Repair of simple and complex abdominal hernias by the laparoscopic technique is now the method of choice in many centers. Laparoscopic repair offers equivalent outcomes to open repair, with the additional benefits of greater patient satisfaction and reduced hospitalization. For some hernias, like incisional, the outcome appears to be superior using the minimally invasive technique. Laparoscopic hernia repair is similar to other laparoscopic procedures. This type of operation is done using a tiny telescope called a laparoscope. It is linked to a special camera. The device allows the doctor to see the hernia on a video screen. It requires smaller incisions (usually 1/5 to 1/2 of an inch). The laparoscopic approach to both inguinal and ventral hernias has resulted in a reduced hospital stay and faster recovery time.

• Laparoscopic Inguinal Hernia Repair
  Inguinal hernias are repaired with a 1cm incision for the camera and two 5mm ports. The preperitoneal repair, developed 40 years ago by Dr. Stoppa as an open operation and recently translated into a laparoscopic approach, is used to recreate the pelvic floor. The peritoneum is mobilized to the level of the umbilicus to create a large space behind the rectus abdominal muscle. A 6-by-6-inch piece of mesh is introduced into the concavity of the pelvis, which covers the origin of the defect from the inside, rather than the more traditional one that lay on top of the hernia. Currently, the two most popular laparoscopic techniques are :
• TAPP (Trans abdominal preperitoneal)
• TEP (total extra peritoneal)
  The most ardent critique of the TAPP procedure is that it is an intra-abdominal procedure with significant potential morbidity. On the other hand, the TEP procedure avoids intra-abdominal access. A major advantage of laparoscopic inguinal hernia repair is that bilateral hernias, which are not uncommon, can be repaired during the same operation. The laparoscopic procedure also allows the physician to see and repair small hernias not detected by a physical examination. Patients who cannot have laparoscopic inguinal hernia repair are those who have had bladder surgery, open prostate surgery, radiation for prostate cancer, or other prior invasion of the preperitoneal space.
• Laparoscopic Ventral Hernia Repair
  Incisional, Ventral, Epigastric, or Umbilical hernias are defects of the anterior abdominal wall. They may be congenital (umbilical hernia) or acquired (incisional). Incisional hernias form after surgery through the incision site or previous drain sites, or laparoscopic trocar insertion sites. About 95% of ventral hernias can be repaired laparoscopically. It is recommended that patients with hernias resulting from prior incisions, patients with umbilical hernias that have increased over time, patients who are substantially overweight, or patients with hernias larger than 4cm, have the hernia repaired laparoscopically with mesh. The only patients who cannot have a laparoscopic ventral repair are those who have experienced a loss of domain or those with severe adhesions that cannot be safely reduced laparoscopically.
  The mesh has a smooth surface that faces the small bowel and prevents it from adhering to the mesh, while a rougher surface on the side facing the abdominal wall allows for rapid tissue ingrowth. Because the mesh is placed inside the abdomen, behind the defect, any strain tends to push it more tightly against the abdominal wall and distributes the pressure throughout the mesh. In comparison, traditional mesh repair uses an incision extending beyond the length of the hernia on either side to gain access to the hernia. Mesh is placed on the outside of the defect, and any strain would tend to push the mesh away, thus increasing the likelihood of a recurrence.