Is contralateral exploration justified in endoscopic total extraperitoneal repair of clinical unilateral groin hernias - A Prospective cohort study

Background Laparoscopic adult hernia repair has the clinical advantage of allowing the surgeon to explore asymptomatic contralateral inguinal hernia. We conduct a retrospective study to compare the occurrence of contralateral metachronous inguinal hernia (CMIH) after laparoscopic total extraperitoneal (TEP) repair with or without contralateral exploration. Methods One hundred and fifty-one consecutive patients undergoing unilateral laparoscopic TEP repair during November 2007 to November 2012 were enrolled into groups with contralateral or no contralateral exploration. Preoperative, intraoperative, and postoperative factors were recorded then reviewed for analysis. The primary end-point was the occurrence of contralateral inguinal hernia. The patients were regularly interviewed postoperatively at outpatient clinics. Results Finally, 68 patients in the exploration group and 46 in the non-exploration group were eligible for analysis. All demographic data, except age, was comparable between the two groups. Twenty-three of 68 (33.8%) in the exploration cohort had at least one occult contralateral inguinal hernia detected and repaired at the time of primary repair. In contrast to the high incidence (6/46, 13%) of CMIH in the non-exploration cohort, there was only one metachronous occurrence (1/68, 1.4%) after negative contralateral exploration at a median follow-up of longer than 3 yrs (p = 0.02). The peri-operative results were comparable between groups regarding operative time, analgesic requirements, complications, and chronic pain. Conclusions Simultaneous exploration and repair of the incidental defects on the contralateral inguinal region during laparoscopic TEP repair of unilateral inguinal hernia is recommended in selected patients based on its high safety and clinical effectiveness in preventing later CMIH.