An inguinal hernia is the most common type of abdominal wall hernia, accounting for roughly three-quarters of all cases. If you've been diagnosed with one, the next question is usually: which type of surgery is right for me — keyhole, or open?
What is an inguinal hernia?
An inguinal hernia develops when part of the intestine or abdominal fat pushes through a weak point in the lower abdominal wall, near the groin. The underlying weakness may be present from birth or develop gradually over time, and pressure from heavy lifting, chronic coughing, straining, or obesity can make it worse.
While not always dangerous in the short term, inguinal hernias don't resolve on their own — and surgery is usually recommended once they start causing pain or affecting daily life.
Two distinct types
Direct Inguinal Hernia
Develops later in life, as a result of gradual muscle weakening. It pushes directly through the wall of the inguinal canal. More common in older men.
Indirect Inguinal Hernia
More common in younger people, typically arising from a natural opening that didn't fully close after birth. Enters the inguinal canal from the top.
Who is at higher risk?
Signs and symptoms
- A visible bulge in the groin, more noticeable during activity or coughing
- A heavy or dragging sensation in the groin
- A burning or pinching feeling at the site
- Pain when lifting objects or straining
- Pain or swelling in the testicles, if the protrusion extends into the scrotum
- In infants — a visible bulge when crying, coughing, or straining
⚠️ Seek immediate medical attention if you experience:
- Severe abdominal or groin pain
- Nausea and vomiting
- Fever
- A bulge that changes colour — blue, purple, or dark
- Inability to pass gas or have a bowel movement
These symptoms can indicate a strangulated hernia — a trapped hernia whose blood supply has been cut off. This is a medical emergency.
How is it diagnosed?
Most inguinal hernias can be diagnosed through a thorough medical history and physical examination alone. Imaging such as ultrasound or CT scan may be used when needed to assess size and severity more precisely.
Keyhole vs Open Surgery — which is better?
Inguinal hernia repair is one of the most commonly performed surgeries worldwide. Left untreated, complications can develop — including an incarcerated hernia (trapped and unable to be pushed back) or a strangulated hernia (a life-threatening loss of blood supply).
There are two main surgical approaches, plus a newer robotic option growing in popularity:
Minimally Invasive
- Less post-operative pain
- Faster recovery — back to work in about 1 week
- Shorter hospital stay
- Lower bleeding risk
- Smaller scars, better cosmetic result
- Requires general anaesthesia
- Generally higher cost
Traditional Approach
- Can be done under local anaesthesia
- Longer recovery — typically 4–6 weeks before returning to work
- Larger single incision
- Preferred for bilateral hernias (both sides)
- Suitable when general anaesthesia isn't advisable
The right choice depends on your specific situation — including whether both sides are affected, your fitness for general anaesthesia, and personal preference. This is best worked through together with your surgeon.
What happens during the procedure?
Before surgery
You'll receive fasting instructions and be asked about any medical conditions, supplements, or medications. Your surgeon will confirm whether general or local anaesthesia is appropriate for you.
During keyhole surgery
Three small incisions are made near the belly button and lower abdomen. A tiny camera is inserted, the abdomen is gently inflated with air for a clearer view, and small instruments reposition the hernia and reinforce the area, usually with mesh.
During open surgery
A single, larger incision is made in the groin. The hernia is manually repositioned and the area reinforced with mesh or stitches before closing.
Procedure length & discharge
The procedure typically takes 30 to 90 minutes. Most patients go home the same day.
Recovery after surgery
Mild bleeding, pain, or numbness around the surgical site is common. Bloating or shoulder discomfort after keyhole surgery is also normal — a side effect of the air used during the procedure, which resolves on its own.
Full recovery generally takes 4 to 6 weeks, though gentle movement like walking is encouraged early on to support healing. Pain relief medication will be prescribed as needed.
The bottom line: Both keyhole and open surgery are effective, well-established options for inguinal hernia repair. The right choice comes down to your individual circumstances — discussing the pros, cons, and your own priorities with your surgeon is the best way to decide.
Dr Cha Kar Huei
Consultant General Surgeon (Gastrointestinal, Bariatric & Robotic Surgery), Hospital Picaso