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

Abstract

<h4>Background</h4>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.<h4>Methods</h4>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.<h4>Surgical technique</h4>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.<h4>Results</h4>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.<h4>Conclusions</h4>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.