Evidence-based medicine and special aspects in bilateral inguinal hernia repair

Inguinal hernia repair has been the domain of surgeons since antiquity. Currently, inguinal hernia repair is still the object of surgical meetings and worldwide discussions. With the introduction of innovative endpoints in hernia surgery such as quality of life, pain, convalescence and patient's comfort as well as by developing new surgical techniques such as the 'tension free' techniques or the laparoscopic procedures, changes in the way of thinking about inguinal hernia repair have evolved. While new classifications for groin hernias have been published, there have also been many trials set up to evaluate the treatment of groin hernias. To date, the results of a multitude of trials are available regarding the treatment of unilateral inguinal hernias. Only little is known and written, however, about bilateral inguinal hernias, their development and treatment. With the development of new technique for repair and new classifications to categorize hernias, it has become apparent, how little information has been compiled about bilateral inguinal hernias. Following the concept of Evidence-based Medicine, this extended review gives an overview of the current literature of bilateral inguinal hernias and their treatment. To this we add our own experience from the Cologne Merheim Hernia Study Group.