Should bilateral inguinal hernias be repaired during one operation?

Background: We tested the hypothesis that performing an open tension-free bilateral inguinal hernia repair at one operation would have similar outcomes as performing an open tension-free unilateral repair. Methods: In our prospective study of 243 patients who underwent inguinal hernia repair, 197 were unilateral (UL) and 46 were simultaneous bilateral (SBL). Prospectively the surgeon completed a standardized form during the first postoperative visit. Long-term follow-up was obtained by telephone interview. Results: Respectively for UL versus SBL: age 56 ± 16 years versus 60 ± 12 years, regional anesthesia 93% versus 94%, operating room time 76 ± 22 minutes versus 114 ± 21 minutes (P < 0.05), and operating room costs $1,513 versus $1,793. Also observed were nonsignificant differences in overnight admissions 9.6% versus 4.3%, wound infection 0% versus 2.2%, number of days of narcotic pain pills taken 3.5 ± 2.7 versus 3.3 ± 2.2, postoperative day first left home 2.4 ± 1.6 versus 2.8 ± 1.7, postoperative day drove car 4.6 ± 2.1 versus 5.0 ± 2.3. Telephone contact was made in 62% after a follow-up period of 28 ± 17 months. Recurrences were observed in 6 of 151 (4.0%): UL 4.2% and SBL 3.0%. Conclusions: We believe a tension-free technique allows bilateral inguinal hernias to be repaired during one operation with similar outcomes as a unilateral tension-free repair and less cost than a sequential bilateral repair.