Surgical Endoscopy

, Volume 27, Issue 11, pp 4142–4146 | Cite as

The incidence and natural course of occult inguinal hernias during TAPP repair

Repair is beneficial
  • Baukje van den HeuvelEmail author
  • Nikki Beudeker
  • Joris van den Broek
  • Auke Bogte
  • Boudewijn J. Dwars



One of the proposed advantages of laparoscopic inguinal hernia repair is complimentary inspection of the contralateral side and possible detection of occult hernias. Incidence of occult contralateral hernias is as high as 50 %. The natural course of such occult defects is unknown and therefore operative rationale is lacking. This study was designed to analyze the incidence of occult contralateral inguinal hernias and its natural course.


A total of 1,681 patients were diagnosed preoperatively with unilateral inguinal hernia. None of these patients had complaints of the contralateral side preoperatively. All patients underwent laparoscopic inguinal hernia transabdominal preperitoneal (TAPP) repair. Operative details were analyzed retrospectively. Patients with occult contralateral defects were identified and tracked. Patients with an evident occult hernia received immediate repair. Patients with a smaller beginning or incipient hernia were followed.


In 218 (13 %) patients, an occult hernia was found at the contralateral side during preoperative exploration. In 129 (8 %) patients, an occult true hernia was found. In 89 (5 %) patients, an occult incipient hernia was found. An incipient hernia was defined as a beginning hernia. All patients with an incipient hernia were followed. The mean follow-up was 112 (range 16–218) months. Twenty-eight (32 %) patients were lost to follow-up. In the 61 remaining patients, 13 (21 %) occult incipient hernias became symptomatic requiring repair. The mean time between primary repair and development of a symptomatic hernia on the contralateral side was 88 (range 24–210) months.


This study shows that the incidence of occult contralateral hernias is 13 % during TAPP repair of unilateral diagnosed inguinal hernias. In 5 % of the cases, the occult hernia consisted of a beginning hernia. Eventually, one of five will become symptomatic and require repair. These outcomes support immediate repair of occult defects, no matter its size.


Hernia Endoscopy Inguinal Occult Repair 



Baukje van den Heuvel, Nikki Beudeker, Joris van den Broek, Auke Bogte, and Boudewijn Dwars have no conflicts of interest or financial ties to disclose.


  1. 1.
    Dulucq JL, Wintringer P, Mahajna A (2011) Occult hernias detected by laparoscopic totally extra-peritoneal inguinal hernia repair: a prospective study. Hernia 15(4):399–402PubMedCrossRefGoogle Scholar
  2. 2.
    Panton ON, Panton RJ (1994) Laparoscopic hernia repair. Am J Surg 167(5):535–537PubMedCrossRefGoogle Scholar
  3. 3.
    Thumbe VK, Evans DS (2001) To repair or not to repair incidental defects found on laparoscopic repair of groin hernia: early results of a randomized control trial. Surg Endosc 15(1):47–49PubMedCrossRefGoogle Scholar
  4. 4.
    Koehler RH (2002) Diagnosing the occult contralateral inguinal hernia. Surg Endosc 16(3):512–520PubMedCrossRefGoogle Scholar
  5. 5.
    Crawford DL, Hiatt JR, Phillips EH (1998) Laparoscopy identifies unexpected groin hernias. Am Surg 64(10):976–978PubMedGoogle Scholar
  6. 6.
    Griffin KJ et al (2010) Incidence of contralateral occult inguinal hernia found at the time of laparoscopic trans-abdominal pre-peritoneal (TAPP) repair. Hernia 14(4):345–349PubMedCrossRefGoogle Scholar
  7. 7.
    Sayad P et al (2000) Incidence of incipient contralateral hernia during laparoscopic hernia repair. Surg Endosc 14(6):543–545PubMedCrossRefGoogle Scholar
  8. 8.
    Bochkarev V et al (2007) Bilateral laparoscopic inguinal hernia repair in patients with occult contralateral inguinal defects. Surg Endosc 21(5):734–736PubMedCrossRefGoogle Scholar
  9. 9.
    Paajanen H, Ojala S, Virkkunen A (2006) Incidence of occult inguinal and Spigelian hernias during laparoscopy of other reasons. Surgery 140(1):9–12 (discussion 12–13)PubMedCrossRefGoogle Scholar
  10. 10.
    van Veen RN et al (2007) Patent processus vaginalis in the adult as a risk factor for the occurrence of indirect inguinal hernia. Surg Endosc 21(2):202–205PubMedCrossRefGoogle Scholar
  11. 11.
    van Wessem KJ et al (2003) The etiology of indirect inguinal hernias: congenital and/or acquired? Hernia 7(2):76–79PubMedCrossRefGoogle Scholar
  12. 12.
    Pawanindra L et al (2010) Is unilateral laparoscopic TEP inguinal hernia repair a job half done? The case for bilateral repair. Surg Endosc 24(7):1737–1745CrossRefGoogle Scholar
  13. 13.
    Wauschkuhn CA et al (2010) Laparoscopic inguinal hernia repair: gold standard in bilateral hernia repair? Results of more than 2800 patients in comparison to literature. Surg Endosc 24(12):3026–3030PubMedCrossRefGoogle Scholar
  14. 14.
    Schmedt CG et al (2002) Simultaneous bilateral laparoscopic inguinal hernia repair: an analysis of 1336 consecutive cases at a single center. Surg Endosc 16(2):240–244PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  • Baukje van den Heuvel
    • 1
    Email author
  • Nikki Beudeker
    • 1
  • Joris van den Broek
    • 1
  • Auke Bogte
    • 2
  • Boudewijn J. Dwars
    • 1
  1. 1.General SurgerySlotervaartziekenhuisAmsterdamThe Netherlands
  2. 2.Gastroenterology and HepatologyUniversity Medical Center UtrechtUtrechtThe Netherlands

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