Laparoscopic surgery for an inguinal hernia

Laparoscopic surgery allows an inguinal hernia to be repaired through small incisions, accessing the weakened area of the groin from the inner surface of the abdominal wall. During the procedure, the surgeon repositions the tissues that have protruded through this area and usually places a mesh to significantly reinforce the region.
The aim is to achieve a long-lasting repair and facilitate a gradual return to normal activities. There are two main techniques, known as TEP and TAPP. They use different approaches to reach the area where the mesh is placed, but essentially aim to achieve the same objective.

Laparoscopic inguinal hernia surgery: what the repair involves

An inguinal hernia occurs when an area of the abdominal wall in the groin loses its strength, allowing fat or other tissues from inside the abdomen to protrude through it. The aim of the surgery is to repair this weakened area.

In a laparoscopic procedure, the surgeon does not access the hernia directly via an incision in the groin. Instead, they insert a small camera and various instruments through small abdominal incisions and reach the groin area from the inside.

This approach allows for a clear view of the area where the weakness has occurred and enables the repair to be carried out from the back of the abdominal wall. The procedure is usually performed under general anaesthesia.

The aim of the repair and how the mesh works

The aim of the operation is not simply to remove the bulge caused by the hernia. The repair is intended to strengthen the area of the abdominal wall that has lost its strength and reduce the likelihood of the hernia recurring.

To achieve this, a surgical mesh is usually used. Rather than simply covering the specific point where the hernia has appeared, the mesh is extended over a wider area of the groin region.

This reinforces the entire area prone to weakness and distributes the forces exerted on the abdominal wall during everyday activities such as walking, standing up, coughing or exercising.

The international update to the HerniaSurge guidelines on the treatment of inguinal hernias continues to recommend mesh repair as the preferred option for most adults requiring surgery for an inguinal hernia.

There are different types of mesh and various ways of placing or stabilising it. The choice depends on the characteristics of the hernia and forms part of the surgical planning.

How the procedure is carried out: TEP and TAPP techniques

The operation begins with several small incisions through which a camera and surgical instruments are inserted. The surgeon locates the hernia from the back of the abdominal wall, carefully releases the tissues that have protruded through the weakened area and returns them to their correct position.

The surgeon then prepares the space where the mesh will be placed. The mesh is positioned between the abdominal wall and the thin membrane lining the inside of the abdomen, known as the peritoneum. This area is called the preperitoneal space.

The TEP and TAPP techniques use different approaches to reach this same space. In the TAPP technique, the surgeon first enters the abdominal cavity and, from there, accesses the area where the mesh will be placed. Once the repair is complete, the peritoneum is closed again so that the mesh remains separate from the abdominal organs.

In the TEP technique, the space behind the abdominal wall is accessed directly without intentionally entering the abdominal cavity. For the patient undergoing surgery, the most important thing is that both techniques have the same aim: to repair the hernia by placing a wide reinforcement behind the inguinal region.

The 2024 Cochrane review comparing TEP and TAPP found no sufficiently robust evidence to consider either technique universally superior in terms of outcomes such as recurrence, serious complications or chronic pain.

The choice depends on the characteristics of the hernia, previous operations and, most importantly, the surgeon’s experience.

What outcomes can laparoscopic hernia repair offer?

Nowadays, a successful hernia repair is not judged solely on the disappearance of the lump. It is also important that the repair is long-lasting, that the patient can gradually resume their normal activities, and that the procedure leaves as little persistent pain as possible.

When the techniques are performed correctly by experienced teams, TEP, TAPP and the main open repairs using mesh achieve low and broadly comparable rates of recurrence — that is, the hernia reappearing.

The most significant differences are seen in recovery and pain. The HerniaSurge guidelines conclude that the laparoscopic TEP and TAPP techniques generally allow for a faster recovery and are associated with a lower risk of persistent pain than the Lichtenstein open repair—one of the most widely used open techniques—provided there is adequate surgical expertise.

