Closed (laparoscopic) inguinal hernia surgery stands out as a minimally invasive method with transabdominal preperitoneal (TAPP) and totally extraparietal (TEP) techniques.
These methods offer important advantages such as less pain, rapid recovery and low recurrence rates compared to open surgery. However, achieving these advantages depends on the surgeon’s experience. Inexperienced surgeons may encounter complications and high recurrence rates. The European Hernia Society recommends laparoscopic surgery as the primary method for experienced surgeons, especially in bilateral and recurrent hernias.
General Surgery Specialist Who is Op. Dr Ahmet Bekin?
Place and Date of Birth
1983 - IstanbulAreas of Expertise
Hernia Surgery, Reflux Surgery, Obesity Surgery, Advanced Laparoscopic Surgery, Robotic SurgeryAreas of Interest
Laser Surgical Treatments, Minimally Invasive Surgery, Single Incision Surgery, Endocrine Surgery, Oncological SurgeryEducation
2000 - 2006 Kocaeli University Faculty of Medicine
2006 - 2011 Istanbul University Faculty of Medicine (Çapa), Department of General Surgery
Laparoscopic inguinal hernia surgery was developed and popularised as a minimally invasive method in the 1990s. This technique is performed using small incisions and special surgical instruments. During the operation, a synthetic mesh is placed to strengthen the hernia area and this mesh supports the natural healing process of the tissues. This procedure, performed with FDA approved devices and materials, causes less trauma than open surgery. As a result, patients usually recover in a shorter time and feel less pain in the postoperative period. In addition, the laparoscopic method leaves smaller scars in terms of aesthetics and accelerates the return to daily life. It stands out as a safe and effective treatment option when applied by experienced surgeons.
When Is Laparoscopic Inguinal Hernia Used?
Laparoscopic inguinal hernia surgery offers an effective and advantageous treatment option for certain patient groups. Especially some situations require this method to be preferred as a priority:
Bilateral inguinal hernias
Recurrent hernias
Femoral hernias
Severe symptomatic hernias
Patients who expect a rapid recovery
Aesthetic concerns and minimally invasive preferences
Patients suitable for general anaesthesia
Laparoscopic surgery not only offers aesthetic and recovery time advantages, but can also reduce the risk of complications. Especially in femoral hernias and recurrent hernias, surgeons consider this method as a more effective treatment approach due to the different anatomical perspective it provides. However, the feasibility of the laparoscopic method should be carefully evaluated in patients with previous major abdominal surgery.
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Who is not suitable for laparoscopic inguinal hernia?
Laparoscopic inguinal hernia surgery is not suitable for some patients. In this case, alternative approaches are preferred for the safety of patients and the success of surgical results. The reasons for inappropriateness are analysed in two groups as absolute and relative contraindications.
Absolute Contraindications
Not suitable for general anaesthesia
Strangulated hernias
Fluid accumulation in the abdomen
Relative Contraindications:
Previous large abdominal operations
Obesity
Large inguinoscrotal hernias
Use of blood thinners
70 years of age or older
History of radical prostaticomy
To determine whether laparoscopic surgery is appropriate, the patient’s general health status, existing diseases and the characteristics of the hernia should be carefully evaluated. A personalised approach should be adopted for each patient and risks should be minimised.
How is Laparoscopic Inguinal Hernia Performed?
Laparoscopic inguinal hernia surgery is performed with TAPP and TEP techniques as a minimally invasive method. The surgical process requires careful preparation and careful application.
Preoperative Preparation:
General anaesthesia is applied.
The patient is placed in supine position.
Trendelenburg position may be preferred.
Port Placement:
Three ports are used for TAPP method.
In the TEP method, the abdomen is not entered, the preperitoneal area is used.
Creating the Working Area:
In the TAPP method, the abdomen is inflated with carbon dioxide gas.
In TEP method, preperitoneal area is prepared with a balloon.
Hernia Sac Procedures:
The hernia sac is carefully located.
The contents are pushed back into the abdomen and repaired.
In indirect hernias, the pouch is tied.
Net Placement:
A net of approximately 10×15 cm is used.
The mesh covers weak areas in the groin area.
Stitching, glue or potholders can be used for fixation.
Closure Procedures:
Peritoneum is closed in TAPP method.
Since the peritoneum is not opened in the TEP method, this step is skipped.
The gas is evacuated and the ports are removed.
