
Technically it is possible to repair virtually any hernia by a laparoscopic approach, whether this is always necessary and can be justified or beneficial is not always true. There is certainly no advantage in repairing small umbilical hernias laparoscopically, and some large inguinal and ventral hernias are technically impossible to repair by a laparoscopic approach.
On the other hand there are several situations such as recurrent hernias or where there is more than one hernia where a laparoscopic approach is considered the best or gold standard in hernia repair.
The biggest advantage for a laparoscopic approach over traditional open surgery is in postoperative pain and recovery. When considering the long term results of hernia repair of any hernia type patients should consider two things, what is the chance that the hernia will come back (recurrence rate) and, what is the chance of being left with chronic pain. Certainly for incisional hernia's, recurrence rates and chronic pain in most studies are lower in laparoscopic repairs than open approaches. A laparoscopic approach will often pick up incisional hernias that an open approach will often miss and hence reduce recurrence rates.
The biggest debate is that of first up unilateral inguinal hernia. There are many studies which show exceptional results from a laparoscopic approach with low recurrence rates fast recovery and low rates of chronic pain. When laparoscopic inguinal hernia repair is compared with open surgery there is certainly a significant advantage in terms of post- operative pain and more importantly in the rate of chronic pain. In terms of recurrence there have been several studies which did show higher recurrence rates in patients having a laparoscopic repair versus an open repair.
However when the same studies looked at the results of experienced laparoscopic surgeon's the recurrence rates were the same as the open approach. The moral of the story is that if you are going to have a laparoscopic repair, you should insure that it is being performed by someone who is well trained and experienced in laparoscopic hernia repair.
In terms of patients who have inguinal hernia's on both sides there is little debate that a laparoscopic approach is far better give that both sides can be done through the same incision's. The other major indication for a laparoscopic approach is those patients who have already had an open repair which has recurred. By using the laparoscopic approach the surgeon can avoid the scar tissue from the previous surgery and better visualize the hernia. The benefits for both recurrent and bilateral hernias have been well proven in major clinical trials.