If your doctor has recommended surgery for an inguinal hernia, you may understand why the hernia needs repairing but still wonder what actually happens once you enter the operating room.
Does the surgeon remove the hernia? Is the intestine cut? Where does the mesh go? And what is the difference between open and laparoscopic repair?
Understanding each step of inguinal hernia repair surgery.
First, What Exactly Is Being Repaired?
An inguinal hernia occurs when tissue from inside the abdomen—often fat or part of the intestine—bulges through a weak area in the lower abdominal wall near the groin. The surgery usually does not involve removing a normal section of intestine. In an uncomplicated repair, the bulging tissue is generally moved back into the abdomen and the weakened area is reinforced.
If you would like to understand the condition itself before reading about surgery, you can visit our detailed guide to inguinal hernia.
For a broader overview of surgical techniques, see hernia repair.
Before Surgery: Preparing for Inguinal Hernia Repair
Before the operation, the surgical team reviews your medical history, medicines, allergies, previous operations, and other health conditions. You will usually receive instructions about when to stop eating and drinking before surgery. You may also be told whether any regular medicines need to be taken, adjusted, or temporarily stopped.
A calm conversation with the care team before surgery day.
Step 1: Anaesthesia Is Given
The first surgical step is making sure you do not feel pain during the procedure. The type of anaesthesia depends partly on how the hernia is being repaired.
- Open inguinal hernia repair may sometimes be performed using local anaesthesia with sedation, spinal anaesthesia, or general anaesthesia.
- Laparoscopic repair is generally performed under general anaesthesia, meaning you are asleep during the operation.
Two surgical approaches, one shared goal of repair.
During Open Inguinal Hernia Repair
The surgeon makes one incision in the groin over or close to the hernia. The tissues are carefully separated until the surgeon can identify the hernia sac and the weakened area in the abdominal wall.
During Laparoscopic Inguinal Hernia Repair
Instead of one larger groin incision, the surgeon makes several small incisions in the abdomen. Small hollow tubes called ports are inserted through these openings. Carbon dioxide gas is used to create working space inside the abdomen, and a laparoscope—a narrow instrument containing a camera—is inserted so the surgeon can see the area on a monitor. Special surgical instruments are then passed through the other small openings.
Step 3: The Hernia Contents Are Returned to the Abdomen
The surgeon then deals with the tissue that has pushed through the weakened area. In a typical uncomplicated hernia, the protruding fat or intestine is gently returned to its normal position inside the abdomen. The hernia sac is then managed according to the type of hernia and surgical technique being used. This is sometimes described as reducing the hernia. The surgeon also checks the area carefully before completing the repair.
Step 4: The Weak Area Is Reinforced
Returning the tissue to the abdomen solves only part of the problem. The opening or weakness that allowed the hernia to develop also needs to be repaired. In many adult inguinal hernia operations, the surgeon places a piece of surgical mesh over the weak area.
Mesh acts like gentle scaffolding to support healing tissue.
Does Every Inguinal Hernia Repair Use Mesh?
No, but mesh is commonly used for adult inguinal hernia repair. There are also non-mesh or tissue repairs, where the surgeon reconstructs and strengthens the weakened area using the patient's own tissues and sutures.
The choice depends on factors such as:
- The type and size of the hernia
- Whether the operation is planned or an emergency
- Risk of infection or contamination
- Previous hernia operations
- The patient's medical circumstances
- The surgical technique and surgeon's assessment
Mesh should therefore not be thought of as automatically suitable or unsuitable for every patient. The repair needs to be individualised.
Step 5: In Laparoscopic Surgery, the Repair Is Completed From Behind the Abdominal Wall
During laparoscopic inguinal hernia surgery, the mesh is generally positioned in a deeper layer so that it covers and reinforces the weak groin area from behind. You may hear surgeons use the terms TAPP or TEP.
- TAPP (Transabdominal Preperitoneal Repair): The surgeon enters the abdominal cavity and then reaches the layer where the mesh is placed.
- TEP (Totally Extraperitoneal Repair): The operation is performed in the space between layers of the abdominal wall without entering the main abdominal cavity.
