Contralateral exploration and repair of occult inguinal hernias during laparoscopic inguinal hernia repair

During keyhole surgery for a groin hernia, the surgeon often finds a small, hidden hernia on the opposite side. A systematic review in BJS Open concludes that, as a general rule, these hernias do not need to be repaired straight away.

Researchers at McGovern Medical School in Houston reviewed 13 studies including around 5,000 patients who had keyhole surgery for a hernia on one side. They wanted to know how often a hidden (occult) hernia is found on the opposite side, and whether it is worth repairing it at the same time.

Key findings

Hidden hernias are common: About 15% of patients had a hernia on the opposite side that could not be felt during examination. Repair carries a risk of complications: Around 1 in 10 patients who had the hidden hernia repaired experienced a complication after surgery. These were mostly temporary pain, fluid collection (seroma) or bleeding. Fewer than 3% developed long-term pain. Most never develop symptoms: Among patients whose hidden hernia was left alone, only about 3 in 10 later needed surgery because of symptoms. The numbers per 1,000 patients: Routinely checking the other side finds about 150 hidden hernias. If all of them are repaired, 15 patients will have a complication and 105 will have an operation they did not need. If the surgeon waits instead, 45 patients will need surgery later. Conclusion: There is no basis for routinely repairing hidden hernias on the opposite side. The authors point out, however, that the evidence is weak, because it comes mainly from observational studies.

What does this mean for you as a patient? If you have a hernia on one side, it is usually safe to operate on that side only. If you have symptoms on the other side but no hernia can be felt, it may still be sensible to examine that side and possibly repair it. Discuss this with your surgeon before the operation.