Single incision laparoscopic hernia repair is often possible even in complex cases—but prior open abdominal surgery can make the operation technically challenging.
Hello, I’m Dr. Hwang, director of the Single-Incision Laparoscopic Surgery Center at St Mary’s K Surgery clinic.
Recently, since opening the clinic, I successfully completed 100 single-incision laparoscopic cases. Among them were 52 gallbladder surgeries, 35 hernia repairs, and the remainder were appendectomies. I will continue doing my best to provide safe, high-quality surgical care for every patient.
In this post, I share a real case of single incision laparoscopic hernia repair using the TEP approach—even though the patient had a significant history of open abdominal surgery.
Case Summary
A male patient in his late 30s visited our clinic for surgery after developing a right inguinal hernia about two months prior.
Importantly, he had undergone an emergency open abdominal surgery (laparotomy) about three years ago for sigmoid colon volvulus (twisting of the bowel). At that time, he was told the situation was severe enough that a temporary stoma (colostomy) might have been required. As you can imagine, it was a major emergency.
As a result, he had a large lower abdominal scar from the prior open surgery.
Why This Case Was Challenging
For many inguinal hernias, we can use a laparoscopic technique called TEP (Totally Extraperitoneal) repair, which is performed in the preperitoneal space (outside the abdominal cavity).
However, when a patient has had a major lower abdominal open surgery, the key surgical planes are often disrupted by:
- Dense adhesions
- Scarred fascial layers
- Distorted anatomy, especially in the lower abdominal wall
In a TEP repair, we must safely create and maintain a working space between the rectus muscle and the transversalis fascia. Prior surgery can make that space very difficult to develop.
Even so, the patient strongly wished to avoid another large incision—after having suffered through a major laparotomy before—so we carefully decided to attempt a single-incision laparoscopic TEP approach.
Surgery Details
- Date: November 24, 2025
- Procedure: Single-incision laparoscopic TEP (Totally Extraperitoneal) right inguinal hernioplasty
- Hospital stay: 2 nights / 3 days
Key Intraoperative Findings & Progress (Simplified)
As expected, there were significant adhesions, and maintaining a clear view was not easy. In such cases, gas can sometimes enter the abdominal cavity, which may further reduce visibility—creating a difficult cycle.
Still, step by step, we carefully secured the preperitoneal working space and identified the correct tissue planes. Fortunately, we were able to find the boundary where the peritoneum “drops away” and proceed safely.
Hernia type: Indirect inguinal hernia
Once the space was created, the rest of the operation progressed smoothly:
Dissection of the hernia sac from the spermatic cord structures
Protecting the vas deferens and testicular vessels is essential.
High ligation of the sac (loop ligation)
Resection of the sac
Parietalization (pulling the peritoneum down to reduce recurrence risk)
Placement of a large mesh (10 cm × 16 cm)
One major advantage of TEP repair is that we can place a wide mesh in an ideal plane, which is often difficult with incision-based hernia techniques. Because the mesh is placed in a deeper layer (behind the abdominal wall), it can also be advantageous from an infection-risk standpoint in properly selected patients.
Another key strength of the TEP approach is that it allows the surgeon to evaluate and address multiple potential groin hernia sites and reduce recurrence risk through broad coverage.
Incision & Recovery
Because the surgery was done through a single incision hidden within the umbilical fold, there was no obvious visible scar afterward.
Interestingly, the “before and after” umbilical appearance looked almost the same.
This was a difficult case and took nearly twice the usual operative time, but we were able to complete the procedure safely using the single-incision laparoscopic technique.
The patient was discharged on postoperative day 2.
This case shows that single incision laparoscopic hernia repair using the TEP approach can still be feasible even after prior lower abdominal open surgery, when performed with careful dissection
One Technique Doesn’t Fit Everyone
The advantage of single incision laparoscopic hernia repair is minimal visible scarring with a fast recovery in selected patients. While I perform most hernia repairs using single-incision laparoscopy, the best approach depends on:
- the patient’s overall condition
- hernia type and severity
- anesthesia suitability
- bowel involvement (obstruction/strangulation)
- whether mesh can be used safely
Depending on the situation, we may choose different techniques, such as:
- Open Lichtenstein repair under local anesthesia (for patients who cannot undergo general anesthesia)
- TAPP (Transabdominal Preperitoneal) approach (in cases involving bowel obstruction or suspected strangulation/necrosis)
- Desarda repair (a non-mesh option in selected cases where mesh is not suitable)
If you are considering single incision laparoscopic hernia repair, we can recommend the most appropriate method after reviewing your hernia type, anesthesia suitability, and surgical history.
Typical Hernia Surgery Cost (Guide)
At our clinic, we treat common benign surgical conditions—inguinal hernia, gallbladder disease, and appendicitis—using single-incision laparoscopic techniques whenever appropriate.
In general, these approaches can offer:
- minimal or hidden scarring
- less postoperative pain
- faster recovery
- low recurrence rates in properly selected cases
Estimated out-of-pocket cost (typical example)
The standard hospital stay for inguinal hernia surgery is 2 nights and 3 days. For a semi-private room (2-bed), the estimated self-pay cost typically ranges from $4,000 to $5,000 for patients without health insurance.
✅ Important: This is a general guide only. The final cost can vary depending on:
- insurance coverage and benefit category
- additional tests or imaging
- anesthesia and medications
- mesh type and surgical complexity
- unexpected findings or complications
If you’d like an estimate tailored to your case, please contact the clinic, and we can guide you based on your condition and insurance situation.
Final Takeaway
Even in patients with a history of major open abdominal surgery, a single-incision laparoscopic TEP repair may still be possible in selected cases—when performed carefully and with appropriate surgical planning. If you are considering single incision laparoscopic hernia repair, we can recommend the most appropriate method after reviewing your hernia type, anesthesia suitability, and surgical history.
If you have been diagnosed with an inguinal hernia and want to discuss the most suitable method for you, we’ll be happy to help.
To schedule a consultation:
Please contact St Mary’s K Surgery clinic to discuss your diagnosis, options, and an individualized cost estimate.
If you’d like to see a single-incision laparoscopic gallstone surgery case, please take a look here. link
FAQ (Copy & Paste)
Q1. Can you do single-incision laparoscopic hernia repair after open abdominal surgery?
Yes, it may be possible, but it depends on the location of the previous incision, the expected adhesions, and the patient’s anatomy. Lower abdominal scars often make preperitoneal dissection more difficult, so careful surgical planning is essential.
Q2. What is TEP, and why is it used for inguinal hernia repair?
TEP (Totally Extraperitoneal) repair places mesh in the preperitoneal space without entering the abdominal cavity. It can provide wide mesh coverage and allows evaluation of potential groin hernia sites in a single operation.
Q3. How long is the hospital stay and recovery?
In many routine cases, patients can go home within 1–2 days. For complex cases or patients with prior surgery, the stay can be slightly longer depending on pain control and recovery.
Q4. Is mesh always required?
Mesh is commonly used to reduce recurrence risk. However, in selected situations where mesh is not suitable, non-mesh techniques may be considered. The best approach should be decided after individual evaluation.
Q5. How much does hernia surgery typically cost?
Costs vary depending on insurance coverage, room type, mesh selection, and surgical complexity. In our clinic, a typical example for a 2-night/3-day stay in a twin room may be around KRW 1.3 million out-of-pocket, but individual variation is expected.
For reference: What is TEP/TAPP?
