Anesthesia General anesthesia (you are fully asleep). Rarely spinal anesthesia is used.

Port Placement Surgeon makes 3–5 small incisions (5–12 mm each):

• One near or in the umbilicus (belly button) for the camera
• Two or three others in the lower abdomen for instruments CO₂ gas is insufflated (pumped in) to create working space (pneumoperitoneum).

Identification & Reduction of the Hernia Camera (laparoscope) gives a magnified high-definition view. The hernia sac is identified from inside the abdomen, gently pulled back (reduced), and often separated from important structures (cord structures in men, round ligament in women).

Mesh Placement (the key strengthening step) Two main laparoscopic techniques for inguinal hernias:

• TAPP (TransAbdominal PrePeritoneal) – Peritoneum (inner lining) is opened like a flap – Mesh is placed in the pre-peritoneal space (behind the muscle defect) – Peritoneum is closed over the mesh
• TEP (Totally ExtraPeritoneal) – Surgeon stays outside the abdominal cavity entirely (no peritoneal incision) – Balloon dissector often used to create the pre-peritoneal space – Preferred by many experts because it avoids entering the abdomen (lower risk of bowel injury)

For ventral/umbilical/incisional hernias: mesh is usually placed intraperitoneally (IPOM technique) with special coated mesh that is safe against bowel.

Mesh Fixation Mesh is secured with:

• Absorbable or permanent tacks/screws
• Fibrin glue or self-gripping mesh (less chronic pain in some studies)
• Sutures (transfascial in larger ventral hernias)

Closure Gas is let out, ports removed, incisions closed with absorbable suture or glue + Steri-Strips. Usually no drains.