How is inguinal hernia repair carried out?

An inguinal hernia repair can be carried out as either open surgery or laparoscopic (or keyhole) 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'll usually be able to go home onthe same day. Some people stay in hospital overnight if they have other medical problems or if theylive alone.

This means you'll 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 6-8cm long. The surgeon then places 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 usually dissolve on their own over the course of a few days after 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.

Laparoscopic (keyhole) surgery

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

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

Athin 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 both keyhole and open surgery for hernias are safe and work well. Read the NICE guidelines on usingkeyhole surgery to treat inguinal hernia .

With keyhole surgery, there's usually less pain after the operation because the cuts are smaller. There's 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)
• havehernias on both sides at the same time (bilateral hernias)

However, the risks of serious complications, such as the surgeon accidentally damaging the bowel, are higher with keyhole surgery than with 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 largely depends on:

• your general health elderly people or people in bad health may be too weak or frail to safelyhave 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, and not all surgeons have enough experience in keyhole techniques

Recent guidance from the British Hernia Society advises to repair most primary, single-sided hernias (those appearing for the first time on just one side) using the open technique. Keyhole techniques are usually only recommended for recurrent or bilateral hernias.

Keyhole surgery can also beuseful if your surgeon isn't sure exactly what type of hernia you have.