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Laparoscopic (keyhole) hernia repair for inguinal, umbilical, incisional, and recurrent hernias. Day surgery. Mesh reinforcement. Home the same day or after one night. Dr. Srinivas Bojanapu at Dhaara Liver Clinic, Yelahanka.
A hernia occurs when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue. The most common types are inguinal (groin), umbilical (navel), incisional (through a previous surgical scar), and hiatal (diaphragm). Hernias do not resolve on their own — they gradually enlarge, and without repair, can become incarcerated (trapped) or strangulated (blood supply cut off), requiring emergency surgery.
Laparoscopic hernia repair is now the gold standard for most hernia types. Using 3 small keyhole incisions (5–10 mm), a camera and instruments are passed through trocars to reduce the hernia and place a mesh over the defect. The mesh becomes integrated into the surrounding tissue, providing a permanent repair that is significantly stronger than the original tissue. The operation takes 30–60 minutes under general anaesthesia.
| Aspect | Laparoscopic (Keyhole) | Open |
|---|---|---|
| Incisions | 3 small ports (5–10 mm) | 4–8 cm groin/abdominal cut |
| Hospital stay | Same-day or 1 night | 1–3 days |
| Return to desk work | 3–5 days | 1–2 weeks |
| Return to physical work | 3–4 weeks | 6–8 weeks |
| Post-op pain | Mild — paracetamol usually sufficient | Moderate — stronger analgesics needed |
| Recurrence risk | Low with mesh (1–3%) | Low with mesh (2–4%) |
| Bilateral inguinal hernia | Both repaired through same ports | Requires two separate incisions |
| Scar | 3 tiny scars | Visible scar in groin or abdomen |
Open repair is reserved for specific situations: large incisional hernias with complex abdominal wall defects, previous multiple repairs with significant scarring, or patient preference. Dr. Srinivas will discuss the optimal approach based on your hernia type and clinical history.
A hernia causing pain, discomfort, or a bulge that interferes with daily activities should be repaired electively. Waiting increases hernia size and makes repair more complex.
Hernias do not stay the same size — they slowly enlarge. A small hernia repaired today is a 30-minute day surgery. A large hernia repaired in 2 years may require complex abdominal wall reconstruction.
Inguinal hernias in physically active patients — manual workers, gym users, sportspeople — should be repaired promptly. Activity increases intra-abdominal pressure and accelerates hernia growth and incarceration risk.
If the hernia cannot be pushed back and becomes tender, firm, or associated with nausea — this is incarceration. Go to hospital immediately. Emergency hernia surgery carries higher risk than elective repair.
Umbilical hernias in cirrhotic patients with ascites require careful management — the hernia will enlarge as ascites increases, and rupture is a serious risk. Repair should be planned during a stable phase with controlled ascites.
Watchful waiting is an option only for minimally symptomatic small inguinal hernias in elderly patients with significant surgical risk. For most patients, elective repair before symptoms worsen is the better choice.
TEP is the preferred laparoscopic approach for inguinal hernia. Three small incisions are made in the lower abdomen. A balloon dissector creates a working space outside the peritoneal cavity (in the preperitoneal space). The hernia sac is reduced and a large mesh (15 × 10 cm) is placed over the groin defect. The mesh is fixed with tacks or fibrin glue. The peritoneum is never entered — this reduces the risk of injury to bowel and internal organs.
TAPP enters the peritoneal cavity first, then creates a preperitoneal flap to place the mesh. Used for recurrent hernias (especially after previous TEP), bilateral hernias, and cases where anatomy makes TEP technically difficult. Provides a wider view of the anatomy.
For incisional hernias (through previous surgical scars), a special composite mesh is placed inside the peritoneal cavity directly over the defect, overlapping the edges by at least 5 cm in all directions. The intraperitoneal surface of the mesh has an anti-adhesion coating to prevent bowel adhesion. This technique avoids dissecting through scar tissue from the previous incision.
For symptomatic hiatal hernias causing GERD that is not controlled by medication, laparoscopic fundoplication (Nissen or Toupet) wraps the upper stomach around the lower oesophagus to recreate the anti-reflux mechanism. The hiatal defect is also repaired with or without mesh reinforcement depending on size.
Most laparoscopic hernia repairs at Dhaara Liver Clinic are planned as day surgery — you arrive, have surgery, recover for a few hours, and go home the same day.
Modern synthetic mesh (polypropylene) used for hernia repair has a long safety record. Mesh infection is rare (<1%) with laparoscopic technique. Mesh rejection (chronic mesh pain or seroma) occurs in a small minority and is managed with physiotherapy and, rarely, mesh removal. The benefit — dramatic reduction in hernia recurrence from 10–15% (suture-only repair) to 1–3% (mesh repair) — far outweighs the small risk of mesh-related complications for most patients.
Yes. Dr. Srinivas Bojanapu at Dhaara Liver Clinic, Yelahanka, performs laparoscopic hernia repair for all hernia types — inguinal, umbilical, incisional, recurrent, and hiatal. He is an DrNB-qualified Surgical Gastroenterologist with extensive laparoscopic surgery experience. Hernia surgery in Yelahanka — no need to travel to Central Bangalore.
Most patients go home the same day. Pain is mild — usually managed with paracetamol and ibuprofen for 3–5 days. Return to desk work: 3–5 days. Driving: from 5–7 days. Return to physical work, gym, or sport: 3–4 weeks. Recovery is significantly faster than open repair (which requires 6–8 weeks for physical work). A small number of patients (large incisional hernias, complex cases) stay one night in hospital.
Symptomatic hernias should be repaired. For an asymptomatic or minimally symptomatic small inguinal hernia in an older patient with high surgical risk, watchful waiting is an option — but the hernia must be reviewed if it becomes painful, grows, or cannot be reduced. All umbilical and incisional hernias that cause symptoms should be repaired, as should inguinal hernias in younger or physically active patients. The risk of watchful waiting is incarceration — emergency surgery, which carries higher risk and longer recovery than elective repair.
Recurrent hernia (hernia returning after a previous repair) is best managed laparoscopically — especially if the original repair was open surgery. A laparoscopic approach enters through a different anatomical plane, avoiding the scar tissue from the prior repair. Dr. Srinivas has specific experience in recurrent inguinal hernia repair (TEP/TAPP after open repair) and recurrent incisional hernia (IPOM or component separation for large defects).
Yes, but timing and preparation are critical. Umbilical hernias in cirrhotic patients with ascites are at risk of enlargement and rupture as ascites increases intra-abdominal pressure. Repair requires ascites to be well-controlled before surgery (diuretics, large-volume paracentesis if needed), careful peri-operative management, and a surgeon with HPB expertise who understands liver disease. Dr. Srinivas manages this exactly — hernia surgery combined with portal hypertension and cirrhosis expertise. Do not delay: a ruptured umbilical hernia in a cirrhotic patient is a surgical emergency with high mortality.
Yes. Diabetes and obesity are common in the patient population at Dhaara Liver Clinic. Laparoscopic hernia repair is routinely and safely performed in diabetic and overweight patients. Optimisation before surgery is important: blood sugar control (HbA1c ideally below 8%), weight management, and pre-operative assessment. Laparoscopic repair is actually preferred over open in obese patients — it has fewer wound complications and faster recovery. Dr. Srinivas will assess your specific risk factors at the pre-operative consultation.
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