Laparoscopic Inguinal Hernia Repair

Peter J. Lydon, MD, FACS

The preferred minimally invasive approach for inguinal hernias in Dr. Lydon’s practice is the “Totally Extra-Peritoneal” (TEP) inguinal hernia repair. Dr. Lydon has been a regional leader and teacher of this repair since 1994. He has been involved in over 2500 repairs. The laparoscopic repair is preferred for the recurrent, bilateral inguinal hernias, and patients who desire a more rapid recovery after surgery.

The TEP procedure is performed by creating an operative space outside of the abdominal cavity but behind the muscles of the groin. This procedure allows a more rapid recovery than the traditional “open” repair because there is minimal muscle dissection when the hernia is repaired from the inside. A “Trans-Abdominal Pre-Peritoneal” (TAPP) approach is very similar to the TEP but initially uses the abdominal cavity to begin the dissection. This approach may be selected for the larger and more complex inguinal hernias or in patients who have had prior abdominal surgery. The recovery after both a TEP and TAPP repair is identical. The Bard 3D mesh is used in most cases which minimizes the need for fixation of the mesh in most cases.

Few or no tacks results along with minimal muscle dissection results in less post operative pain and minimizes the risk of nerve entrapment and chronic groin pain syndromes. Because the operative space created during the procedure requires inflation of the abdomen with carbon dioxide, general anesthesia is necessary. Most patients can get back to regular activities within a week.

Laparoscopic view of right direct inguinal hernia before reduction

Laparoscopic view of right direct inguinal hernia after reduction

Laparoscopic view of Bard 3D mesh placement right groin