Surgeons have been performing laparoscopic repairs for the past decade. More and more surgeons are learning and perfecting this minimally invasive technique.

To perform a laparoscopic inguinal hernia repair, the surgeon makes 3 – 4 small incisions on the abdominal wall and inserts small tubes, through which an endoscope and dissecting instruments can be passed. The entire procedure is watched by the operating team on a video screen. The space under the inguinal canal is dissected and any organs that have entered the hernia sac are brought back into the abdominal cavity. A piece of mesh is then placed over the weakened area and held in place with any of a variety of attachment devices.

This surgery is called posterior hernia repair because the hernia is being repaired from behind the abdominal wall. It differs from traditional mesh repairs, in which the mesh is placed on the outside of the abdominal wall.

In certain cases, a surgeon may elect to use tissue grafts rather than synthetic mesh. Tissue that is derived from a human is called a tissue allograft. Tissue derived from an animal is called a xenograft.

Advantages of laparoscopic tension-free repair:

• Pressure from within the abdominal cavity helps to hold the mesh in place
• May result in less pain and shorter recovery time
• Allows for visualization of undiagnosed hernias
• May have advantages in repair of bilateral and recurrent hernias

Disadvantages of laparoscopic tension-free repair:

• Must be performed under general anesthesia
• Can require an overnight stay in the hospital
• Procedure can take 60 minutes
• There is a slight risk of injury to the urinary bladder, the intestines, blood vessels, nerves, or the sperm tube going to the testicle

Laparoscopic surgery may not be appropriate for patients who:

• Are pregnant
• Cannot tolerate general anesthesia
• Have a severe lung disease
• Have had multiple previous abdominal surgeries
• Have a bleeding disorder or are taking medications to prevent blood clots
• Are obese

During a laparoscopic procedure, the surgeon needs to clearly visualize the underlying anatomy in order to put a piece of mesh in the proper place. Some mesh products are designed to make this easier. For example, the new PROCEED* Surgical Mesh has highly visible blue stripes to aid the surgeon with orientation and placement of the mesh.