title: Bilateral and Unilateral Total Extraperitoneal Inguinal Hernia Repair (TEP) have Equivalent Early Outcomes: Analysis of 9395 Cases.
abstract: BACKGROUND
  To date, no randomized controlled trials have been carried out to compare the perioperative outcome of unilateral and bilateral inguinal hernia repair using an endoscopic technique. In a Swiss registry study comparing unilateral with bilateral inguinal hernias, no further details were given regarding the nature of the intra- and postoperative complications. In addition, some authors have raised the issue of prophylactic repair of a clinically healthy other groin side.
  
  
  METHODS
  In the Herniamed Registry, in total 9395 patients with a TEP were enrolled. These comprised 6700 patients with unilateral (71.31%) and 2695 patients (28.69%) with bilateral inguinal hernia repair. The outcome variables, analyzed in a multivariable model, were the intra- and postoperative as well as general complication rates, reoperation rate, duration of operation, and length of hospital stay.
  
  
  RESULTS
  While no significant difference was found in the overall number of intraoperative complications between the unilateral and bilateral group (p=0.310), a significantly higher number of urinary bladder injuries in the bilateral TEP operation of 0.28% compared with 0.04% for unilateral TEP (p=0,008) were noted. The greater probability of reoperation (0.82% for unilateral vs. 1.78% for bilateral TEP; p<0,001) in the unadjusted analysis was confirmed in the multivariable model [OR 2.35 (1.504; 3.322); p=0.001]. A significantly higher intraoperative urinary bladder injury rate and reoperation rate because of postoperative surgical complications constitute a difference in the perioperative outcome between unilateral and bilateral TEP which that warrants attention. Based on these results, prophylactic operation of the healthy other groin should not be recommended.
authors.affiliation: Department of Surgery and Center for Minimally Invasive Surgery, Vivantes Hospital, Academic Teaching Hospital of Charité Medical School, Neue Bergstraße 6, 13585, Berlin, Germany, ferdinand.koeckerling@vivantes.de.
authors.forename: F
authors.initials: F
authors.lastname: Köckerling
authors.forename: C
authors.initials: C
authors.lastname: Schug-Pass
authors.forename: D
authors.initials: D
authors.lastname: Adolf
authors.forename: T
authors.initials: T
authors.lastname: Keller
authors.forename: A
authors.initials: A
authors.lastname: Kuthe
mesh_terms: D005260:Female; D006552:Hernia, Inguinal / Q000601:surgery*; D059685:Herniorrhaphy / Q000379:methods*; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D012042:Registries; D012086:Reoperation; D013557:Switzerland; D001743:Urinary Bladder / Q000293:injuries / Q000601:surgery
references.citation: Hernia. 2011 Aug;15(4):403-8
references.pmid: 21259030
references.citation: Hernia. 2009 Aug;13(4):343-403
references.pmid: 19636493
references.citation: Surg Endosc. 2011 Sep;25(9):2773-843
references.pmid: 21751060
references.citation: Surg Endosc. 2010 Jul;24(7):1737-45
references.pmid: 20135181
references.citation: Surg Endosc. 2010 Dec;24(12):3026-30
references.pmid: 20454807
references.citation: Surg Endosc. 2012 May;26(5):1364-8
references.pmid: 22113423
references.citation: Surg Endosc. 2013 Oct;27(10):3505-19
references.pmid: 23708718
references.citation: Hernia. 2012 Jun;16(3):269-76
references.pmid: 22389073
references.citation: J Minim Access Surg. 2006 Sep;2(3):171-3
references.pmid: 21187991