Ambulatory bilateral groin hernia repair: open preperitoneal versus laparoscopic outcomes

To evaluate short and long-term outcomes of bilateral groin hernia (BGH) repair using an open preperitoneal approach (OPA) compared to minimally invasive surgery (MIS) in ambulatory surgery.

A retrospective cohort study was conducted including patients undergoing ambulatory BGH repair between 2010 and 2018 at Vall d'Hebron University Hospital (Barcelona) using either OPA (a modified Wantz technique) or MIS [transabdominal preperitoneal (TAPP) or totally extraperitoneal (TEP)]. Demographic, perioperative, and postoperative data were analysed. Chronic postoperative inguinal pain (CPIP) was assessed at two time points: early (3-12 months) and late (> 12 months postoperatively). Long-term follow-up was conducted through structured telephone interviews using the Hernia Recurrence Inventory survey. Multivariate logistic regression and ROC analysis were used to identify predictors of CPIP.

A total of 244 patients (488 hernias) met the inclusion criteria, with a median follow-up of 116 months. OPA patients were older and had more comorbidities (P < 0.001). Operative time was shorter in the OPA group (median 70 vs. 110 min; P < 0.001). No significant differences were found in recurrence rates or surgical site occurrences. Multivariate analysis showed that OPA was independently associated with a lower risk of CPIP between 3-12 months postoperatively (OR 0.091, P < 0.001) compared to MIS. At long-term follow-up, higher Body Mass Index (BMI) was the only factor associated with persistent pain (OR 1.2, P = 0.024).

OPA is a safe and effective technique for BGH repair, offering shorter operative times and lower risk of CPIP between 3-12 months postoperatively compared to MIS, while maintaining comparable long-term outcomes (> 12 months).