Keyhole repair of inguinal hernia

The Laparoscopic inguinal hernia (Totally Extra Peritoneal; TEP) surgery is a technique to repair your hernia with three small scars placing the mesh in the preperitoneal plane.

This has a number of advantages

  • Improved recovery
  • Less chronic pain
  • The mesh is in a more physiologically appropriate layer of the abdominal wall
  • Indicated in repair of recurrent hernia
  • Indicated in bilateral hernia (both left and right)


You may be told to discontinue your blood thinning agents preoperatively.


You will be under a General Anaesthesia (GA). There will be three small scars in the lower abdomen. Through these the mesh is introduced and placed behind the abdominal wall muscles


Bleeding and infection rates are very low. Occasionally there can be bruising in the inguinal region.

Recurrence rates for the Laparoscopic inguinal hernia is approximately 1-2%, this is similar to the traditional Open inguinal hernia repair.

Conversion to an Open Inguinal hernia (i.e. larger scar) repair occurs in less than 2%.

Post operative chronic pain is less with laparoscopic inguinal hernia repair. This is due to the position of the mesh away from the nerves, and thus less direct irritation of the nerves. Chronic pain can occur following the laparoscopic inguinal hernia repair. This is thought to be due to on going nerve stimulation or preoperative tears in the surrounding ligaments. Tacking devices are no longer used in the laparoscopic repair.


You will be given pain relief to go home with. The water-proof dressings can be removed after 4 days. The Steri-strips beneath these can be left until they start to come away (usually 7 days). The scars will be closed with a dissolving suture.

Driving is to be avoided until you can perform the emergency brake without hesitation (usually 3-4 days).

No heavy lifting 2 weeks. Heavy lifting is anything that requires two hands to lift (usually greater than 5kg)

Return to work will be variable, but at least one week. Please ask for an off work certificate if needed.

You will be seen in clinic in 2 weeks post surgery


Recently there has been some discussion into the validity of mesh. This was due to the use of mesh in repair of the pelvic floor (not inguinal hernias). Mesh placed incorrectly can cause problems.

Mesh is indicated in inguinal hernia repairs and has been used successfully for over 30 years. The NZ General Surgical Association recently released a statement affirming the above.


New Zealand Association General Surgeons position statement Mesh hernia repair

There has been much controversy in the media recently regarding transvaginal mesh prolapse repair and its potential associated risks of infection, erosion and chronic pain.

  1. Unfortunately, the media have portrayed the outcomes of this one gynaecological procedure to include all surgical use of mesh for hernia repair. It has caused unnecessary widespread patient stress and anxiety throughout New Zealand. The use of mesh in General Surgery to repair hernias of the groin or the abdominal wall is well established internationally and is considered the procedure of choice.
  2. For ventral hernias with fascial defects greater than 2cm in diameter mesh must be used to reinforce the tissue repair.
  3. If not the hernia recurrence rate without mesh is unacceptably high. For groin hernia repair most surgeons worldwide use mesh for the repair. The use of mesh for abdominal and groin hernia repair is safe. Chronic pain may occur after hernia repair in less than 10% of patients. However, it is important to remember that chronic pain after groin hernia repair is higher for patients having non-mesh repair compared to mesh repair.
  4. Mesh infection after abdominal hernia repair is uncommon, less than 1 %.
  5. For laparoscopic inguinal hernia repair it is even lower.

The use of surgical mesh is an important part of the curriculum for general surgical training and NZ general surgeons have extensive experience in the use of mesh for hernia repair.

The good results of mesh hernia repair in general surgery should not be bought into disrepute by categorising all mesh repairs as the same.

Steven Kelly, General Surgeon, Christchurch on behalf of the Executive, New Zealand Association of General Surgeons (NZAGS)