Abstract:Background:
The incidence of contralateral occult hernia (COH) varies from 4.2% to 57.5%. Total extraperitoneal (TEP) gives us opportunity to visualize contralateral groin for occult hernia and its simultaneous repair. Ultrasonography (USG) helps to diagnose occult hernia preoperatively with detection rate of 96.6% with specificity 84.4%.
Objective:
The aims of this study were to identify the incidence of contralateral occult inguinal hernia in clinically diagnosed unil… Show more
“…In one study [ 17 ] follow-up duration was not reported. In a further study [ 19 ] zero events were reported in both study arms, preventing synthesis. Five studies [ 16 , 17 , 21 – 23 ] contributed to an effect direction plot for this outcome (Table 1 ).…”
Section: Resultsmentioning
confidence: 99%
“…Upon full-text examination, only 26 of these articles contained data comparing technique outcomes. A further 18 articles from this group were excluded due to contamination with recurrent hernia repairs, prophylactic repairs, or an excluded TEP methodology, leaving 8 articles [ 3 , 4 , 16 , 17 , 19 , 21 – 23 ], with a total of 18,153 patients, included in the final analysis. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Studies which included repairs of contralateral occult hernias [ 16 , 17 , 19 , 23 ] discovered intraoperatively, via imaging, or clinically, were excluded from analysis regarding pain and convalescence. The literature has demonstrated that patients who have more pain in the preoperative period are also more likely to have more pain in the postoperative period [ 31 ].…”
Section: Resultsmentioning
confidence: 99%
“…Further postoperative complications were reported by the included studies, but these were either unique or unable to be synthesized due to there being zero events in both study arms. Six studies [ 3 , 4 , 16 , 17 , 19 , 21 ] reported data of miscellaneous postoperative complications. In the effect direction plot (Table 1 ), three studies reported increased postoperative complications following bilateral operations, one study saw increased postoperative complications following unilateral operations, and the remaining two studies had conflicting/unclear results.…”
Section: Resultsmentioning
confidence: 99%
“…All included studies [3,4,16,17,19,[21][22][23] reported operative time (n = 18,153). The duration of bilateral IH repair was universally greater than that of unilateral repairs.…”
Purpose
Laparoscopic herniorrhaphy (LH) has become the treatment of choice in many centers for patients with inguinal hernia (IH). Our aim was to compare the morbidity outcomes of bilateral vs unilateral IH repair using the laparoscopic total extra-peritoneal (TEP) technique, to determine whether undertaking bilateral IH repair places patients at additional risk.
Methods
Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots.
Results
Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair.
Conclusion
Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.
“…In one study [ 17 ] follow-up duration was not reported. In a further study [ 19 ] zero events were reported in both study arms, preventing synthesis. Five studies [ 16 , 17 , 21 – 23 ] contributed to an effect direction plot for this outcome (Table 1 ).…”
Section: Resultsmentioning
confidence: 99%
“…Upon full-text examination, only 26 of these articles contained data comparing technique outcomes. A further 18 articles from this group were excluded due to contamination with recurrent hernia repairs, prophylactic repairs, or an excluded TEP methodology, leaving 8 articles [ 3 , 4 , 16 , 17 , 19 , 21 – 23 ], with a total of 18,153 patients, included in the final analysis. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Studies which included repairs of contralateral occult hernias [ 16 , 17 , 19 , 23 ] discovered intraoperatively, via imaging, or clinically, were excluded from analysis regarding pain and convalescence. The literature has demonstrated that patients who have more pain in the preoperative period are also more likely to have more pain in the postoperative period [ 31 ].…”
Section: Resultsmentioning
confidence: 99%
“…Further postoperative complications were reported by the included studies, but these were either unique or unable to be synthesized due to there being zero events in both study arms. Six studies [ 3 , 4 , 16 , 17 , 19 , 21 ] reported data of miscellaneous postoperative complications. In the effect direction plot (Table 1 ), three studies reported increased postoperative complications following bilateral operations, one study saw increased postoperative complications following unilateral operations, and the remaining two studies had conflicting/unclear results.…”
Section: Resultsmentioning
confidence: 99%
“…All included studies [3,4,16,17,19,[21][22][23] reported operative time (n = 18,153). The duration of bilateral IH repair was universally greater than that of unilateral repairs.…”
Purpose
Laparoscopic herniorrhaphy (LH) has become the treatment of choice in many centers for patients with inguinal hernia (IH). Our aim was to compare the morbidity outcomes of bilateral vs unilateral IH repair using the laparoscopic total extra-peritoneal (TEP) technique, to determine whether undertaking bilateral IH repair places patients at additional risk.
