Laparoscopic Hernia Surgery in Lucknow

Overview of Laparoscopic Hernia Surgery

Laparoscopic hernia surgery is a minimally invasive technique in which a hernia is repaired through three small (5–10 mm) port incisions instead of one larger open incision. A laparoscope (small camera) provides a magnified internal view, while specialised long instruments allow the surgeon to dissect tissue planes, reduce the hernia, and place a reinforcing mesh — all from behind the abdominal wall.

The technique was first introduced for inguinal hernia in the early 1990s and has since become a recognised standard of care endorsed by every major contemporary hernia guideline body, including HerniaSurge International (2018), the International Endo Hernia Society (IEHS), the European Hernia Society (EHS) and SAGES. Modern laparoscopic hernia surgery is particularly well-suited to bilateral hernias, recurrent hernias after previous open repair, and patients who need to return rapidly to physically demanding work.

Dr A K Bansal offers the complete range of laparoscopic hernia techniques — TEP and TAPP for groin hernia, and IPOM, IPOM-Plus and eTEP for umbilical and incisional hernia — with technique selected on the basis of hernia anatomy, prior surgery, patient body habitus and individual preference.

How Laparoscopic Hernia Repair Works

The general technical principles common to all laparoscopic hernia repairs are:

1. General anaesthesia is administered. Most laparoscopic hernia repairs cannot be done under local anaesthesia because the abdomen is insufflated with CO2.
2. Three small port incisions are placed (typically 10 mm at the umbilicus and two 5 mm working ports). The exact port placement depends on technique and hernia location.
3. The abdomen or pre-peritoneal space is insufflated with CO2 gas to a low controlled pressure, creating a working chamber.
4. The hernia sac and contents are reduced back into the abdomen.
5. A flat synthetic mesh is positioned to cover the defect with a wide overlap on all sides. The plane depends on technique (pre-peritoneal for TEP/TAPP/eTEP; intra-peritoneal for IPOM).
6. The mesh is fixed with sutures, absorbable tackers or self-gripping technology — fixation is increasingly minimised to reduce chronic pain.
7. The CO2 is released, the port incisions are closed, and most patients are mobilised the same day.

Types of Laparoscopic Hernia Repair

For groin (inguinal and femoral) hernia:

• TEP (Totally Extra-Peritoneal): the entire repair is performed in the pre-peritoneal plane behind the abdominal wall, without entering the peritoneal cavity. Bowel and intra-abdominal organs are never exposed.
• TAPP (Trans-Abdominal Pre-Peritoneal): the peritoneum is entered first to inspect the abdominal cavity and reduce the hernia, then the pre-peritoneal plane is opened to place the mesh, and the peritoneum is closed over the mesh.

For umbilical, epigastric, primary ventral and incisional hernia:

• IPOM (Intraperitoneal Onlay Mesh): a dual-surface mesh is placed inside the peritoneal cavity, against the parietal peritoneum, and fixed with tackers and/or sutures.
• IPOM-Plus: defect closure with sutures prior to mesh placement, restoring anatomy and reducing post-operative bulge and seroma rates compared with bridging IPOM.
• eTEP / eTEP-RS (Extended Totally Extra-Peritoneal repair): a newer minimally invasive technique that recreates the retro-rectus plane endoscopically — combining the biological advantages of the Rives-Stoppa plane with the wound benefits of laparoscopy.

Who Is Suitable for Laparoscopic Hernia Repair?

Laparoscopic repair is particularly advantageous for the following groups:

• Bilateral inguinal hernia — both sides are repaired through the same three port incisions in one anaesthetic, with no extra incisions
• Recurrent hernia after previous open repair — laparoscopy accesses virgin tissue planes from behind, avoiding scarred anatomy
• Patients in physically demanding occupations — faster return to work for inguinal hernia in many studies
• Athletes and active patients — faster return to sport
• Patients with cosmetic concern — three small port scars instead of one longer incision
• Obese patients with ventral hernia — open repair carries higher wound complication risk in obesity; laparoscopy avoids large midline wounds
• Multiple ventral defects — all defects can be visualised and covered with one mesh

When Laparoscopic Repair Is Not Recommended

Laparoscopic hernia repair is not suitable for every patient. Recognised relative or absolute contraindications include:

