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Hernia Repair Guide: Evolution from Open Surgery to Robotic Precision

By Dr. Atul Wadhwa in General Surgery , Bariatric Surgery / Metabolic , Department of General Surgery and Robotics

Jan 06 , 2026 | 2 min read

The term “hernia” originates from Latin, meaning rupture. It refers to the unusual bulging of an organ or tissue through a weakened area in its surrounding structures. While hernias can develop in different parts of the body, they most frequently affect the abdominal wall, especially the inguinal region.

Abdominal wall hernias most frequently develop in the inguinal, femoral, and umbilical regions, along the linea alba, the lower semilunar line, and previous surgical incision sites. The lifetime risk for inguinal hernia is 27% for men and 3% for women, with about 27% performed in adults younger than 65 years old. Ventral hernias were more common in women overall. It is seen in about 59% of women as compared to 41% of men. The estimated incidence of abdominal wall hernia in persons older than 65 years old is 13/1000.

Hernias pose some additional challenges in older adults. Because they are chronic, they often distort normal anatomy and cause tissue planes to lose strength. In addition, loss of tissue strength may make anatomic repair more difficult.

Repair of an abdominal wall hernia represents the most common surgical procedure in surgical practice. The issue of watchful waiting instead of immediate repair of asymptomatic and mildly symptomatic hernia in older adults remains controversial.

The mainstay of hernia repair is to provide a tension-free repair with reinforcement of the weak area with a mesh. It can be performed using open, laparoscopic, and robotic-assisted techniques.

Open, tension-free mesh repair of inguinal, femoral, and umbilical hernias has been performed in the past. It is a time-tested procedure that is still being performed with selective indications.

Laparoscopic repair provides the advantages of smaller incisions. Less blood loss, less postoperative pain, and a lesser chance of wound infection, hence early recovery. The laparoscopic approach also provides the mechanical advantage of placing a large piece of mesh behind the defect and providing a tension-free repair. It gives the best results for bilateral inguinal hernias, ventral hernias in obese patients, recurrent hernias and incisional hernias. With all its advantages, laparoscopic repair has become the most favoured technique for hernia repair.

With advancements in the field of medicine, the introduction of robotic surgery hasn't left the field of hernia untouched. In addition to the advantages of laparoscopic or minimal access techniques, they provide the benefits of being more precise, reducing blood loss, and improving the visualisation of structures. Another advantage of the robotic approach is the three-dimensional optics and wristed instrumentation. This allows for improved visualisation of the anatomy compared to the two-dimensional view of laparoscopy. In our hospital, we use the platform provided by the Da Vinci robotic system, providing the best possible solution to all hernia problems.

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