Laparoscopic Hernia Repair (TEP / TAPP)

Medically reviewed by Dr Murlidhar Boob, MS, FAIS, DLS, FMAS — Laparoscopic Surgeon & Surgical Gastroenterologist

What it is

Laparoscopic hernia repair is the closing of a weak point in the abdominal wall from the inside, with a mesh, through three small ports — instead of a cut made directly over the swelling. The two standard techniques are TEP (totally extraperitoneal) and TAPP (transabdominal preperitoneal). They reach the same place by slightly different routes and give much the same result; the choice is usually made by the surgeon on the day, based on your particular hernia and any previous surgery you have had.

The first thing worth understanding is that a hernia is not a growth. It is a gap. The abdominal wall has natural weak spots — the groin most of all, where structures pass through on their way to the testis or the thigh — and when the layers there give way, fat or a loop of intestine slides through and shows up as a bulge under the skin. That is why no tablet, no oil and no exercise cures a hernia. A hole in a wall has to be covered.

The mesh is what covers it. It is a soft sheet laid flat behind the defect, wide enough to overlap all the weak areas of that groin at once, and held there initially by the pressure of the abdomen from within. Over the following weeks your own tissue grows into it and the repair becomes part of you.

Who needs it

• Inguinal hernia — the common groin hernia, and the great majority of what we repair.
• Femoral hernia, lower and more towards the inner thigh, seen more often in women. These get stuck far more readily than inguinal hernias, so we advise repair even when they are small and painless.
• Hernias on both sides, where one operation can fix both.
• Recurrent hernia after a previous open repair — here the keyhole route is often the better choice, because it approaches the defect through tissue that has not been scarred by the earlier surgery.
• Umbilical, paraumbilical and small incisional hernias in selected patients.
• Any hernia that is growing, aching, dragging by the end of the day, or becoming harder to push back.
• A hernia that will not go back in at all, especially with pain, vomiting or a tender lump — that is an emergency, not an appointment.

“It doesn’t really hurt. Can’t I just wear a hernia belt?” A belt holds the bulge in while you are wearing it, and that is the whole of what it does. It does not repair anything, and it does not stop the real danger — a loop of bowel slipping in and getting trapped, which turns a planned hour-long operation into emergency surgery on a sick patient. If you are otherwise fit, a belt is a way of postponing a decision rather than making one. There are exceptions: a small, soft, painless hernia in an elderly man with serious heart or lung disease may reasonably be watched. That is a judgement to make with a surgeon.

How it is done

You are asleep under general anaesthesia.

In TEP, a small cut is made just below the navel and the space in front of the abdominal lining — between muscle and peritoneum — is opened up and gently inflated with carbon dioxide. The abdominal cavity itself is never entered. Two more slim ports go in along the midline. Working in this space, the hernia sac is separated from the cord structures and eased back, the entire weak area of the groin is exposed, and a mesh of roughly 15 by 10 centimetres is spread flat to cover it. The gas is then let out slowly so that the abdominal lining settles back and presses the mesh into place.

In TAPP, the telescope goes into the abdominal cavity itself, the peritoneum over the groin is opened like a flap, the same dissection and mesh placement are done, and the flap is closed over the mesh at the end. TAPP gives a wider view and is often preferred for a hernia that is stuck, a very large one, or when both sides need checking.

For hernias on both sides, both groins are done through the same three ports in one sitting. The ports themselves are 5 to 10 millimetres and close with absorbable stitches under the skin, so there is nothing to remove afterwards.

Anaesthesia, duration and hospital stay

General anaesthesia for the laparoscopic operation. (Open repair, by contrast, can be done under spinal or even local anaesthesia — which is why it remains the right answer for some patients.)

A one-sided repair takes 45 to 90 minutes. Both sides together take 90 to 120 minutes, occasionally longer if the hernia is large, long-standing or has been operated before.

Most people come in on the morning of surgery and go home the same evening or the next morning — so either day care or a single night. You will be sitting up and sipping fluids within a few hours, eating a normal dinner, and walking to the bathroom unaided. Older patients, those with other medical problems and emergency admissions stay longer.

Recovery

Day 1. Soreness in the groin and around the navel port, well controlled with oral painkillers. Some men notice mild swelling or bruising in the scrotum — this looks alarming and is almost always harmless, settling over one to three weeks. Get up and walk the same evening; it genuinely speeds everything up.

The first week. Discomfort on coughing, sneezing and getting out of bed is normal. Support the area with your hand when you cough. Keep the dressings dry for two to three days, then shower as usual. Eat normally, drink well and keep the bowels soft — straining on the toilet is the one thing you should actively avoid. Most people are off painkillers by day four or five.

Weeks 2 to 4. Office work, driving, walking, stairs and everyday household lifting are all fine. A feeling of tightness or a firm ridge where the mesh sits is expected and fades. Swimming once the wounds are fully healed.

By six weeks. Gym, cycling, farm work, factory work, heavy lifting — everything. The mesh is well integrated by then. Three small marks are all that remains, and most patients stop noticing them within the year.