A systematic review and meta-analysis published in 2024 on chronic pain following inguinal hernia repair also found a lower incidence of persistent inguinal pain with laparoscopic techniques.

These results describe what happens, on average, in groups of patients. They do not allow us to predict exactly how much pain a specific individual will experience or how long it will take them to fully resume their normal activities.

How to choose between laparoscopic surgery and other approaches

There is no single surgical technique that is suitable for all hernias or for all patients. When selecting the approach, the type and size of the hernia are taken into account, as well as whether it affects one or both groins, whether it is a first-time operation or a recurrence, any previous operations, and the patient’s general health.

The type of anaesthesia also plays a role. TEP and TAPP are usually performed under general anaesthesia. Some open repairs can be carried out under local anaesthesia, an option that may be particularly useful for certain patients.

Previous pelvic or prostate surgery, pelvic radiotherapy, or certain large inguinal-scrotal hernias may make the laparoscopic approach technically more complex, in which case another technique may be more suitable.

The HerniaSurge recommendations emphasise tailoring the choice to the characteristics of the individual, the hernia and the expertise available.

Therefore, the decision is not about choosing the most modern technique, but rather the repair method that offers the best conditions for that specific case and for the team carrying it out.

Risks and possible complications

During the first few days after the operation, it is common to experience some discomfort around the small incisions and in the groin area. There may also be some swelling or small bruises.

Another relatively common finding is a seroma. A seroma is an accumulation of fluid in the space previously occupied by the hernia tissues. It may be noticeable as a small lump and cause concern as it may appear as though the hernia has returned.

The body often gradually reabsorbs this fluid. If the lump grows larger, becomes particularly painful, persists or causes concern, it should be assessed by the surgical team. Urinary retention, infection or larger bruises may also occur.

Serious complications are rare, but the proximity of blood vessels, the bladder, the bowel and other structures necessitates a careful surgical technique. In rare cases, injury to any of these structures may occur.

Pain that persists for months and begins to interfere with daily activities is a different condition from the usual pain experienced in the first few days. This problem is known as chronic post-operative inguinal pain.

It can occur following any hernia repair. The nerves in the region, scarring, inflammation and other factors may contribute to its development.

Current evidence suggests a lower risk of persistent pain following TEP and TAPP than following the Lichtenstein open repair, although no technique can completely rule out this possibility.

There is also a small risk that the hernia may recur. Modern mesh repairs have low recurrence rates when performed correctly.

Recovery and a gradual return to normal activities

Recovery begins a few hours after the operation. Provided the patient’s clinical condition allows it, they are encouraged to get up and walk on the day of the operation itself. Gradually regaining mobility is part of the post-operative process itself.

Many laparoscopic procedures can be carried out on an outpatient basis or with a short hospital stay, although this depends on the nature of the operation and the individual patient.

During the first few days, it is common to experience some discomfort when getting up, walking, coughing or making certain movements. This discomfort usually diminishes gradually.

Not everyone recovers at the same pace. Returning to work depends largely on the nature of the job. A sedentary job places very different demands on the body compared to one that involves lifting weights or significant physical exertion.

The same applies to exercise. There is no single number of days that applies to everyone for when they can resume driving, working, lifting weights or playing sport. The pace of recovery must be adapted to how the discomfort evolves, the type of activity and the surgical team’s instructions.

Generally speaking, the evidence compiled in the HerniaSurge guidelines supports a faster recovery following laparoscopic techniques in appropriately selected patients

Post-operative follow-up

After discharge, the small abdominal incisions will gradually heal and any discomfort should gradually subside. For a while, you may experience some tightness, swelling or changes in sensitivity in the area.

Follow-up appointments allow us to check the healing process, assess any seromas or swelling, and address any queries regarding a return to work, physical activity or exercise. Significant worsening of pain rather than improvement, a fever, clear signs of infection in the wounds or other notable symptoms require medical assessment.

