Laparoscopic vs open hernia repair

An inguinal (groin) hernia occurs when tissue, often a loop of bowel or fat, pushes through a weakness in the abdominal wall. Surgery repairs the weakness, usually by placing a synthetic mesh to reinforce it.

In open repair, the surgeon makes a cut in the groin, pushes the hernia back and places mesh in front of the weakened area. In laparoscopic repair, a camera and instruments are placed through small cuts in the abdomen, and the mesh is placed behind the abdominal wall, either by working inside the abdominal cavity (TAPP) or outside it (TEP).

Open repair is the long-established operation, does not require general anaesthetic, and is widely practised with reliable results. It suits older patients with heart or lung disease for whom a general anaesthetic carries more risk, and large hernias that descend into the scrotum may be easier to manage openly in some cases.

Its downsides include more wound discomfort in the early period for some people, a greater chance of nerve irritation in the groin, and more difficulty in treating both sides at once.

Keyhole repair tends to cause less early pain and allows a quicker return to activity in many studies, with a lower rate of persistent groin pain. It is useful for hernias on both sides, for recurrences after open repair (because it avoids scarred tissue), and for women, in whom the hernia type is often femoral and benefits from imaging the whole area.

It needs general anaesthetic, carries small risks of bowel or blood vessel injury that are specific to keyhole surgery, and depends on the surgeon's experience. NICE specifically advises it should only be done by surgeons trained in the technique who perform it regularly.

NICE TA83 supports laparoscopic repair as an option alongside open repair, so the decision rests on individual factors. Surgeons weigh the type and size of hernia, whether it is the first or a recurrence, whether both sides are affected, fitness for general anaesthetic, and which technique they perform best. Outcomes depend more on the surgeon's volume than on the approach alone.

For people with few symptoms, watchful waiting is an accepted option in men whose hernia is not causing significant problems, though a hernia that becomes painful, cannot be pushed back or causes vomiting needs urgent attention.

• Single first-time hernia in a fit adult: either approach is reasonable; ask about your surgeon's experience with each.

• Hernias on both sides, or a recurrence after open repair: laparoscopic repair is often preferred.

• Significant heart or lung disease making general anaesthetic risky: open repair under local anaesthetic is often safer.

• Strong wish for earlier return to work or sport: discuss recovery expectations for each approach.

• Hernia suddenly painful, hard or irreducible, or with vomiting: emergency; go to A&E or call 999.

Keyhole surgery is not painless or instantly back-to-normal, and mesh is used in both approaches. Open repair is also not outdated; it remains a sound choice for many people. And no repair is guaranteed against recurrence.

Another misconception is that a hernia will heal on its own or be fixed by a truss. Surgery repairs the defect, and watchful waiting is a decision with a clinician rather than a cure.