We usually review you at about a week, and again at six weeks.

Why keyhole rather than open surgery

The open operation — a cut over the groin, the mesh stitched in from the front — is a good operation and still the right one in many situations. But for a large number of patients the keyhole approach has real, practical advantages.

The mesh sits behind the defect rather than in front of it, so the pressure inside the abdomen holds it against the wall instead of trying to push it off. Both sides can be repaired in one anaesthetic through the same three ports. There is no cut through the groin itself, which means less pain in the first week, a quicker return to work — typically one week rather than two or three — and a lower rate of the long-term groin discomfort that some patients get after open repair. For a hernia that has come back after previous open surgery, the keyhole route avoids the old scar tissue altogether.

The honest counterpoint: open repair needs no general anaesthesia, which matters for a patient with significant heart or lung disease. It is also often the more sensible choice for a very large hernia that has descended into the scrotum. And, as with any laparoscopic operation, there is a small chance of converting to open surgery if the anatomy turns out to be difficult — that decision is made for your safety, not out of failure.

Risks and complications

• Seroma — a soft collection of fluid in the space where the hernia used to sit. Common, often mistaken by patients for the hernia returning, and it usually absorbs on its own over some weeks.
• Bruising and swelling of the scrotum or the skin over the groin.
• Urinary retention in the first day, more likely in older men with prostate enlargement; a temporary catheter sorts it out.
• Chronic groin pain in a small minority, from nerve irritation around the repair.
• Recurrence of the hernia — uncommon after a good mesh repair, but not impossible.
• Infection, at a port site or rarely involving the mesh itself.
• Injury to the bladder, bowel or blood vessels during dissection or port placement — rare, but real.
• Injury to the vas deferens or the vessels to the testis, which is why the dissection around the cord is done so carefully.
• Conversion to open surgery.
• Anaesthetic risks, which the anaesthetist will discuss with you separately.

Alternatives

Watchful waiting is a legitimate option for a small, soft, painless inguinal hernia in a man who is elderly or has serious medical problems — as long as he knows the warning signs and comes in at once if the lump becomes hard or painful. It is not appropriate for femoral hernias, or for any hernia causing symptoms.

A truss or hernia belt controls the bulge; it does not treat it, and prolonged use can make the tissues around the defect harder to work with later.

Open mesh repair (Lichtenstein) is a well-proven operation, can be done under spinal or local anaesthesia, and remains a good choice for large scrotal hernias or patients unfit for general anaesthesia.

Open repair without mesh is now reserved for unusual situations, such as an infected field, because the recurrence rate is higher.

There is no medical treatment that closes a hernia. What does help is treating the things that keep pushing on it — a chronic cough, constipation, straining to pass urine, smoking and excess weight. Our general surgery and gastroenterology department page describes the wider range of work our surgical team handles, and if you are weighing up another common keyhole operation, our page on laparoscopic gallbladder removal is written the same way.

What it costs

Laparoscopic hernia repair at Shubham Hi-Tech Hospital: ₹51,000 – ₹85,000. This is an all-inclusive figure covering the surgeon’s fee, operation theatre, anaesthesia, mesh, room rent for a typical stay, medicines and routine investigations.

Please note: The figures above are indicative estimates for a typical case. The final cost depends on your individual condition, the complexity of the surgery, the room category you choose, how long you stay, and any complications that arise. Deluxe and super-deluxe rooms are charged higher. Emergency admissions and night or holiday surgery attract additional charges. These charges are subject to change without prior intimation. Please call us on +91-8668954915 for a written estimate for your own case before you decide anything.

Preparing for your surgery

• Bring any ultrasound or CT reports, and the operation notes if you have had a hernia repaired before.
• List every medicine you take. Blood thinners such as aspirin, clopidogrel and warfarin need planning — never stop them on your own.
• Tell us about diabetes, heart disease, asthma, prostate trouble and any previous abdominal or pelvic surgery.
• Routine blood tests, an ECG and a chest X-ray are usually asked for before admission.
• If you smoke, stopping even two weeks beforehand measurably reduces chest complications and helps the repair hold.
• Treat a chronic cough or constipation before the operation rather than after it.
• Nothing to eat for six hours and nothing to drink for two hours before surgery, unless told otherwise.
• Pass urine just before going to theatre; it reduces the chance of retention afterwards.
• Bring snug-fitting underwear or a scrotal support — it makes the first week considerably more comfortable.
• Arrange an attendant for the night and someone to bring you home.
• Keep about a week free from work, and four to six weeks free from heavy lifting.

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A hernia rarely becomes an emergency, but when it does, it does so without warning. If you have a bulge in the groin — new or one you have lived with for years — bring your reports to the surgical team at Shubham Hi-Tech Hospital, Amravati, and we will tell you honestly whether it needs repairing now, later, or simply watching. Call +91-8668954915, get in touch here, or see all the procedures we perform.

Disclaimer: This article is for general information only and is not a substitute for professional medical advice. Please consult a qualified doctor for guidance specific to your situation.