Methods
Manuscripts published up to the end of 2021 on PubMed/MEDLINE, EMBASE, Cochrane Library, Scopus, and Web of Science were searched. Patients (> 16 years) undergoing a primary elective unilateral or bilateral TEP operation, using the standard 3-port laparoscopic technique, were identified. Quality of evidence was assessed using the GRADE criteria. Meta-analysis was conducted where possible. Where this was not possible, vote counting was conducted using effect direction plots.
Results
Eight observational studies, with a total of 18,153 patients were included. Operative time was significantly longer for bilateral operations. There was no significant difference in conversion to open, post-operative seroma, urinary retention, haematoma, and length of hospital stay. There was an increased rate of hernia recurrence in patients undergoing bilateral IH repair.
Conclusion
Although limited by the observational nature of the included studies, there is no conclusive evidence to suggest a differential burden of morbidity between unilateral and bilateral TEP IH repair. As all included papers are from observational studies only, evidence from all outcomes is at best very low quality. This manuscript thereby highlights a need for randomized controlled trials to be conducted in this area.
Purpose
When laparoscopically repairing a symptomatic inguinal hernia, surgeons will discover a contralateral asymptomatic hernia in 22% of patients. It is estimated 30% of asymptomatic hernias become symptomatic and require repair. Thus, should they be repaired in a 2-for-1 operation? The main purpose is to examine the evidence and make a recommendation for the need to repair the contralateral asymptomatic inguinal hernia prophylactically in the adult population during unilateral inguinal hernia presentation.
Method
A systematic literature search was conducted up to 15 February 2021 using PubMed and the Cochrane Library. Management pathway taken, mean operating time, duration of follow-up, pain, duration of hospital stay and perioperative complications were extracted. Risk of bias was assessed using the ROBINS-I tool.
Results
Six non-randomised studies (1774 patients) were included; 978 patients had both hernias repaired, 796 patients had only the symptomatic hernia repaired. There was no significant difference in length of hospital stay, return to activities of daily living nor complications. Mean operating time was slightly lower for patients who had unilateral hernia repair (mean difference = − 14.57 min, 95%CI − 25.59, − 3.45). Reported pain scores were lower for patients who only had one hernia repaired (− 0.33 units, 95%CI − 0.48, − 0.18). The overall risk of bias for the six studies were low-to-moderate risk.
Conclusion
Asymptomatic inguinal hernias can be repaired when found. While there is minimal increase in operation time and pain, no significant difference to total hospital stay. Importantly, this is likely to prevent the need for another operation in almost a third of patients.
INTRODUCTION:
It has been reported that there is a significantly high chance of contralateral concurrent occult or subsequent inguinal hernia in patients with unilateral inguinal hernia. The objective of this study is to investigate the feasibility of bilateral laparoscopic exploration for all unilateral cases followed by laparoscopic bilateral total extraperitoneal repair and to compare complications, recurrence rates, postoperative pain, and operative duration with prospectively performed unilateral repairs.
MATERIALS AND METHODS:
A total of 60 patients were included in this prospective longitudinal study from March 2018 to March 2019. Patients attending the outpatient department for unilateral inguinal hernia were counseled about the trial. Patients who gave consent for bilateral inguinal exploration and repair were kept in group A, and those who did not consent to bilateral exploration and underwent unilateral repair were kept in group B. The patients were divided into two groups of 30 patients each.
RESULTS:
The mean age of patients in group A was 36.57 ± 11.80 years and in group B was 43.03 ± 13.106 years (P = 0.049). The incidence of occult contralateral hernia is 26.7%, with the most common on the left side (33.3%). It was found that the duration of surgery for group A (82 ± 4.74 min) was longer than that for group B (66.30 ± 6.27 min) with a P value of 0.001. Intraoperative blood loss in the case of group B was 16.63 ± 2.341 ml, and for group A, it was 20.03 ± 2.671 ml (P < 0.001). No major complications were observed. There was no significant difference in pain upto a 1-month follow-up in both groups. No recurrence or pain was noticed in either group at 3 and 6 months.
CONCLUSION:
There is no significant difference in pain, complications, and recurrence between both groups, with one-fourth of patients having OCH. Young to middle-aged patients can easily tolerate the longer operative time at the cost of slightly more blood loss. Thus, selected patients with unilateral hernias can be given the option of bilateral repair with no added risk associated with surgery.
Trial registration:
ClinicalTrials.gov, identifier NCT06380621.
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