Society of American Gastrointestinal and Endoscopic Surgeons

View all recommendations from this society

Released August 27, 2020; Update January 19, 2022.

Avoid open surgery for elective repair of bilateral inguinal hernias if minimally invasive approaches are feasible.

Minimally invasive inguinal hernia repair is associated with faster return to work, less postoperative pain, and lower incidence of chronic groin pain compared to open surgery. For bilateral inguinal hernia, the benefits are increased as both hernias can be repaired through the same incisions in one operation. Modeled analyses suggest that a laparoscopic approach is more cost-effective for bilateral hernias compared to open surgery.

These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.

How The List Was Created

The SAGES Quality, Outcomes and Safety (QOS) Committee appointed a task force (composed of active members of the committee) to develop a list of potential recommendations after being provided with information and links to the Choosing Wisely® website. This group compiled a list of recommendations which fit the criteria outlined by the ABIM Foundation. A literature search was performed to ensure the recommendations were evidence-based. The task force then distributed the list to the full membership of the SAGES QOS Committee, asking the members of the committee to rank the recommendations by level of importance and clinical relevance. The top recommendations were discussed by the committee and selected for inclusion in this list. The list was reviewed and approved by the SAGES Executive Committee and SAGES Board of Governors.


International guidelines for groin hernia management. Hernia : the journal of hernias and abdominal wall surgery 22, 1-165 (2018).

Ielpo, B., et al. Cost-effectiveness of Randomized Study of Laparoscopic Versus Open Bilateral Inguinal Hernia Repair. Annals of surgery 268, 725-730 (2018).

Simons, M.P., et al. European Hernia Society guidelines on the treatment of inguinal hernia in adult patients. Hernia : the journal of hernias and abdominal wall surgery 13, 343-403 (2009).