Inguinal Hernia: Open vs Laparoscopic Hernia Repair & the Role of Mesh

A Doctor-Led Guide from Dr. Sundhar Surgical & Regenerative Center, Perungalathur

An inguinal hernia may begin as a small bulge or swelling in the groin, but the underlying problem is a weakness or opening in the abdominal wall through which tissue can push. For many people, the immediate concern is simple: “Will the hernia go away on its own, or does it need surgery?”

Another common question is about the type of surgery. Should the hernia be repaired through an open approach, or can it be treated through laparoscopic surgery?

In his explanation, Dr. Sundhar focuses on an important part of hernia repair: the hernia needs to be reduced and the weakened opening reinforced. Mesh is commonly used to strengthen the repair. Both open and laparoscopic techniques can be used, but the way the surgeon reaches and reinforces the defect is different.

This article explains those differences in simple terms and discusses what patients should understand before deciding on an inguinal hernia repair.

What Is an Inguinal Hernia?

An inguinal hernia occurs when tissue pushes through a weak area in the abdominal wall in the groin region, producing a bulge or swelling. The swelling may become more noticeable when standing, coughing, lifting or straining. (nhs.uk)

Some people experience:

Not every groin swelling is necessarily an inguinal hernia, so proper clinical assessment is important.

A hernia also does not simply mean that “something has come out.” There is usually a defect or weakened area in the abdominal wall that needs to be addressed when surgical repair is indicated.

Why Does an Inguinal Hernia Need to Be Repaired?

One of the simplest ways to understand hernia surgery is to think about the problem in two stages:

First, the herniated tissue is reduced or returned to its appropriate position.

Second, the opening or weakened area is repaired and reinforced.

This second step is important because simply pushing the bulge back does not correct the underlying weakness.

For many inguinal hernia repairs, a mesh is used to reinforce the abdominal wall. International guidelines support mesh-based repair for most adult inguinal hernias, while the exact technique depends on the patient’s circumstances and the surgeon’s assessment. (PubMed)

What Is Hernia Mesh?

A hernia mesh is a surgical material used to reinforce the weakened area where the hernia has developed.

Think of it as strengthening a weak section rather than simply closing the visible bulge.

During an open repair, the surgeon accesses the hernia through an incision in the groin and places mesh over the repaired area. During laparoscopic repair, the surgeon reaches the hernia through small abdominal incisions and positions the mesh internally over the defect. (Fhft)

The exact mesh material, size, position and fixation method are not the same for every patient.

This is why “Which mesh is best?” cannot be answered independently of the type of hernia and surgical technique.

Open Hernia Surgery vs Laparoscopic Hernia Surgery

There are two commonly used approaches for inguinal hernia repair:

Open hernia repair

The surgeon makes an incision in the groin to directly access the hernia. The hernia is reduced and the weakened area is reinforced, commonly using mesh. (Fhft)

Laparoscopic hernia repair

The surgeon uses a camera and specialized instruments introduced through small abdominal incisions. The hernia is reduced and mesh is positioned internally to reinforce the affected area. (Fhft)

Both are established approaches. Laparoscopic surgery is not automatically appropriate for every patient, and the choice depends on factors such as the hernia, previous operations, overall health and the surgeon’s assessment. (Fhft)

How Is Laparoscopic Hernia Repair Different?

One of the key differences is where the surgeon approaches the hernia from.

In open surgery, the surgeon reaches the hernia directly through an incision in the groin.

In laparoscopic surgery, the surgeon approaches the defect through the abdominal wall using a camera and instruments.

This difference can be understood through the simple analogy discussed by Dr. Sundhar: rather than thinking only about the external bulge, think about how the weakened opening is accessed and reinforced from inside.

Laparoscopic techniques such as TEP and TAPP are established approaches for groin hernia repair. Current international guidelines support laparo-endoscopic repair in appropriate patients, with technique selection depending on the individual case. (PubMed)

Does Laparoscopic Surgery Mean a Lower Risk of Hernia Coming Back?

This is an important area where patients should be careful about simplified claims.

The risk of recurrence depends on several factors, including:

Evidence does not support a simple statement that laparoscopic repair always has a lower recurrence rate than open repair. Different approaches have different indications and outcomes, and the international guidelines emphasize selecting the technique according to the patient’s circumstances. (PubMed)

Therefore, the important question is not simply:

“Is laparoscopic surgery better than open surgery?”

A more useful question is:

“Which repair approach is appropriate for my type of inguinal hernia?”

What Happens During Laparoscopic Inguinal Hernia Repair?

Although the exact procedure varies, laparoscopic repair generally involves:

1. Small incisions

The surgeon creates small openings through which the laparoscope and instruments can be introduced.

2. Visualization of the hernias

A camera provides a view of the internal anatomy and the hernia defect.

3. Reduction of the hernia

The protruding tissue is carefully returned from the hernia site.

4. Reinforcement of the defect

A mesh is positioned to cover and reinforce the weakened area.

5. Completion of the repair

The instruments are removed and the small incisions are closed.

The exact operative steps depend on whether the surgeon performs a TEP or TAPP repair, the anatomy involved and the patient’s individual circumstances.

