A comparative study of Stoppa’s repair versus Lichtenstein technique for surgical management of bilateral inguinal hernia

Kiran Patel


Background: The surgical management of bilateral inguinal hernias has been a point of contention for a long time, particularly in terms of whether to repair them sequentially or simultaneously, especially following tension-free surgeries. The present study was planned to compare the outcomes of bilateral inguinal hernia repair between patients who underwent the Stoppa’s repair and those who underwent Lichtenstein tension free mesh hernioplasty repair.

Methods: The study included all patients of both genders with age of 18 years with bilateral inguinal hernias. Patients with following any condition-a complicated inguinal hernia; an obstructed or strangulated inguinal hernia; a recurrent inguinal hernia; previous abdominal surgery; a local skin infection-were excluded from the study. Patients were randomised into 2 groups based on simple randomization-group 1: patients underwent Lichtenstein tension free mesh hernioplasty; and group 2: patient underwent Stoppa's repair.

Results: The operative time was significantly shorter in group 2 patients as compared to group A. In both groups, there were no intraoperative complications. Group 2 patients had significantly lower postoperative pain scores measured by the visual analogue scale at 12 hours postoperatively, but there was no statistically significant difference in pain at 24 hours or 7 days postoperatively. Post-operative hospital stays, return to normal daily activities, and chronic groin pain, there was no statistically significant difference between the two groups.

Conclusions: The present study was unable to show that either technique was superior in the treatment of bilateral inguinal hernias. Both procedures, on the other hand, were capable of achieving favourable postoperative outcomes and had similar problems.


Bilateral inguinal hernia, Surgical management, Stoppa’s repair, Lichtenstein technique, Tension free hernioplasty

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Tuma F, Lopez RA, Varacallo M. Anatomy, Abdomen and Pelvis, Inguinal Region (Inguinal Canal). In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2021. Available at: Accessed on August 08, 2021.

Purkayastha S, Chow A, Athanasiou T, Tekkis P, Darzi A. Inguinal hernia. BMJ Clin Evid. 2008;2008:0412.

Jenkins JT, O'Dwyer PJ. Inguinal hernias. BMJ. 2008;336(7638):269-72.

Rutkow IM. Epidemiologic, economic, and sociologic aspects of hernia surgery in the United States in the 1990s. Surg Clin North Am. 1998;78(6):941-51.

Primatesta P, Goldacre MJ. Inguinal hernia repair: incidence of elective and emergency surgery, readmission and mortality. Int J Epidemiol. 1996;25(4):835-9.

Simons MP, Aufenacker T, Bay-Nielsen M, Bouillot JL, Campanelli G, Conze J et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia. 2009;13(4):343-403.

Duvie SO. One-stage bilateral inguinal herniorrhaphy in the adult. Can J Surg. 1984;27:192-3.

Dakkuri RA, Ludwig DJ, Traverso LW. Should bilateral inguinal hernias be repaired during one operation? Am J Surg. 2002;183:554-7.

Stoppa R, Henry X, Verhaeghe P. Repair of inguinal hernias without tension and without suture using a large dacron mesh prosthesis and by pre-peritoneal approach. A method of reference for selective indication. Ann Chir. 1996;50:808-13.

Nyhus LM, Pollak R, Bombeck CT, Donahue PE. The preperitoneal approach and prosthetic buttress repair for recurrent hernia. The evolution of a technique. Ann Surg. 1988;208:733-7.

McVay CB, Anson BJ. Inguinal and femoral hernioplasty: Anatomic repair. Surg Gynecol Obstet. 1988;88:473-85.

Bittner R, Arregui ME, Bisgaard T, Dudai MR, Ferzli GS, Fitzgibbons RJ et al. Guidelines for laparoscopic (TAPP) and endoscopic (TEP) treatment of inguinal hernia. Int Endohernia Society. Surg Endosc. 2011;25(9):2773-843.

