Laparoscopic bilateral inguinal herniorrhaphies: use of a single giant preperitoneal mesh patch

Recent reports support excellent results following laparoscopic inguinal herniorrhaphy. Similarly, nonlaparoscopic preperitoneal bilateral inguinal herniorrhaphy has been performed with a giant anterior abdominal mesh with excellent results. In order to maximize patient benefit, we have used the laparoscopic approach to repair bilateral inguinal hernias using a large single patch of mesh in the preperitoneal space for the past 12 months. Twenty-nine patients with an age range of 26 to 83 have undergone this procedure. Technical details included creation of preperitoneal flaps to cover the preperitoneal retropubic space and inguinal and femoral canals bilaterally; use of "keyhole" technique to surround cord structures with mesh (transfixing mesh to important anatomic landmarks); and closure of peritoneum. Ninety-four per cent of patients were discharged on the operative day with minimal pain. One-third required pain medication; patients returned to work five to nine days post-operatively. There have been no recurrences, no morbidity requiring hospitalization, and no complications related to mesh or the laparoscopic approach. This procedure combines the benefits of two successful approaches to bilateral inguinal herniorrhaphy, is associated with excellent short-term results, and should be considered as a potential "best option" in patients with bilateral inguinal hernias.