• Patients unable to tolerate general anaesthesia or CO2 pneumoperitoneum (severe cardiopulmonary disease)
• Strangulated hernia with bowel necrosis requiring resection — open or hybrid repair is safer
• Giant incisional hernia with loss of domain — usually best managed with open Rives-Stoppa or component-separation/TAR
• Extensive prior abdominal surgery with hostile adhesions (a relative contraindication)
• Coagulation disorders
• Active intra-abdominal infection or contamination

Laparoscopic vs Open Hernia Repair

Both approaches are guideline-endorsed. Choice should be individualised. In summary:

• Recurrence rates are similar between laparoscopic and open mesh repair in experienced hands
• Post-operative pain is generally less after laparoscopic repair, particularly for the first 1–2 weeks
• Return to work and physical activity is slightly faster after laparoscopic repair, especially for groin hernia
• Cosmesis favours laparoscopic repair (three small scars vs one larger scar)
• Anaesthetic requirement — laparoscopic repair requires general anaesthesia; open repair can be done under local, spinal or general anaesthesia
• Bilateral and recurrent hernias — laparoscopic repair has a clear technical advantage
• Cost — laparoscopic equipment and mesh costs are typically higher than open

Pre-operative Preparation

Standard work-up includes a detailed history, clinical examination of all hernia sites, routine blood investigations, ECG and chest X-ray as indicated by age and comorbidities, and an anaesthetic review. Imaging — ultrasound for occult groin hernia, CT for complex ventral hernia — is requested when needed.

Patients are advised to:

• Stop smoking at least 4 weeks before elective surgery
• Optimise blood sugar in diabetes
• Treat chronic cough, asthma and constipation
• Reduce weight where feasible
• Disclose all medications, particularly anticoagulants and antiplatelet agents, which may need to be adjusted
• Fast as instructed before surgery

During the Surgery

Most laparoscopic hernia repairs take 45–120 minutes depending on hernia type, complexity and any prior surgery. The procedure is performed under general anaesthesia. Three small port incisions are made, the abdomen is insufflated with CO2, the hernia is reduced, mesh is placed and fixed, and the ports are closed.

Patients are usually transferred to recovery within 30 minutes of the operation finishing, mobilised within a few hours, and offered oral fluids and a light meal the same evening.

Recovery After Laparoscopic Hernia Surgery

• Day 0–1: Same-day or next-morning discharge in most uncomplicated cases. Simple analgesia (paracetamol ± short course NSAID). Light meal on the evening of surgery.
• Days 2–7: Resumption of normal household activity. Many desk-workers return to work within a week.
• Weeks 2–4: Resumption of light cardio, walking, and most non-strenuous work.
• Weeks 4–6: Return to heavy lifting, gym strength training, contact sport.

Transient shoulder-tip pain (referred from CO2 under the diaphragm) is common for the first 1–2 days and settles spontaneously. Port-site bruising is normal. Patients are asked to report increasing port-site redness, fever, severe abdominal pain or wound drainage, which may suggest complication.

Risks & Complications

Recognised risks of laparoscopic hernia repair:

• Port-site bleeding or haematoma — usually self-limiting
• Seroma — particularly after larger ventral hernia repairs; mostly resolves spontaneously over 4–8 weeks
• Urinary retention — more common in older men with BPH
• Shoulder-tip pain — transient, from CO2 irritation of the diaphragm
• Chronic groin pain — under 5% after laparoscopic inguinal repair, typically lower than after open
• Mesh infection — uncommon (under 2%)
• Recurrence — under 5% in experienced hands
• Injury to vessels, bowel or nerves — rare; specific to port insertion or dissection
• Risks of general anaesthesia — needs balanced consideration in elderly or comorbid patients

Why Choose Dr A K Bansal for Laparoscopic Hernia Surgery

Dr A K Bansal completed his M.Ch Surgical Gastroenterology at SGPGI Lucknow with All India Rank 1. He is Ex Senior Consultant in the Department of Gastrosciences at Medanta Hospital and currently heads the Department of GI Surgery at Myra City Hospital. His laparoscopic hernia practice covers TEP, TAPP, IPOM, IPOM-Plus and eTEP.

• Full range of laparoscopic techniques — TEP, TAPP, IPOM, IPOM-Plus, eTEP
• 15+ years of surgical experience and 5000+ surgical procedures
• Personalised technique selection based on hernia type, prior surgery and patient factors
• Day-care and single-overnight surgery pathways where appropriate
• Structured post-operative follow-up with clear written instructions

Frequently Asked Questions