Minimal invasive surgery is gaining ground in the treatment of inguinal hernias even though conventional techniques like the Shouldice repair or the Lichtenstein operation are still very popular with many surgeons. I have started doing laparoscopic hernias many years ago and since then have been using this technique (TAPP) almost exclusively.
In laparoscopic hernia repair (TAPP) the defect in the groin is closed without tension from the inside of the abdomen. I use a Vypro mesh that is folded out over the defect and behind the peritoneum, which has to be closed by suture to prevent contact of the mesh with the bowel. From a mechanical point of view this makes perfect sense because the pressure against the defect also comes from within the abdomen and not from the outside. I compare this with the repair of a barrel: nobody would think of patching a barrel from the outside.
The main advantages are less postoperative pain and the almost immediate physical stability and, as we know today, better wound healing and recurrence rates. In general the patients return to work after 8-14 days. I recommend this operation to all my patients who are fit enough for general anesthesia and who have no contraindication for laparoscopy.