If you have been advised to undergo hernia surgery, you may have heard your surgeon mention a laparoscopic or “keyhole” repair. The idea sounds straightforward: smaller cuts instead of one larger incision. But what actually happens inside the abdomen? Where is the mesh placed? Are you asleep during surgery? And does a smaller incision necessarily mean a better operation?
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Laparoscopic hernia repair surgery is a minimally invasive technique in which a surgeon repairs the hernia through several small abdominal incisions using a camera and specialised instruments.
For many suitable patients, it can offer smaller wounds, less early postoperative discomfort, and a quicker return to normal activities. However, laparoscopic repair is not the best approach for every type of hernia, and the decision should depend on the hernia itself rather than simply choosing the operation with the smallest incisions. You can read more about the overall surgical approaches in our guide to hernia repair.
What Is Laparoscopic Hernia Repair?
During traditional open hernia surgery, the surgeon reaches the hernia through an incision directly over or close to the weakened area. During laparoscopic surgery, the surgeon approaches the hernia from inside using a thin camera called a laparoscope. The laparoscope sends a magnified image to a monitor in the operating room.
The surgeon then uses long, narrow instruments inserted through other small openings to return the herniated tissue to its normal position and reinforce the abdominal wall. Mesh is commonly used in adult laparoscopic hernia repair to strengthen the weak area.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Which Types of Hernia Can Be Repaired Laparoscopically?
Laparoscopic techniques can be used for several abdominal wall hernias, although suitability varies from patient to patient.
Inguinal Hernia
Laparoscopic surgery is well established for inguinal hernia repair. It can be particularly useful when someone has hernias on both sides of the groin or when an inguinal hernia has returned after a previous open repair.
Umbilical Hernia
Some umbilical hernias can be repaired laparoscopically, particularly when the defect or wound-related risk makes a minimally invasive approach reasonable.
Ventral Hernia
Selected ventral hernias can also be treated through laparoscopic surgery. The surgeon may close the abdominal wall defect and reinforce the area with mesh through several small incisions.
Incisional Hernia
A laparoscopic approach may also be possible for certain incisional hernias, which develop through or near the scar from a previous abdominal operation. However, previous surgery can create internal scar tissue, so not every incisional hernia is suitable for a laparoscopic operation.
How Is Laparoscopic Hernia Repair Performed?
The exact technique differs according to the location of the hernia, but the general procedure follows several steps.
Step 1: General Anaesthesia Is Given
Laparoscopic hernia repair is usually performed under general anaesthesia, meaning you are asleep throughout the operation. This is different from some open inguinal hernia repairs, which may sometimes be performed using local anaesthesia with sedation.
Step 2: Small Incisions Are Made
The surgeon makes several small openings in the abdomen. Small hollow tubes called ports are placed through these incisions. The laparoscope and surgical instruments pass through the ports.
Step 3: Working Space Is Created
Carbon dioxide gas is introduced to create enough working space for the surgeon to see the abdominal structures clearly and move the instruments safely. This gas is removed toward the end of the operation.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
Step 4: The Hernia Is Identified
Using the camera image, the surgeon identifies the abdominal wall defect and the tissue that has pushed through it. Fat, intestine, or other tissue within the hernia is carefully returned to its proper position.
Step 5: The Weak Area Is Repaired
Depending on the type of hernia and technique, the surgeon may close the actual abdominal wall defect using sutures. A piece of surgical mesh is then commonly positioned so that it covers and reinforces an area larger than the original weakness.
Step 6: The Mesh Is Positioned
The mesh may be secured using sutures, tacks, adhesive, or another fixation method. In some repairs, extensive fixation may not be necessary. The precise location of the mesh depends on the hernia and the surgical technique.
Step 7: The Instruments Are Removed
Once the repair has been checked, the carbon dioxide gas is released and the laparoscope and instruments are removed. The small incisions are then closed with stitches, surgical adhesive, or another suitable closure method.
What Are TEP and TAPP Hernia Repair?
If you are having laparoscopic inguinal hernia surgery, you may hear your surgeon mention TEP or TAPP. Both approaches repair the groin hernia from behind the abdominal wall and commonly use mesh, but they reach the repair area differently.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
TAPP – Transabdominal Preperitoneal Repair
During TAPP surgery, the surgeon first enters the abdominal cavity. A layer called the peritoneum is then opened so the surgeon can reach the space behind it, return the hernia contents, place the mesh over the weak groin area, and close the peritoneal layer afterward.
TEP – Totally Extraperitoneal Repair
During TEP surgery, the surgeon creates a working space between layers of the abdominal wall without deliberately entering the main abdominal cavity. The hernia is repaired and mesh is placed within this deeper tissue space.
Is TEP Better Than TAPP?
Not necessarily. Both are established techniques with good outcomes when performed by experienced surgeons. The choice may depend on:
- The type of inguinal hernia
- Whether the hernia is on one or both sides
- Previous surgery
- The patient's anatomy
- The surgeon's training and experience
The important issue for most patients is not choosing TEP or TAPP themselves, but understanding why their surgeon recommends one approach for their particular hernia.
Why Is Mesh Commonly Used in Laparoscopic Hernia Repair?
