Laparoscopic Inguinal Hernia Repair (SEAL approach)

Left indirect Inguinal hernia anatomy


Inguinal hernias are common in pediatrics. The traditional repair is done through an inguinal incision and is very successful, although still carries a 1% risk of injury to the vas deferens. Most surgeons make a 2 cm or larger incision, but I have seen surgeons using a 1 cm incision. Fast surgeons can do an inguinal hernia repair in minutes.

Incarcerated hernias (bowel or bladder trapped inside a hernia) or very large hernias can be challenging to repair through the groin, as tissues tend to be inflamed and the anatomy distorted. These usually require larger incisions and more tedious dissection.

I prefer the laparoscopic approach (SEAL) for several reasons:

  • Allows visualization of the contralateral ring and easy contralateral repair if needed.
  • Allows visualization of the tissues inside a hernia: bowel, vs omentum vs bladder with an easy reduction of the hernia contents.
  • Leaves almost invisible scars
  • Requires minimal dissection around the vas and vessels (I figure the less dissection around these structures the less likelihood of damaging them)
  • Minimal risk of bladder or bowel injury.
  • A fast procedure, even in cases of incarceration of large hernias.

SEAL stands for subcutaneous endoscopic assisted ligation of the internal ring.

The technique is simple and is demonstrated in this video: