Inguinal hernia surgery: What are the different approaches?

Written by: Ms Daniela Zanotti
Edited by: Carlota Pano

An inguinal hernia occurs when internal tissue protrudes into the groin area. Commonly affecting men, inguinal hernias can be painful, especially when bending over or lifting heavy objects.


Here to provide an expert insight into inguinal hernia surgery, including advantages, risks, and recurrence is Ms Daniela Zanotti, leading Upper GI and General surgeon.



What are the different types of inguinal hernia surgery?


An inguinal hernia repair always involves the insertion of a mesh, which can be done either by open (a cut into the groin) or by laparoscopic (keyhole) surgery.


Laparoscopic surgery can be performed in two different ways:

  • With a transabdominal pre-peritoneal (TAPP) technique, which involves going inside the abdomen.
  • With a totally extra-peritoneal (TEP) technique, which avoids going fully inside the abdomen.


What are the advantages of laparoscopic inguinal hernia surgery?


Laparoscopic surgery offers several advantages, including faster recovery times and the possibility of repairing concurrent bilateral (or associated femoral) hernias at the same time. If a TAPP technique is used, the procedure can also be used as a diagnostic tool.


Laparoscopic surgery, however, poses increased risks to patients (such as, injury to the bowel and urinary retention). Recurrence rates are also higher in moderate to large-size hernias.


How can patients prepare for inguinal hernia surgery?


Before surgery, patients should avoid exercises that involve heavy lifting or any activity that causes pain. Patients should also stop smoking to reduce the chances of developing complications.


Patients with diabetes should, in addition, keep blood sugar levels under control around the time of the procedure.


What happens if an inguinal hernia is left untreated?


If an inguinal hernia is left untreated, it can grow bigger and become more symptomatic with time.


Occasionally, the bowel can become trapped, causing obstruction or strangulation (when the blood supply to the bowel is affected). Symptoms that may indicate obstruction or strangulation include: severe pain, vomiting, and the inability to push the hernia back inside. Patients must immediately seek medical attention if any of these symptoms are experienced, for an urgent operation might be required.


Do inguinal hernias often recur after surgery?


If a mesh is used, the risk of an inguinal hernia recurring is less than two per cent. However, the risk depends on: the size of the hernia; the type of surgical approach; the strength of the abdominal muscles; and if the patient is overweight or has underlying medical conditions.


Hernia recurrence can happen years after a hernia repair. Another operation might then be required.



Ms Daniela Zanotti is a leading Upper GI and General surgeon with more than 10 years’ experience. If you require inguinal hernia surgery, and wish to discuss your options with an expert, do not hesitate to visit her Top Doctors profile today.

By Ms Daniela Zanotti

Ms Daniela Zanotti is a leading Upper GI and General surgeon based in Lincoln and Nottingham. Ms Zanotti’s areas of expertise include acid reflux, gallbladder surgery, hiatal hernia surgery, abdominal wall hernia repair (incl. incisional hernias), laparoscopic hernia surgery and achalasia.
Ms Zanotti first qualified with a medical degree from the University of Brescia in Northern Italy, before going on to train in various hospitals in the UK. She has completed 3 specialist upper-GI fellowships in prestigious hospitals such as University College London Hospital, Guy’s and St Thomas Hospital in London, and the Oxford University Hospital NHS Trust. She is also a fellow of the European Board of Surgery.

Ms Zanotti joined the United Lincolnshire Hospitals NHS Trust in 2020 where she developed and implemented the Upper-GI service for the Lincolnshire population, in close collaboration with the University Nottingham Hospitals Trust.  Ms Zanotti is the upper-GI (oesophago-gastric) cancer MDT lead for the United Lincolnshire Hospitals NHS Trust.
Ms Zanotti currently holds private clinics at the BMI Lincoln Hospital and the Park Hospital in Nottingham. She also provide endoscopy service at the Spire Hospital in Nottingham. She has extensive experience as a consultant Upper GI surgeon thanks to years worked within the NHS.
Ms Zanotti is also highly esteemed in the field of medical education. She functions as both a Clinical and Educational Supervisor for the Foundation Doctors and more senior Trainees. As a Consultant, she supervises surgical trainees in the fields of Upper GI and General Surgery on a daily basis. While completing her fellowship at the Oxford University Hospital NHS Trust, she tutored both 4th and 6th years medical students. She was also an assessor for final-year medical students. In addition to her clinical work and teaching, Ms Zanotti has also published numerous medical articles in peer-reviewed journals.

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