If discomfort in the groin persists for months and begins to interfere with your usual activities, this should also be investigated specifically.

The team’s experience and its importance in the outcomes

TEP and TAPP require specific surgical training. The surgeon works from the posterior aspect of the abdominal wall, where the anatomy is viewed differently to that of a conventional open repair and where there are structures that must be identified with precision.

The international HerniaSurge guidelines emphasise that these techniques involve a significant learning curve and that training and experience influence their outcomes. Therefore, the choice of treatment does not depend solely on which procedure can be performed, but also on the experience of the team carrying it out.

The current role of laparoscopic surgery in inguinal hernias

Laparoscopic repair using TEP or TAPP is currently one of the main surgical options for treating inguinal hernias. Its benefits extend beyond the use of small incisions. It allows the inguinal region to be visualised and repaired from the inside, and a wide mesh to be placed behind the weakened area.

When performed by an experienced surgeon, it offers a durable repair and presents particularly significant advantages in terms of recovery and the risk of persistent pain, whilst maintaining results comparable to other established techniques with regard to the likelihood of the hernia recurring.

The approach is particularly useful in certain scenarios, such as hernias present in both groins or a hernia that recurs after an open repair.

TEP and TAPP are two well-established methods of performing this repair. The available evidence does not allow one to be considered universally superior to the other.

Nor does laparoscopic surgery replace all other approaches. An open repair may offer better outcomes in certain circumstances. The decision must take into account the characteristics of the hernia, the individual’s medical history and needs, and the team’s experience.

The ultimate aim is to achieve a safe and durable repair that enables the patient to resume their usual activities, whilst minimising both the likelihood of the hernia recurring and the risk of persistent pain.

Preguntas frecuentes

Is mesh always used in laparoscopic inguinal hernia surgery?

In TEP and TAPP procedures, a mesh is commonly used as it provides extensive reinforcement of the inguinal region and reduces the likelihood of the hernia recurring. The choice of prosthesis and the method of insertion are tailored to the specific characteristics of each case.

What is the difference between TEP and TAPP?

The main difference lies in the route the surgeon takes to reach the area where the mesh will be placed. In TAPP, the surgeon initially enters the abdominal cavity; in TEP, the surgeon gains direct access to the space behind the abdominal wall. Both techniques have the same objective.

Does laparoscopic surgery cause less pain?

During the first few days, it is normal to experience some discomfort following any surgical procedure. Overall, studies show that TEP and TAPP are associated with a lower risk of persistent pain than the Lichtenstein open repair, although no technique can guarantee that this problem will not occur.

When can I go back to work?

It depends on the individual’s recovery and the type of work. Recovery from a sedentary activity may take less time than from work involving intense physical exertion. There is no single number of days that applies to everyone.

When can I start exercising again?

Activity is gradually being resumed. The timing for returning to intensive training or weight-bearing exercises depends on any discomfort, the extent of the recovery and the advice given by the surgical team.

Could the hernia come back?

Yes. No technique can completely eliminate this risk, although modern mesh repairs have low recurrence rates when carried out correctly.

What is the lump that may appear after the operation?

Fluid sometimes accumulates in the space previously occupied by the hernia. This is known as a seroma and may be noticeable as a small lump. It often gradually subsides, although it should be assessed if it increases in size, causes significant pain or persists.

Can both groins be repaired in a single operation?

Yes. When there are inguinal hernias on both sides, the laparoscopic approach generally allows access to both areas using the same small abdominal incisions.

Medical information for general guidance

The purpose of this information sheet is to explain, in an accessible way, what laparoscopic inguinal hernia surgery involves, when it may be used, what outcomes it can offer and what the recovery process is like.

The information has been compiled from clinical guidelines and up-to-date scientific literature and is reviewed in accordance with standards of medical and educational rigour.

The indication for surgery, the choice between TEP, TAPP or another approach, and the specific details of recovery must be determined on a case-by-case basis following a specialist assessment. This content is not a substitute for a medical assessment.