<P> Techniques to repair inguinal hernias fall into two broad categories termed "open" and "laparoscopic". Surgeons tailor their approach to by taking into account factors such as their own experience with either techniques, the features of the hernia itself, and the person's anesthetic needs . </P> <P> The cost associated with either approach varies widely across regions . As an example the UK's NHS spends £ 56 million a year in repairing inguinal hernias 96% of which were repaired via the open mesh approach while only 4% were done laparoscopically . Updated guidelines published by the International Endohernia Society cast doubt on the comprehensiveness of cost comparison studies due in part to the complexity inherent in calculating costs across institutions . The IES asserts that hospital and societal costs are in fact lower for laparoscopic repairs as compared to open approaches . They recommend the routine use of reusable instruments as well as improving the proficiency of surgeons to help further decrease costs as well as time spent in the OR . </P> <P> All techniques involve an approximate 10 - cm incision in the groin . Once exposed, the hernia sac is returned to the abdominal cavity or excised and the abdominal wall is very often reinforced with mesh . There are many techniques that do not utilize mesh and have their own situations where they are preferable . </P> <P> Open repairs are classified via whether prosthetic mesh is utilized or whether the patient's own tissue is used to repair the weakness . Prosthetic repairs enable surgeons to repair a hernia without causing undue tension in the surrounding tissues while reinforcing the abdominal wall . Repairs with undue tension have been shown to increase the likelihood that the hernia will recur . Repairs not using prosthetic mesh are preferable options in patients with an above - average risk of infection such as cases where the bowel has become strangulated (blood supply lost due to constriction). </P>

Where is mesh placed in inguinal hernia repair