Inguinal hernia repair - How it's performed 

How inguinal hernia repair is carried out 

Inguinal hernia illustration

Illustration of inguinal hernia
  1. Inguinal ligament
  2. Bowel
  3. Inguinal hernia

NHS waiting times

If your GP refers you to a consultant for specialist treatment, such as surgery, you have the right to start treatment within 18 weeks.

You may be able to book your hospital appointment through Choose and Book while you’re still in the GP surgery.

Read more about NHS waiting times for treatment.

There are two ways that an inguinal hernia repair can be carried out. These are open surgery or keyhole surgery (also called laparoscopic surgery).

The hospital will send you instructions about when you need to stop eating and drinking before the operation.

The operation usually takes about 30-45 minutes to complete and you will usually be able to go home on the same day. Some people stay in hospital overnight if they have other medical problems or if they live alone.

Read more about recovering from an inguinal hernia repair.

Open surgery

Open inguinal hernia repair is often carried out under a local anaesthetic or a regional anaesthetic injected into the spine, which means you will be awake during the procedure but the area being operated on will be numbed so you won't experience any pain. 

In some cases, a general anaesthetic is used. This means you will be asleep during the procedure and won't feel any pain.

Once the anaesthetic has taken effect, the surgeon makes a single cut (incision) over the hernia. This incision is usually about 6-10cm long. The surgeon will then place the lump of fatty tissue or loop of bowel back into your abdomen (tummy).

A mesh is placed in the abdominal wall, at the weak spot where the hernia came through, to strengthen it.

When the repair is complete, your skin will be sealed with stitches. These are usually a type that dissolve on their own over the days following the operation.

If the hernia has become trapped (strangulated) and part of the bowel damaged, the affected segment may need to be removed and the two ends of healthy bowel rejoined. This is a bigger operation and you may need to stay in hospital for 4-5 days.

Keyhole (laparoscopic) surgery

General anaesthetic is used for keyhole inguinal hernia repair, so you will asleep during the operation.

During keyhole surgery, the surgeon usually makes three small incisions in your abdomen (instead of a single, larger incision).

A thin tube containing a light source and a camera (laparoscope) is inserted through one of these incisions so the surgeon can see inside your abdomen. Special surgical instruments are inserted through the other incisions so the surgeon can pull the hernia back into place.

There are two types of keyhole surgery:

  • Transabdominal preperitoneal (TAPP) – instruments are inserted through the muscle wall of your abdomen and through the lining covering your organs (the peritoneum). A flap of the peritoneum is peeled back over the hernia and a piece of mesh is stapled or glued to the weakened area in your abdomen wall to strengthen it.
  • Totally extraperitoneal (TEP) – this is the newest keyhole technique. It involves repairing the hernia without entering the peritoneal cavity.

Once the repair is complete, the incisions in your skin are sealed with stitches or surgical glue.

Which technique is best?

The National Institute for Health and Care Excellence (NICE), which assesses medical treatments for the NHS, says that both keyhole and open surgery for hernias are safe and work well. Read the NICE guidelines on using keyhole surgery to treat inguinal hernia.

With keyhole surgery, there is usually less pain after the operation because the cuts are smaller. There is also less muscle damage and the small cuts can be closed with glue.

Keyhole surgery tends to have a quicker recovery time in people who have been treated before and the hernia has come back (recurrent hernia) or people with hernias on both sides at the same time (bilateral hernias), although there is very little difference in recovery time in people who only have a hernia on one side that has not been treated before (single-sided, primary hernia).

However, the risks of serious complications, such as the surgeon accidentally damaging the bowel, are higher in keyhole surgery than open surgery.

The risk of your hernia returning is similar after both operations.

Discuss the advantages and disadvantages of keyhole and open surgery with your surgeon before deciding on the most appropriate treatment.

Deciding which technique to use

The choice of technique for inguinal hernia repair will largely depend on:

  • your general health - elderly people or people in bad health may be too weak or frail to safely have a general anaesthetic, so open surgery using local anaesthetic may be advised
  • the experience of your surgeon - open surgery is more common than keyhole surgery, so not all surgeons have enough experience in keyhole techniques 

Recent guidance from the British Hernia Society advises that most primary, single-sided hernias are best repaired using the open technique.  Laparoscopic techniques are usually only recommended for recurrent or bilateral hernias.

Keyhole surgery can also be useful if your surgeon is not sure exactly what type of hernia you have.

Page last reviewed: 15/10/2013

Next review due: 15/10/2015

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Comments

The 5 comments posted are personal views. Any information they give has not been checked and may not be accurate.

stu72t said on 06 March 2014

I had my Bilateral Inguinal Hernia repair operation on Friday the 28th February at the Spire Regency in Macclesfield.

My experience of the operation, and post op, have on the whole been very positive. I was out of hospital by 3pm on the same day. Having both sides done at the same time did leave me with quite a bit of initial pain, which was controlled by paracetamol. The pain got worse 2-3 days after the Op, but now nearly a week on, the pain has almost gone.

I was warned of the possible side affects, but decided to go ahead and I am glad I did. I expect to make a full recovery and be back at work in a few days.

I did ask about continuing pain after the operation, and was told that sometimes a nerve can be damaged. This can happen, but I was told that it can be sorted with another op if needed to cut the nerve.

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risylee said on 18 September 2013

I have left a comment about the problems of having surgery and mesh inserted on another hernia page (which I cannot find - this website is poorly organised). I totally agree with the adverse comments left below and would advise anyone to be very careful of having mesh inserted. After 2 months I am now in constant pain. The hospital I had it done in (the Royal Free) has statistics which show the outcomes for hernia ops as very good. I don't know how they know as they do not have follow up appointments - how do they know what patients experience? The Consultant to whom I showed thestatistics said he didn;t know where they came from - so obviously the reported 'good' outcomes did not come from him either. Please try t find my other comments before you have this surgery.

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RWarner4701 said on 15 September 2013

Can any type of Hernia make you un fit to join the military? I'm just curious because I'm really interested in joining the Army.

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bluehaze said on 28 July 2013

My husband had TAPP in March. He is in excruciating pain. What is the down side of MESH?

bluehaze

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gharusa said on 15 July 2013

I have read this article ref. Inguinal Hernia.
Can I just point out that i have also read unfavourable comments projected by patients who have had MESH inserted and used for this Hernia operation with adverse post operative side effects like continuous excruciating pain / infections etc. long after the operation which literally have devastated their lives. I am not talking of the odd 1% of patients but hundreds. So why is this MESH still being used ?????? Can anyone justify this ?

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