[Repair of bilateral inguinal hernias--sequential or simultaneous?]

Surgery of inguinal hernia has changed dramatically with the introduction of tension-free hernia repair. There is still some controversy regarding the treatment of bilateral inguinal hernia, but simultaneous operation has gained popularity. The purpose of the present paper is to evaluate recent publications regarding treatment of bilateral inguinal hernia.

For this article, the "Cochrane Database of Systematic Reviews", "BMJ Clinical Evidence", "Pubmed" and "Embase" were searched using the search terms "simultaneous", "bilateral", "inguinal" and "hernia". Number of patients, recurrence rate, complications, study type and authors' conclusions were evaluated. Analysis of the literature showed relevant results in two reviews of the "Cochrane Database", 4 items in "BMJ Clinical Evidence" and 17 clinical studies.

No study showed a difference between recurrence and complication rate (simultaneous bilateral vs. unilateral repair). Recurrence rates were from 0.3 to 19 % (bilateral) and from 0.7 to 15 % (unilateral). Complications were defined heterogeneously and were in a range from 2.5 to 26.7 % (bilateral) and from 3 to 21 % (unilateral). All operative procedures (open suture: Shouldice; open mesh: Lichtenstein, Stoppa; laparoscopic techniques: TAPP / TEP) are adequate for the repair of bilateral hernia.

The simultaneous operation of bilateral hernia is safe and effective. Postoperative pain and length of reconvalescence are comparable to those of the unilateral operation. Only symptomatic bilateral groin hernias should be operated. If no difficulties such as obesity and giant hernia are expected, bilateral hernias should be repaired simultaneously. The choice of the operative method should be made in accordance to the centre's standard procedure. A special operation for bilateral hernias is neither necessary nor justified.