Bilateral inguinal hernia: Epidemiology and outcomes of surgical treatment in Southeast Nigeria

Background: In the past, bilateral inguinal hernias were repaired sequentially to avoid tension in the suture line which was thought to be responsible for high recurrences, but the use of prosthetic meshes to repair the hernia simultaneously has become the standard practice. The purpose of this study is to document the incidence and repair outcomes of bilateral inguinal hernias in our environment. Patients and Methods: This was a 10-year retrospective study of patients who had surgical repair of bilateral inguinal hernia. Results: A total of 308 patients with bilateral inguinal hernias were evaluated, representing 16.6% of all patients with inguinal hernias during the period of study. There were 302 males and six females. Nearly one-quarter (23.4%) presented emergently, but none had complications in both groins. The risk factors for the disease were many. Precisely, 299 (97.1%), 248 (80.5%), 212 (68.8%), 59 ((19.2%), and 36 (11.7%) patients were males, 46 years and above, engaged in regular strenuous activities, had raised intra-abdominal pressure and had a positive family history of bilateral hernias, respectively. Approximately three-quarter (75.3%) were direct, 15.6% indirect, and 9.1% were both direct and indirect. Mesh repair was used in 36.4% of the elective repairs, while the remaining 150 elective cases were repaired using either Modified-Bassini (76, 32.2%) or nylon darn (74, 31.4%) method. Overall, morbidity, mortality, and recurrence rates were 23.1%, 1.6%, and 1.9%, respectively. Morbidity was mainly due to wound infections (10.1%), seroma (3.9%), chronic groin pain (2.0%), bowel injury (1.3%), and others (3.9%). Four deaths occurred in patients with bowel resections complicated with sepsis, enterocutaneous fistula, and abdominal compartment syndrome (one, one, and two patients, respectively). The fifth death was from sepsis in an elderly patient who had laparotomy without intestinal resection. Conclusion: The use of mesh for simultaneous repair of elective bilateral inguinal hernia is associated with lower rates of recurrence and comparable rates of wound infections and seroma compared to suture-based repairs. Simultaneous bilateral repair with mesh implants is therefore feasible, safe, and effective in our environment.