Open inguinal hernia repair is often carried out under local anaesthetic or a regional anaesthetic injected into the spine.
This means you'll be awake during the procedure, but the area being operated on will be numbed so you won't experience any pain.
In some cases, a general anaesthetic is used. 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 to 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 strangulated and part of the bowel is damaged, the affected segment may need to be removed and the 2 ends of healthy bowel rejoined.
This is a bigger operation and you may need to stay in hospital for 4 to 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 3 small incisions in your abdomen instead of a single larger incision.
A thin 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 2 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 then 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 and 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.
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)
- have hernias on both sides at the same time (bilateral hernias)
But 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 safely have 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 be useful if your surgeon isn't sure exactly what type of hernia you have.
NHS waiting times
If your GP refers you to a consultant for specialist treatment, such as surgery, you have the right to start treatment within 18 weeks.
You may be able to book your hospital appointment through the NHS e-Referral Service while you're still in the GP surgery.
Read more about NHS waiting times for treatment.