To repair or not to repair incidental defects found on laparoscopic repair of groin hernia - Early results of a randomized control trial

Background: During laparoscpic transabdominal preperitoneal (TAPP) repair of unilateral groin hernias, a significant proportion of patients are found to have unsuspected hernias (incidental defects) on the contralateral side without any clinically demonstrable signs. The reported incidence is 10% to 25%, and controversy exists about the routine repair of these hernias. We present the early results of a prospective randomized study designed to follow the clinical behavior of incidental defects. Methods: For this study, 32 consecutive men found to have incidental defects on the contralateral side during laparoscopic TAPP repair of groin hernias were prospectively randomized into two categories. In 16 patients (control group), the defects were repaired simultaneously, and in another 16 patients (trial group), surgical repair was not performed. Subsequently, five consecutive patients found to have incidental defects were included in the trial group. Hence, the total number of patients with unrepaired defects was 21. All the patients subsequently were followed up in the clinic and examined by an independent clinician to detect any clinically demonstrable hernias. Results: The median follow-up was 15 months for the control patients and 12 months for the trial patients. During this time, demonstrable hernias developed in 6 patients of the trial group (28.6%). Conclusions: This study demonstrated that despite a short follow-up period, a significant proportion of incidental defects will progress to a symptomatic hernia if left untreated. Hence, their simultaneous repair is justifiable on the grounds that it reduces the number of operations and hospital visits, and thus the cost to the National Health Service. It also is of major benefit to the patient.