Maghsoudi H, Pourzand A. Giant prosthetic reinforcement of the visceral sac: the Stoppa groin hernia repair in 234 patients. Ann Saudi Med. 2005;25(3):228-32.

Rignault DP. Properitoneal prosthetic inguinal hernioplasty through a Pfannenstiel approach. Surg Gynecol Obstet. 1986;163(5):465-8.

Sakorafas GH, Halikias I, Nissotakis C, Kotsifopoulos N, Stavrou A, Antonopoulos C et al. Open tension free repair of inguinal hernias; the Lichtenstein technique. BMC Surg. 2001;1:3.

Hope WW, Pfeifer C. Laparoscopic Inguinal Hernia Repair. In: StatPearls. Treasure Island (FL): StatPearls Publishing. 2021. Available at: Accessed on August 10, 2021.

Zollinger R, Ellison E. Repair of Inguinal Hernia with Mesh (Lichtenstein). In: Zollinger’s Atlas of Surgical Operations, 9th Edition. The McGraw Hill Companies Inc. 2010;458.

Stoppa RE, Rives JL, Warla umont CR, Palot JP, Verh aeghe PJ, Delattre JF. The use of Dacron in the repair of hernias of the groin. Surg Clin North Am. 1984;64:269-85.

Wantz GE. Giant prosthetic reinforcement of the visceral sac. Surg Gynecol Obstet. 1989;169:408-17.

Stoppa RE, Warla umont CR, Verh aeghe PJ, R omero ER, M’Balla-N’DiCJ. Prosthetic repair in the treatment of groin hernias. Int Surg. 1986;71:154-8.

Lerut JP, Luder PJ. Giant prosthetic reinforcement of the visceral sac in inguinal hernia repair: the Stoppa operation. In: Maddern GJ, Hiatt JR, Phillips EH, eds. Hernia repair: open vs. laparoscopic approaches. New York: Churchill Livingstone. 1997;133-44.

Serpell JW, Johnson CD, Jarrett PE. A prospective study of bilateral inguinal hernia repair. Ann R Coll Surg Engl. 1990;72:299-303.

Miller AR, Van Heerden JA, Naessens JM. Simultaneous bilateral hernia repair. A case against conventional wisdom. Ann Surg. 1991;213:272-6.

Amid PK, Shulman AG, Lichtenstein IL. A five-step technique for local anesthesia in inguinal hernia repair. Chirurg. 1994;65:388-90.

Fischer S, Cassivi S, Paul A, Troidl H. Evidence-based medicine and special aspects in bilateral inguinal hernia repair. Hernia. 1999;3:89-95.

Malazgirt Z, Ozkan K, Dervisoglue A, Kaya E. Comparison of Stoppa and Lichtenstein techniques in the repair of bilateral inguinal hernias. Hernia. 2000;4:264-7.

Talha AR, Shaaban A, Ramadan R. Preperitoneal versus Lichtenstein tension-free hernioplasty for the treatment of bilateral inguinal hernia. Egypt J Surg. 2015;34:79-84.

Maciel GS, Simões RL, Do Carmo FP, Garcia JW, Paulo DN. Results of the simultaneous bilateral inguinal hernia repair by the Lichtenstein technique. Rev Col Bras Cir. 2013;40(5):370-3.

Feliu X, Claveria R, Besora P, Camps J, Fernandez-S allent E, Vinas X et al. Bilateral inguinal hernia repair: laparoscopic or open approach? Hernia. 2011;15:15-8.

Fernandez- Lobato R, Tarta s-Ruiz A, Jimenez-Mi ramon FJ, Marin-Lucas FJ, De Adana-Belbel JC, Esteban ML. Stoppa procedure in bilateral inguinal hernia. Hernia. 2006;10:179-83.

Li J, Ji Z, Cheng T. Comparison of open preperitoneal and Lichtenstein repair for inguinal hernia repair: a meta-analysis of randomized controlled trials. Am J Surg. 2012;204:769-78.