Laparoscopic (keyhole) inguinal hernia repair

Considering Hernia Surgery? Why I Offer Laparoscopic Repair

Fifteen years ago, a close family member needed surgery for an inguinal hernia. At that time, the standard approach was traditional “open” surgery, although a newer method - laparoscopic or “keyhole” repair - was gaining traction.

I spent a great deal of time reviewing the available evidence and ultimately concluded that laparoscopic surgery would be the best choice. I remember thinking: If this is the approach I’d want for my own family, I should offer it to my patients too.

Since then, I’ve performed hundreds of laparoscopic hernia repairs and have repeatedly seen the benefits this minimally invasive technique provides.

Understanding Hernias

Most people come to see me because they have noticed a bulge in their groin that may or may not feel uncomfortable. Hernias are rarely that painful but current NHS guidelines tend to prioritise surgical referrals based on pain, which means many patients who are bothered by a hernia in other ways - nuisance discomfort, activity limitation, or concern about worsening - may not qualify for treatment.

The consequence? Most people with asymptomatic groin hernias can avoid surgery and carry on with their lives without being concerned, but others relying on the NHS may have to continue with their daily lives while aggravating the hernia. Rarely, this can even lead to complications that may require emergency surgery. Emergency hernia repairs often involve more complex procedures, longer recovery, and a higher chance of bowel involvement. It also typically rules out the option of keyhole surgery.

Surgical Options

There are two standard techniques for inguinal hernia repair: open surgery and laparoscopic (keyhole) surgery. Both methods reinforce the weak spot in the abdominal wall using a plastic mesh, but they differ significantly in how they achieve this.

Open surgery involves a 6–8 cm incision through the skin and abdominal wall. The hernia is pushed back, and the mesh is placed to support the area. This approach leaves a visible scar, typically has a longer recovery time and carries an increased risk of long-term scar-related pain due to nerve injury.

Laparoscopic surgery is less invasive and involves approaching the hernia from behind the abdominal wall using three small incisions and can be either a Totally Extraperitoneal Repair (TEP) or a Transabdominal Preperitoneal Repair (TAPP). I prefer the TEP method because it avoids entering the abdominal cavity, therefore reducing the risk of bowel injury. Through small incisions, I use specialised instruments to pull back the hernia and insert the mesh with precision.

Why I Prefer Laparoscopic Repair

I offer laparoscopic hernia repair because it typically results in:
•    Quicker return to normal activity, including strenuous exercise, typically after only two weeks (usually four to six weeks after open repair)
•    Minimal scarring
•    Lower risk of chronic groin discomfort, especially when using specially shaped meshes that don’t require fixation.

That said, laparoscopic repair requires a general anaesthetic, which may not be suitable for elderly or frail patients who may benefit from open repair under local anaesthetic. I have a regular session in a community-based practice where I regularly perform open hernia surgery under local anaesthetic. This regular exposure to both techniques is somewhat unusual, but has resulted in me feeling equally confident performing both laparoscopic and open surgery.

What to Expect During a Consultation

I believe in a patient-led approach to care. During your consultation, I will take time to explain what a hernia is and whether surgery would be beneficial for your personal situation. Unlike many surgeons, who focus on either open or laparoscopic techniques, my regular and frequent experience with both laparoscopic and open repair gives me an unbiased perspective, enabling me to tailor discussions and recommendations about the best operation to suit each patient’s individual situation.

While hernias are not typically dangerous, they can impact your quality of life. If you have a hernia and would like expert guidance, arranging a consultation is simple. Please contact my private secretary, who will be happy to find a time that works for you.