Background <p>Patients undergoing unilateral inguinal hernia repair are at risk of metachronous contralateral inguinal hernia development. Scar formation resulting from previous totally extraperitoneal (TEP) inguinal hernia repair may prevent a second TEP on the contralateral side. This study investigated the feasibility and safety of metachronous contralateral TEP in patients after prior unitralateral TEP repair.</p> Methods <p>Thirty-eight cases of metachronous contralateral inguinal hernia patients with a history of primary unilateral TEP repair were retrospectively analyzed for outcomes including recurrence and perioperative complications.</p> Results <p>The mean interval between primary unilateral and contralateral repair was 51.7 ± 35.6 months, ranging from 4 to 130 months. Contralateral TEP was successfully achieved in 37 cases, where identifying the epigastric vessels and lateral space dissection first approach facilitated effective and safe dissection of the preperitoneal space despite scarring in the midline and the posterior pubic space. Only one case was converted to the Lichtenstein procedure. No major complications occurred and perioperative parameters were comparable between repairs, except for a significantly higher operation time in the repeat TEP group (<i>P</i> = 0.036). Complete follow-up information was available in 35 of 38 patients with a mean follow-up time of 30.9 ± 14.2 months. No patient experienced recurrence.</p> Conclusions <p>Previous unilateral TEP should not be a contraindication for contralateral metachronous TEP. Contralateral TEP can be repaired safely with outcomes equivalent to primary TEP repair.</p>