I have been diagnosed with a groin hernia on one side… what is the risk of developing one on the other side? Should I ask the surgeon to repair both sides at the same time?

It is not uncommon for patients operated on for a groin hernia on one side to wonder whether they may develop one on the other side. The question is legitimate because hernias are common, with nearly one in three men undergoing surgery for a groin hernia during their lifetime, and it is not unusual for people in their circle to have had surgery on both sides simultaneously or successively. Since a hernia can cause pain or discomfort in daily life, the idea of experiencing the same situation on the other side naturally raises concern.

A large study conducted in Taiwan followed 170,492 men who underwent unilateral inguinal hernia repair between 1998 and 2010, with a median follow-up of more than seven years. It showed that about 10.5% of them had to undergo reoperation for a hernia on the opposite side, with an average delay of four years. The risk is relatively low but real, and it increases gradually over time, reaching about 7% at five years. It should also be noted that among the patients reoperated, nearly 4% required emergency surgery due to a complicated hernia, either incarcerated or strangulated.

The factors that increase this risk include age, particularly after 45 years with a peak observed between 65 and 80 years, and the type of hernia initially repaired, since direct hernias, which reflect a more diffuse weakness of the abdominal wall, expose more often to a contralateral occurrence. Certain diseases also play a role, such as cirrhosis or other severe liver conditions, prostate disease, heart failure, or a history of cancer.

Does this mean that both sides should be repaired during the first operation? The answer is no, not systematically, since the risk remains limited. However, bilateral repair may be considered if the surgeon already observes a weakness on the opposite side or if the patient presents suggestive symptoms, even without a visible bulge. It is then essential to rule out other causes of groin pain, since this symptom can be related to very diverse origins, neurological, spinal, muscular, joint, or tendon-related, and does not justify abdominal wall surgery on its own. In very specific situations, simultaneous repair may thus avoid a second hospitalization.

The key point is to discuss this with a surgeon who has particular expertise in abdominal wall surgery, in order to ensure both diagnostic reliability and the appropriateness of the surgical indication. The diagnosis relies primarily on clinical examination, performed in the standing position and sometimes lying down. Ultrasound is usually not useful and can even be misleading by producing false positives. The decision to repair one or both sides must always be made jointly between the surgeon and the patient, after clear and complete information.

References

Lee CH, Chiu YT, Cheng CF, Wu JC, Yin WY, Chen JH. Risk factors for contralateral inguinal hernia repair after unilateral inguinal hernia repair in male adult patients: analysis from a nationwide population-based cohort study. BMC Surg. 2017;17:106. doi:10.1186/s12893-017-0302-

Stabilini C, Veenendaal N, Aasvang E, et al. Update of the international HerniaSurge guidelines for groin hernia management. BJS Open. 2023; zrad080. doi:10.1093/bjsopen/zrad080.