Today, the primary indications for laparoscopic hernias repair are recurrent groin hernias (inguinal hernias) and hernias on both sides of the groin (bilateral inguinal hernias).

What is a laparoscopic hernia repair?

Laparoscopic hernia repair is a minimal access surgical technique for repairing groin (inguinal) and femoral hernias using an instrument called a laparoscope. There are 2 main types of laparoscopic hernia repair, namely, Transabdominal Preperitoneal Repair (TAPP) and Transabdominal Extraperitoneal Repair (TEPP). Each type of repair has it's own set of benefits and risks.

What is the TAPP method?

The TAPP method is performed by inserting the laparoscopic instruments into the abdominal cavity while the abdomen is inflated with carbon dioxide gas. An incision is made into the membrane lining the abdominal cavity (peritoneum) of the groin region where the hernia is located. The peritoneum is then lifted off the surrounding muscles, blood vessels, and bony structures. The hernial sac or sacs may either be removed from the anatomic defects or holes through which they protrude or, some surgeons opt to cut the hernia sac and leave a portion of the hernia sac behind.

A large piece of polypropylene mesh (usually measuring 12 cm by 14 cm), is cut in a semicircular fashion and positioned over the hernia sites. This mesh is then stapled with an automatic stapling device called a hernia tacker, which inserts titanium staples to hold the mesh in position. On completion of the procedure, the lining of the abdominal cavity is repositioned over the mesh.

What is the TEPP method?

The TEPP repair uses a different approach. A balloon is usually inserted between the abdominal muscles and the peritoneum, the balloon is inflated to create what is called a preperitoneal space at the site of the hernia. The space may also be created without the use of the balloon. The balloon is removed and this space is further inflated with carbon dioxide. The surgeon then inserts the instruments and completes the dissection or separation of the hernia sac or sacs. The mesh is then inserted and fastened as previously described. This technique has the advantage of staying outside the main abdominal cavity, and the space can also be flooded with local anesthetic on completion of the procedure providing the patient with a pain-free repair for several hours.

What's involved in the traditional treatments for hernias repair?

Inguinal hernias have been repaired by surgeons for over 100 years. The traditional approach involves an incision in the groin, which is called an anterior approach (frontal approach), and there are a variety of open repairs. Today, most surgeons perform tension-free hernioplasty.

Lichtenstein repair involves the attachment of a synthetic polypropylene mesh to the muscles and ligaments around the hernia sites in the groin. Other open repairs that involve suturing the hernia, rather than using mesh, include the McVay repair, the Shouldice repair, and the Bassini repair.

Open inguinal hernia repair is a more invasive procedure with a higher potential for nerve damage than laparoscopic hernia repair, and it is feasible, through very small incisions, to achieve a tension-free laparoscopic hernia repair comparable to the standard open tension-free Lichtenstein repair.

Glossary of terms

Hernia: the protrusion or projection of an organ or a part of an organ through the wall of the space that normally contains the organ. Hernias can result from failure of certain normal openings to close during development; weakness resulting from debilitating illness, old age, or injury; prolonged distention as from tumours, pregnancy, obesity; and increased intra-abdominal pressure resulting from lifting heavy loads or coughing.

Femoral hernia: when part of the intestines drop through the femoral canal.

Hernial sac: located in the peritoneum, a sac-like protrusion containing a herniated organ.

Inguinal region: the groin.

Peritoneum: serous membrane lining the abdominal cavity.

O.N.M. Panton, MB, General Surgeon 
in association with the MediResource Clinical Team