This surgical method offers lower complication and recurrence rates, especially when performed by experienced surgeons. The placement technique of the mesh used may vary according to the surgeon’s preferences. In addition, postoperative care and patient education play a critical role in the healing process.
What are the Side Effects of Laparoscopic Inguinal Hernia?
Laparoscopic inguinal hernia surgery is generally considered a safe and effective method. However, some side effects and complications may develop during or after this procedure. These may be related to the preoperative planning, the experience of the surgeon and the general health status of the patient.
Complications that may occur during surgery:
Vascular injuries
Intestinal injuries
Bladder injuries
Early postoperative complications:
Seroma or haematoma
Urinary retention
Wound infection
Late postoperative complications:
Chronic groin pain
Hernia recurrence
Mesh displacement or erosion
Testicular complications
Nerve injuries
The surgeon’s experience and careful surgical technique play a critical role in preventing such complications. Complication rates are lower especially in laparoscopic surgeries, but they are still not completely risk-free. Informing patients about possible risks and complications before surgery is important for process management.
How Successful is Laparoscopic Inguinal Hernia?
Laparoscopic inguinal hernia surgery is considered one of the effective and reliable methods offered by modern medicine. This surgical method, which is performed with techniques such as transabdominal preperitoneal (TAPP) and completely extraperitoneal (TEP), attracts attention with low recurrence rates and high patient satisfaction. Scientific studies show that the success rate of laparoscopic inguinal hernia surgery is generally over 95%:
TAPP and TEP techniques
Low recurrence rates
High patient satisfaction
Fast healing process
Minimal risk of complications
The experience of the surgeon and the quality of the equipment used play an important role in the success of the laparoscopic method. This surgical method gives better results especially in bilateral or recurrent hernias. The reduction of pain in the postoperative period allows patients to return to their daily lives faster. In addition, short hospitalisation periods and aesthetic advantages are among the reasons why the method is preferred.
However, patient selection and correct technique application are among the factors affecting the success of the surgery. The rarity of postoperative complications and the low rate of need for a second operation increase the reliability of laparoscopic methods. It will be possible to use this surgery more widely in the future, supported by training programmes and technical advances.
How to Prepare for Laparoscopic Inguinal Hernia?
There are steps to be taken to prepare for laparoscopic inguinal hernia surgery. Preoperative health of the patient is important for the operation process and afterwards. The following topics are important points in this preparation process:
Health Checks
Blood tests
ECG
Additional tests if necessary
Medicines Used:
Informing your doctor about the medicines you use
Stopping blood thinners on doctor’s advice
Lifestyle Changes:
Not smoking
Avoiding alcohol consumption
Preoperative instructions:
Not eating after midnight
Not drinking anything, including water
Showering with antibacterial soap
Surgery Day
Wearing comfortable clothes
Leaving valuables at home
To get a close support for transport
The preoperative process includes not only physical but also psychological preparation. It is important that the patient shares his/her concerns about the surgery with his/her doctor and seeks answers to the questions he/she is curious about. In addition, having information about postoperative care and points to be considered makes the process more comfortable.
How Should Care Be After Laparoscopic Inguinal Hernia?
Care after laparoscopic inguinal hernia surgery is of great importance to accelerate the healing process and prevent complications. Certain rules should be observed to ensure that the patient can return to his/her daily life faster. The following are the main points of postoperative care.
Pain Management:
Painkillers for mild pain
Opioid medication for severe pain on doctor’s recommendation
Use of laxatives against the risk of constipation
Wound Care:
Removal of bandages within 24-48 hours
Waiting for the steri-strips to fall off spontaneously
No shower for the first 36 hours
Movement and Activity:
Starting slow walks in the early period
Avoid heavy lifting for the first two weeks
Careful performance of daily activities
Nutrition and Bowel Health:
Consumption of fibre foods and plenty of water
Stool softeners to prevent constipation
Monitoring for signs of complications:
Redness, swelling or inflammation at the wound site
Consult a doctor if the seroma does not go away for a long time
The need for a catheter in patients with difficulty urinating
Check-ups and Long Term Follow-up:
First follow-up visit within 7-14 days
Seeking a specialist opinion in case of prolonged pain
After laparoscopic inguinal hernia surgery, the patient can accelerate the healing process with small changes in lifestyle. Smoking may adversely affect wound healing, so it is recommended to quit smoking. In addition, regular exercise without overdoing physical activities contributes positively to the healing process. In this process, it is important to report any suspicious situation to the doctor.
