Incidence of incipient contralateral hernia during laparoscopic hernia repair

Background: In addition to its well-known benefits of decreased postoperati ve pain and shorter recovery time, laparoscopic hernia repair has the major advantage of allowing the surgeon to explore the side contralateral to the clinically diagnosed hernia. The purpose of this study was to evaluate the incidence of incipient unsuspected contralateral hernia during totally ext raperitoneal (TEP) laparoscopic inguinal herniorrhaphy and to analyze the r isks and benefits of identifying these hernias at the time of the initial s urgery. Methods: We did a retrospective review of the charts of all of the 724 male patients who underwent laparoscopic TEP repair of 958 groin hernias betwee n September 1991 and September 1999. The initial clinical impression of the existence of unilateral or bilateral hernias was noted and compared to our operative findings. The same surgeon per formed all the repairs. Explorati on of the contralateral side was performed in a systematic fashion. A secon d mesh prosthesis was placed if a contralateral hernia was found. Results: Bilateral hernia repair was performed on 234 patients (32.3%). In 62 of them (11.2%), the contralateral hernia was diagnosed only at the time of the procedure. Operative time ranged from 14 to 185 min (median, 38.6). The operative time for the contralateral exploration ranged from 2 to 5 mi n (median, 2.8). The rate of complications was 4.1%, but no complications w ere directly related to the exploration of the asymptomatic side. Conclusion: Our study shows that a large number of inguinal hernias are und iagnosed by physical examination (11.2%). Systematic contralateral explorat ion using the TEP approach is safe and does not greatly increase the operat ive time. Early identification and repair of a contralateral hernia obviate s the need for reoperation, reduces overall costs to the health care system , and eliminates any further work loss for the patient.