Morphological characteristics and side-to-side concordance in adults with bilateral inguinal hernias undergoing laparoscopic totally extraperitoneal repair

Abstract

This study aimed to describe the morphological characteristics and assess side-to-side concordance in adults with bilateral inguinal hernias undergoing laparoscopic totally extraperitoneal (TEP) repair. A descriptive study was conducted involving 65 patients at Thanh Nhan Hospital, including a retrospective phase from March 2021 to December 2023 and a prospective phase from January 2024 to December 2025, with 130 groins assessed intraoperatively. The mean patient age was 63.8±11.8 years, and all patients were male. Direct hernias were the most common type (56.9%), followed by indirect hernias (36.9%) and combined hernias (6.2%). According to the Nyhus classification, type IIIA was predominant (56.9%), followed by type II (25.4%) and type IIIB (14.6%). The mean hernia defect diameter was 2.01±0.78 cm, with defects measuring from 1.5 to less than 3 cm accounting for 60%. Concordant hernia types were observed in 75.4% of patients, while 69.2% had concordant Nyhus classifications between the two groins. The Kappa coefficients were 0.542 for hernia type and 0.480 for the Nyhus classification, indicating moderate concordance. However, a substantial proportion of patients showed morphological differences between the two groins, highlighting the importance of independent and systematic assessment of each groin during TEP repair.