Midline single-port eTEP stoppa repair for bilateral inguinal hernia: How I do it.

BACKGROUND

Early bilateral extraperitoneal unification through a midline single-port eTEP approach enables the creation of a wide, continuous lower abdominal working cavity without crossover manipulation. We evaluated the feasibility and outcomes of this technique for primary bilateral inguinal hernia repair.

METHODS

This retrospective case series represents the complete institutional experience with midline single-port eTEP Stoppa repair between January 2020 and December 2025. Primary bilateral hernias were included; recurrent, incarcerated, and large scrotal hernias were excluded. Operative outcomes, complications (Clavien-Dindo classification), and follow-up data were analyzed.

SURGICAL TECHNIQUE: Through a transverse infraumbilical midline incision, the bilateral retrorectus and preperitoneal spaces are unified at the beginning of the procedure, and a single-port device is inserted to establish a wide extraperitoneal working cavity. Bilateral inguinal dissection is then performed without crossover manipulation, followed by deployment of a single large mesh according to Stoppa principles.

RESULTS

Forty-four consecutive patients underwent the procedure. Median operative time was 121 min. No conversions occurred. Intraoperative peritoneal injury occurred in 12 patients and was repaired laparoscopically. No Clavien-Dindo grade ≥ II complications were observed. Median length of stay was 2 days (range 1-3). Median follow-up was 565 days (IQR 287-1050), with no recurrences or incisional hernias detected.

CONCLUSIONS

Midline single-port eTEP Stoppa repair establishes early bilateral extraperitoneal continuity, creating a wide lower abdominal operative field and eliminating crossover manipulation. This technique may represent a structurally distinct alternative to conventional bilateral TEP and may offer potential ergonomic advantages.