Types of inguinalhernia surgery

The repair can be done two ways.

Open surgery. Your surgeon makes an incision near the hernia site and pushes the bulging tissue back into your abdomen. The surgeon may or may not remove the sac around the hernia. Usually a mesh will then be placed between the abdominal wall muscles to repair the hernia defect. Your surgeon may attach the mesh with sutures depending on the type of mesh used. The wound is then closed using sutures, surgical glue or sometimes surgical skin staples.

Laparoscopic (often called keyhole) surgery. Your surgeon makes several small punctures or incisions in your abdomen and then inserts hollow tubes into the openings. They’ll then inflate the pelvic space with a gas and put surgical tools and a light and camera through the tubes. Your surgeon repairs the hernia by placing a piece of mesh over the weak spot in your abdominal wall and then staples or glue the mesh in place. There are two options to do the repair - inside the peritoneal cavity (the sac that contains all of your abdominal organs) or outside this sac in the extra-peritoneal space. Sometimes your surgeon may need to change to an open procedure because of difficulties during keyhole surgery.

Open or laparoscopic: which is best?

The choice of technique largely depends on:

• Your surgeon’s preference and experience – laparoscopic surgery is becoming more common as more surgeons become experienced in laparoscopic approaches. However, this doesn’t mean that the one option is better than the other. It’s important you speak with your surgeon to discuss the pros and cons of each approach.
• Your general health – if you’re elderly or have other health problems, you may not be able to safely have general anaesthetic and this means you can’t have laparoscopic surgery. In this case, open surgery using local anaesthetic may be advised.

An open inguinal hernia repair can be done with local anaesthetic, while a laparoscopic repair requires a general anaesthetic, which has increased risks.

The post-operative discomfort depends on the technique used and the type of pain relief provided by your surgeon and anaesthetist. While some surgeons believe a laparoscopic approach is associated with less discomfort than an open approach (and this depends on the technique used), laparoscopy is associated with a slightly higher risk of serious complications, like your surgeon accidentally damaging your bowel. The risk of your hernia returning is similar for both operations.