Both are established laparoscopic approaches. Which technique is used depends on the patient, hernia characteristics, previous surgery, and the surgeon's expertise.
Step 6: The Surgeon Checks the Repair
Before closing the operation, the surgeon checks that the hernia has been properly reduced, the repair is secure, and there is no concerning bleeding. In laparoscopic surgery, the carbon dioxide gas used to create working space is then released. The instruments and ports are removed.
Step 7: The Incision Is Closed
The final surgical step is closing the incision or incisions. This may be done using:
- Dissolvable stitches
- Non-dissolvable stitches
- Surgical clips or staples
- Surgical adhesive
A dressing may then be placed over the wound. At this point, the actual hernia repair is complete.
What Happens Immediately After Inguinal Hernia Surgery?
After surgery, you are taken to a recovery area while the effects of anaesthesia wear off. The healthcare team monitors things such as your blood pressure, breathing, pain, wound, and ability to urinate.
Some discomfort, bruising, or swelling around the groin is expected during the early recovery period. Men may also notice temporary swelling or bruising around the scrotum. After laparoscopic surgery, some people experience temporary bloating or shoulder discomfort from the gas used during the procedure.
Do You Have to Stay in Hospital?
Many patients recover comfortably at home the same day.
An overnight or longer stay may sometimes be required depending on:
- The complexity of the hernia
- Whether surgery was planned or emergency
- The patient's age and general health
- How the patient recovers from anaesthesia
- Any complications during or after surgery
Open vs Laparoscopic Inguinal Hernia Repair: Are the Steps Very Different?
Different surgical paths, the same goal of lasting repair.
| Open Repair | Laparoscopic Repair |
|---|---|
| One incision is made in the groin | Several small abdominal incisions are made |
| The surgeon reaches the hernia directly through the groin | A camera and instruments are used to reach the hernia internally |
| May be possible with local, regional, or general anaesthesia depending on the case | Usually requires general anaesthesia |
| Mesh or a tissue repair may be used | Mesh is commonly used |
| One larger wound | Several smaller wounds |
Neither approach is automatically best for every patient. Hernia size, whether the hernia is on one or both sides, previous operations, recurrence, general health, and surgeon experience can all influence the decision.
How Long Does Inguinal Hernia Repair Take?
The exact operating time varies according to the type of hernia and technique being used. A straightforward repair may be relatively short, while a recurrent, bilateral, large, or complicated hernia can require more time. The time spent at the hospital will also be longer than the operation itself because it includes preparation before surgery and recovery from anaesthesia afterward.
What If the Surgeon Finds Trapped Intestine?
A routine elective repair is different from emergency surgery for an incarcerated or strangulated hernia. If intestine becomes trapped in the hernia and its blood supply is threatened, emergency surgery may be necessary.
The surgeon returns the trapped tissue to the abdomen and checks whether it is healthy. If a portion of intestine has been severely damaged because its blood supply was cut off, additional bowel surgery may occasionally be required. This is one reason sudden severe groin pain, a hernia that can no longer be pushed back, vomiting, abdominal swelling, fever, or redness around the hernia should not be ignored.
What Are the Main Risks of Inguinal Hernia Repair?
Inguinal hernia repair is commonly performed, but like any operation it can have complications. Possible problems include:
- Bleeding or bruising
- Wound infection
- Fluid collection or swelling
- Difficulty urinating temporarily
- Persistent groin pain or numbness
- Hernia recurrence
- Rare injury to nearby structures
- Complications related to anaesthesia
Your individual risk depends on your health, the type of hernia, whether the operation is elective or emergency, and the surgical approach being used.
The Bottom Line
The steps of inguinal hernia repair are easier to understand when you remember the main goal: put the herniated tissue back where it belongs and reinforce the weak area that allowed it to come through. With open surgery, the surgeon reaches the hernia through an incision in the groin. With laparoscopic surgery, the repair is performed through several small abdominal incisions using a camera and specialised instruments.
In either case, the hernia is reduced, the abdominal wall is repaired—commonly with mesh in adults—the surgical area is checked, and the incision is closed. The precise technique will differ from patient to patient, so your surgeon may describe steps that vary slightly from this general sequence.
