Our Summary

When a person gets a hernia (a condition where an organ pushes through an opening in the muscle or tissue that holds it in place) on one side of their groin (the area where the thigh meets the lower abdomen), it’s common for them to get surgery to repair it. However, sometimes a person might get a hernia on the other side of their groin later on.

This study aimed to figure out how often this happens. The researchers searched through several databases for studies that reported on cases where this had happened.

They found 19 studies that involved a total of 277,288 patients. Their analysis of these studies showed that about 8.3% of the people who got surgery to repair a hernia on one side of their groin ended up getting a hernia on the other side.

This number varied depending on how long the researchers followed up with the patients. For instance, after three years, about 5.2% of the patients had developed a hernia on the other side. After five years, this number increased to 8.0%, and after ten years, it was 17.1%.

The researchers concluded that there isn’t enough evidence to suggest that everyone who gets surgery to repair a hernia on one side of their groin should also get a preventative surgery on the other side. They suggest that this decision should be made on a case-by-case basis, considering factors like the person’s risk of developing a hernia, the type of surgery they’re getting, and their risk of experiencing long-term pain after the surgery.

The researchers also note that more long-term studies are needed to better inform this decision.

FAQs

  1. What is a metachronous contralateral inguinal hernia (MCIH)?
  2. What percentage of patients develop a MCIH after a unilateral inguinal hernia repair?
  3. Is there sufficient clinical evidence to support a prophylactic contralateral repair in all patients after a unilateral inguinal hernia repair?

Doctor’s Tip

A helpful tip a doctor might tell a patient about hernia repair is to discuss with their surgeon the possibility of undergoing prophylactic contralateral repair at the same time as the primary unilateral surgery. This may help reduce the risk of developing a metachronous contralateral inguinal hernia in the future. However, it is important to consider individual factors and potential risks before making a decision. Further research and long-term data are needed to guide this decision-making process.

Suitable For

Patients who are typically recommended for hernia repair include those with symptomatic inguinal hernias, hernias that are causing complications such as incarceration or strangulation, and patients with a high risk of developing a metachronous contralateral inguinal hernia. However, based on the findings of the systematic review mentioned above, there is insufficient clinical evidence to support prophylactic contralateral repair in all patients. A patient-specific approach should be taken in the decision to perform prophylactic repair, considering potential risk factors for hernia development, type of surgical approach, and general risk factors for chronic postoperative inguinal pain. More long-term prospective data are needed to guide the decision for prophylactic contralateral mesh placement.

Timeline

  • Before hernia repair:
  1. Patient experiences symptoms of inguinal hernia such as a bulge in the groin, pain or discomfort, and weakness in the abdominal wall.
  2. Patient consults with a healthcare provider who diagnoses the hernia and recommends surgical repair.
  3. Patient undergoes pre-operative evaluations such as physical examination, imaging tests, and blood work to assess their overall health and suitability for surgery.
  • After hernia repair:
  1. Patient undergoes hernia repair surgery, which can be done through open surgery or laparoscopic surgery.
  2. Patient is discharged from the hospital on the same day or after a short stay, depending on the type of surgery and individual recovery.
  3. Patient follows post-operative instructions such as taking pain medication, avoiding strenuous activities, and caring for the surgical incision.
  4. Patient attends follow-up appointments with the healthcare provider to monitor their recovery and address any concerns.
  5. Patient gradually resumes normal activities and experiences relief from hernia symptoms.
  6. Some patients may develop a metachronous contralateral inguinal hernia (MCIH) in the future, which may require additional surgery.

What to Ask Your Doctor

Some questions a patient should ask their doctor about hernia repair include:

  1. What are the potential risks and complications associated with hernia repair surgery?
  2. How long is the recovery process after hernia repair surgery?
  3. Will I need to follow any specific post-operative instructions or restrictions?
  4. How likely am I to develop a metachronous contralateral inguinal hernia (MCIH) after unilateral hernia repair?
  5. What factors should be considered in deciding whether to have prophylactic contralateral repair during the initial surgery?
  6. What are the potential benefits of prophylactic contralateral repair versus waiting for a MCIH to develop?
  7. Are there any specific risk factors for hernia development that may make me a better candidate for prophylactic contralateral repair?
  8. How will you determine if I need a second surgery for a MCIH in the future?
  9. What type of surgical approach will be used for my hernia repair, and how does this impact the likelihood of developing a MCIH?
  10. Are there any alternative treatment options for hernia repair that I should consider?

Reference

Authors: Vissers S, De Groof P, Fieuws S, Abramovich T, Van De Winkel N, Miserez M. Journal: Surg Endosc. 2024 Sep;38(9):4831-4838. doi: 10.1007/s00464-024-11118-w. Epub 2024 Aug 7. PMID: 39110220