228
references.citation: Surg Endosc. 2003 Sep;17(9):1386-90
references.pmid: 12802653
references.citation: Adv Surg. 2006;40:299-317
references.pmid: 17163110
references.citation: Surg Endosc. 2007 May;21(5):734-6
references.pmid: 17310298
references.citation: Chirurg. 1997 Oct;68(10):977-85
references.pmid: 9453906
references.citation: Acta Biomed Ateneo Parmense. 1997;68(1-2):5-10
references.pmid: 9478251