Returning the protruding tissue to the abdomen is only part of the operation. The weakened abdominal wall also needs reinforcement. Mesh covers a broader area around the defect and helps distribute pressure across stronger surrounding tissue. In laparoscopic inguinal hernia repair, mesh is generally placed behind the weak groin area.
Mesh is also commonly used during laparoscopic ventral and incisional repairs, although the exact position varies according to the technique. Using mesh does not mean the hernia can never return, but mesh-based repair reduces recurrence for many adult hernias.
What Are the Benefits of Laparoscopic Hernia Surgery?
The main potential benefits relate to its minimally invasive approach.
Smaller Incisions
Rather than one larger wound directly over the hernia, laparoscopic surgery uses several smaller incisions.
Less Early Postoperative Pain
For inguinal hernias, laparoscopic approaches are generally associated with less early pain than traditional open anterior mesh repair when performed appropriately.
Faster Return to Normal Activities
Some patients can return to routine activities and work sooner after minimally invasive inguinal repair compared with open surgery. The actual timeline still depends on the physical demands of work and the type of repair performed.
Useful for Bilateral Inguinal Hernias
If hernias are present on both sides of the groin, both can often be repaired through the same laparoscopic access points during one operation.
Useful for Some Recurrent Hernias
If an inguinal hernia returns after an open anterior repair, a laparoscopic approach can allow the surgeon to reach the hernia through a different tissue plane rather than repeatedly operating through the previous groin scar.
When Might Laparoscopic Hernia Repair Not Be Suitable?
An open operation may sometimes be safer or more practical. Factors that can influence this decision include:
- Extensive scar tissue from previous abdominal surgery
- A very large or complex hernia
- Certain medical conditions
- A hernia requiring major abdominal wall reconstruction
- Inability to safely undergo general anaesthesia
- Difficulty obtaining safe minimally invasive access
- Emergency situations involving complicated anatomy or bowel damage
The surgeon must consider the safest way to achieve a durable repair rather than trying to perform laparoscopic surgery at all costs.
Can Laparoscopic Surgery Be Converted to Open Surgery?
Yes. Occasionally, a surgeon begins laparoscopically but decides that completing the operation through an open incision is safer. This may happen because of:
- Extensive internal scar tissue
- Unexpected bleeding
- Difficulty seeing the anatomy clearly
- Injury or concern involving the intestine or another organ
- An unexpectedly complex hernia
Conversion to open surgery should not automatically be viewed as a complication or failure. It is sometimes a safety decision made during the operation.
What Are the Risks of Laparoscopic Hernia Repair?
Like every operation, laparoscopic hernia repair carries possible complications. These may include:
- Bleeding
- Wound or mesh infection
- Seroma or fluid collection
- Bruising and swelling
- Temporary difficulty urinating
- Persistent pain or numbness
- Injury to the bowel, bladder, blood vessels, or other nearby structures
- Complications related to general anaesthesia
- Hernia recurrence
The risk varies according to the type of hernia, previous surgery, general health, and complexity of the operation.
What Is Recovery Like?
After surgery, you are moved to a recovery area while the anaesthetic wears off. Some soreness is expected during the first few days. You may also experience abdominal bloating or temporary shoulder discomfort related to the carbon dioxide gas used during surgery.
Walking is generally encouraged early because gentle movement supports circulation and recovery. Many uncomplicated laparoscopic hernia operations are performed as day surgery, meaning the patient can return home once they are awake, medically stable, able to walk safely, and have adequate pain control. Larger ventral or incisional repairs may require an overnight or longer hospital stay.
*AI-generated image - for illustration only. Clinical accuracy is not guaranteed.
When Can You Return to Work?
There is no single return-to-work date. Someone working at a computer may be ready much sooner than someone whose job involves construction, lifting, climbing, or other strenuous physical activity. Recovery also depends on whether the operation involved a small inguinal hernia or a larger abdominal wall repair.
Follow your surgeon's individual advice regarding:
- Driving
- Heavy lifting
- Gym exercise
- Running
- Physical work
- Sports
Laparoscopic vs Robotic Hernia Repair: Are They the Same?
They are related but not identical. Both are minimally invasive and use small abdominal incisions and a camera. During conventional laparoscopic surgery, the surgeon directly holds and operates the long surgical instruments while looking at a monitor.
During robotic surgery, the surgeon controls specialised robotic instruments from a surgical console. Robotic instruments can provide greater movement for certain complex suturing tasks, but this does not automatically make robotic surgery more effective than conventional laparoscopy for a straightforward hernia.
The Bottom Line
Laparoscopic hernia repair surgery uses several small incisions, a camera, and specialised instruments to repair the hernia from inside the abdominal wall. Mesh is commonly placed to reinforce the weakened area, and inguinal hernias may be repaired using TEP or TAPP techniques.
For suitable patients, laparoscopic surgery can offer smaller wounds, less early postoperative discomfort, and an earlier return to normal activities. It can be particularly useful for bilateral inguinal hernias and certain recurrent hernias after previous open surgery. But laparoscopic surgery is not automatically the best option simply because it is minimally invasive.
Large or complex abdominal wall hernias, significant previous surgery, anaesthesia considerations, or other medical factors may make an open or different surgical approach more appropriate. The goal should always be the same: choose the approach that provides a safe, durable repair for the specific hernia—not simply the smallest incision.
