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BACKGROUND
Whether bilateral total extraperitoneal (TEP) inguinal hernia repair is associated with worse outcomes than unilateral TEP continues to be a matter of debate. This study aimed to compare different outcomes of large cohorts of patients undergoing bilateral versus unilateral TEP.

METHODS
Based on prospective data of the Swiss Association of Laparoscopic and Thoracoscopic Surgery (SALTS), all patients undergoing elective unilateral or bilateral TEP from 1995 to 2006 were included in the study. The outcomes compared included conversion rates; intraoperative, surgical, and general postoperative complications; duration of operation; and length of hospital stay (LOS). Unadjusted and risk-adjusted multivariable analyses were performed.

RESULTS
Data for 6,505 patients undergoing unilateral (n = 3,457) and bilateral (n = 3,048) TEP were prospectively collected. The average age and the American Society of Anesthesiologists (ASA) score were similar in the two groups. The patients undergoing bilateral TEP repair had a slightly increased rate of intraoperative complications (bilateral, 3.1% vs. unilateral, 1.9%) and surgical postoperative complications (bilateral, 3.2% vs. unilateral, 2.3%). The operation time was longer for bilateral TEP repair (86 vs. 67 min). No significant differences in postoperative LOS, general postoperative complications, or conversion rates were found.

CONCLUSIONS
This is the first population-based analysis in the literature to compare different outcomes in a prospective cohort of more than 6,500 patients undergoing bilateral versus unilateral TEP. Although the rates for intraoperative and surgical postoperative complications were slightly higher for the patients undergoing bilateral TEP repair, the absolute differences were small and of minor clinical relevance. Bilateral TEP repair is associated with a minimal increase in operating time and similar LOS, general postoperative complications, and conversion rates. Therefore, for patients with bilateral inguinal hernia, a simultaneous endoscopic approach represents an excellent therapeutic option.