What Did Dr. Sundhar Mean by Closing the Hernia From the Inside?

The central concept in the video is the difference between approaching the defect from outside versus approaching it from inside.

This is a useful way to help patients understand why laparoscopic surgery is different from open repair.

In laparoscopic repair, the surgeon works in the appropriate anatomical plane and places the mesh internally over the groin defect. This allows the weakened area to be reinforced from the inside rather than simply addressing the external bulge.

However, the exact mechanics of the repair are more complex than simply saying that one method “closes the hole from inside” and the other “closes it from outside.”

The surgeon considers the type, location and size of the hernia before deciding on the most appropriate repair.

What About Biological Mesh for Inguinal Hernia?

Dr. Sundhar’s video also discusses biological mesh and its potential role in hernia repair.

This point needs to be explained carefully for patients.

Mesh materials can differ in their composition and behaviour within the body. Biological meshes are designed differently from conventional synthetic meshes, but they should not be presented as universally better, safer or less likely to cause infection.

Recent evidence has not established biological mesh as routinely superior for elective laparoscopic inguinal hernia repair. In fact, a 2025 randomized clinical trial found higher twoyear recurrence and seroma rates with biological mesh compared with synthetic mesh in the studied population. (PubMed) A 2026 systematic review likewise found no clear overall superiority of biological mesh and reported a higher incidence of seroma, while noting uncertainty around some outcomes. (PubMed)

What does this mean for patients?

It means mesh selection should be individualized.

The surgeon may consider:

The type of mesh should therefore be discussed with the surgeon rather than chosen simply because one material is described as “natural” or “advanced.”

Can an Inguinal Hernia Be Left Untreated?

Not every inguinal hernia requires immediate surgery.

For some people with minimal or no symptoms, watchful waiting may be an option, depending on the patient’s health, symptoms and circumstances. (PubMed)

However, an inguinal hernia may become larger or increasingly uncomfortable over time. In some cases, tissue can become trapped, leading to a painful, non-reducible hernia and potentially requiring emergency surgery. (Fhft)

This is why the decision should be based on a proper medical assessment rather than simply waiting indefinitely.

When Should an Inguinal Hernia Be Evaluated Urgently?

A hernia that suddenly becomes very painful, hard, swollen or difficult to push back requires urgent medical attention.

Other concerning symptoms may include:

These symptoms can indicate complications such as obstruction or strangulation and should not be ignored. (Fhft)

How Is the Right Hernia Surgery Chosen?

There is no single operation that is ideal for every person with an inguinal hernia.

During consultation, the surgeon may consider:

The type of hernia

The location and characteristics of the defect matter.

The size of the hernia

Larger or more complex hernias may require a different approach.

Previous surgery

A previous open or laparoscopic repair can influence the choice of approach.

Overall health

Medical conditions and fitness for anaesthesia and surgery are important.

Whether the hernia is recurrent

Recurrent hernias may require a different approach from the original repair.

Patient preference

Where more than one appropriate option exists, discussing the advantages and limitations of each approach can help with decision-making.

International guidelines emphasize individualized selection of open versus laparo-endoscopic repair rather than treating one approach as universally suitable. (PubMed)

Questions to Ask Your Surgeon Before Hernia Surgery

Before proceeding with an inguinal hernia repair, consider asking:

1. What type of inguinal hernia do I have?

2. Does my hernia require surgery now?

3. Is open or laparoscopic repair appropriate for me?

4. Which laparoscopic technique would be used?

5. Will mesh be required?

6. What type of mesh is being considered and why?

7. What are the possible risks of the procedure?

8. What should I expect during recovery?

9. Does my previous surgical history affect the procedure?

10. What symptoms would require urgent medical attention?

These questions can help you understand the reasoning behind your treatment plan rather than choosing a procedure based only on the word “laparoscopic.”

A Message From Dr. Sundhar

“When treating an inguinal hernia, our objective is not simply to push the bulge back. We need to address the defect and reinforce the weakened area appropriately. Mesh is commonly used for this purpose, and the surgical approach can be open or laparoscopic depending on the patient’s condition.

Laparoscopic repair allows us to approach the hernia through small incisions and place the reinforcement from the internal side. But the right technique and mesh should always be decided according to the individual patient’s hernia and clinical needs.”

This doctor-voice section should be reviewed and approved by Dr. Sundhar before publication so that it accurately represents his intended clinical statement.

Inguinal Hernia Treatment in Perungalathur

If you have noticed a groin bulge, swelling or recurring discomfort, don’t assume that it is simply a problem that needs to be tolerated.

An evaluation can help determine whether you have an inguinal hernia, whether observation is appropriate, or whether surgical repair should be considered.

At Dr. Sundhar Surgical & Regenerative Center, patients from Perungalathur and surrounding areas can consult the surgical team for evaluation and discussion of appropriate hernia treatment options.

Dr. Sundhar Surgical & Regenerative Center

No.12, Vivekanandar Street, N.G.O. Nagar, Phase II, First Street, Alapakkam, Perungalathur, Chennai – 600 063

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