Contralateral metachronous inguinal hernias in adults: role for prophylaxis during the TEP repair.
OBJECTIVE
Contralateral exploration during laparoscopic totally extraperitoneal (TEP) inguinal herniorrhaphy allows for the repair of incidentally found hernias. Nonetheless, some patients with a negative contralateral exploration subsequently develop a symptomatic hernia on that side. We pondered the incidence of contralateral metachronous hernia development and whether prophylactic "repair" in these circumstances would be beneficial.


METHODS
A retrospective analysis of patients who underwent laparoscopic TEP exploration at our institution was performed. Demographic, operative and follow-up information was obtained through medical record review, physical examination and telephone/mailed survey.


RESULTS
From 1995 to 2009, a total of 1,479 inguinal herniorrhaphies on 976 patients were performed by a single staff surgeon. Bilateral exploration was completed in 923 (95%) of these patients, of whom bilateral repair was performed on 503 (55%). The study cohort comprises the 409 (42%) patients having a unilateral repair with a negative contralateral exploration and no previous contralateral hernia repair (n = 11). With a median follow-up of 5.9 years (range 0-14), 33 (8.1%) hernias developed on the previously "healthy" side, yielding incidence rates at 1, 5 and 10 years of 1.6, 5.9 and 11.8%, respectively. The median time to hernia development was 3.7 years (range 0.1-12.4). Of the 30 inguinal hernias that have been repaired, 25 (83%), 3 (10%) and 2 (7%) were of indirect, direct and pantaloon types, respectively.


CONCLUSIONS
When considering prophylactic repair during TEP explorations, a yearly risk of 1.2% of developing a contralateral hernia after negative exploration needs to be balanced against the low but potential risk of groin pain following prophylactic repair.
Department of Surgery, College of Medicine, Mayo Clinic, 200 First Street, SW, Rochester, MN 55905, USA.
B
B
Zendejas
E O
EO
Onkendi
R D
RD
Brahmbhatt
S M
SM
Greenlee
C M
CM
Lohse
D R
DR
Farley
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006552:Hernia, Inguinal / Q000453:epidemiology / Q000517:prevention & control* / Q000601:surgery; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D055502:Secondary Prevention; D013526:Surgical Mesh; D013997:Time Factors; D014481:United States / Q000453:epidemiology; D055815:Young Adult
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