BackgroundInternational guidelines currently recommend laparoscopy for bilateral inguinal hernia repair (BIHR). Our study aims to evaluate the trends and factors associated with the choice of laparoscopy for BIHR in Spain.MethodsWe performed a retrospective analysis of patients undergoing BIHR between 2016 and 2019. We used the national database of the Spanish Ministry of Health: RAE-CMBD. We performed a univariate and multivariable logistic regression analysis to identify the factors associated with the utilization of laparoscopy. We identified perioperative complications and the factors associated with their occurrence through multivariable logistic regression analysis.ResultsA total of 21,795 BIHRs were performed: 84% by open approach and 16% by laparoscopic approach. Laparoscopic approach increased from 12% in 2016 to 23% in 2019 (p< 0.001). The 40% of hospitals did not use laparoscopy, and only 8% of the hospitals performed more than 50% of their BIHRs by laparoscopy. The utilization rate of laparoscopy was not related to the number of BIHRs performed per year (p= 0.145). The main factor associated with the choice of laparoscopy in multivariable logistic regression analysis was the patient’s region of residence (OR2.04, 95%CI1.88–2.21). Other factors were age < 65 years (OR1.65, 95%CI1.52–1.79) and recurrent inguinal hernia (OR1.31, 95%CI1.15–1.49). The type of approach for BIHR was not independently associated with perioperative complications.ConclusionsDespite a significant increase in recent years, laparoscopic BIHR in Spain remains low. The main factor associated with the utilization of laparoscopy was the patient’s region of residence; this factor seems to be related to the presence of hospitals with a high rate of laparoscopic approaches where the patient lives. The type of approach was not independently associated with perioperative complications. More efforts are needed to increase laparoscopic use in patients with bilateral inguinal hernias.Graphical abstractSupplementary InformationThe online version contains supplementary material available at 10.1007/s00464-023-09967-y.