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TransInguinal Preperitoneal (TIPP) Technique

Surgical Repair of Inguinal, Femoral, Umbilical and many Simple and Complex Incisional Hernias can be SAFELY and EFFECTIVELY performed as a Same Day, out-patient ambulatory procedure. This includes most "RECURRENT" hernias as well.

For the most common Inguinal Hernia, we utilize a "Tension Free" repair (Trans-Inguinal, Pre-Peritoneal (TIPP) method), increasingly recognized as overall, the most superior method for hernia surgery. We are convinced that this technique is truly the "State of the Art" in hernia surgery, providing the safest, most effective repair with the least post-operative pain. This method is the only safe, open surgical hernia repair method that completely addresses and reinforces the hernia-prone region called the Myopectineal Orifice of the groin. Complete, Tension-Free mesh reinforcement of the Myopectineal Orifice provided by this method is now fully recognized, by Hernia Specialists world-wide, as the critically most important feature of an effective, primary inguinal hernia repair for preventing recurrences later on.

We utilize a Mini-Incision "Open" or TransInguinal Preperitoneal (TIPP) Technique, using ,mild sedation and local anesthesia (i.e., Novocaine-like medication) for the overwhelming majority of all hernia repairs. Surgery is performed through a small incision (about 2 inches in most average patients). With the patient awake, yet calm and sedated, comfortably free of pain, the risks of General Anesthesia are avoided. Our patients are walking shortly after surgery, and are discharged home within about 1-2 hours.

Once the hernia (bulge) is freed up by gentle dissection, it is returned through the hole or weakness into its proper position. Rather than just covering the weakness at this point, a specially designed, sterile "Mesh" system is gently placed through the defect. It opens to cover and effectively repair the defect from the inside, the best place for mesh to be positioned. This technique is now commonly referred to as the Trans-Inguinal, Pre-Peritoneal (TIPP) method. This soft, flexible and pliable mesh, safely placed behind the muscle-fascia layer, extends well beyond the under edges of the defect to reduce pressure on the hernia defect opening, and at the same time reinforces the entire surrounding hernia-vulnerable area (called the Myopectineal Orifice). The mesh is held in place without tension. No painfully tight sutures are placed to pull muscle unnaturally together, nor are staples or tacks utilized in this method. By utilizing mesh to reinforce the defect, suture line tension that is previously seen in standard tissue-to-tissue repairs is eliminated, while fully preserving both the normal anatomic structure and physiologic functions of the inguinal area. The mesh not only reinforces and repairs the hernia defect, but acts as a "growth plate" (or re-bar), enhancing and supporting the in-growth of the patient's own host tissue to both further reinforce and strengthen the area, and to "fix" the mesh in place; it will neither move nor migrate. Importantly, this TIPP repair for inguinal hernias is associated with significantly lower risk of developing chronic post-operative groin pain (called Post-Herniorrhaphy Pain Syndrome) seen with many other inguinal hernia repair methods. In ndomized clinical studies, the TIPP Tension Free approach has been shown to be comparable or better than other popular mesh repair in terms of reduced risk of hernia recurrence, fewer postoperative complications, shorter duration of operation, more rapid recovery, minimal post-operative restrictions, and lower intensity of postoperative pain. 1

After this "underlay" mesh is properly positioned, an additional sheet of mesh is included over the defect as an insurance reinforcement to the entire area. This is placed in a completely tension free fashion, being held in place by a "VELCRO-Like" effect of the mesh itself. Since there is no tension and only a minimal amount of surgical dissection, there is little post operative pain, and patients return to NORMAL ACTIVITY in DAYS. This technique has been essentially utilized for over 10 years, with recurrence rates of Less than 1/2 %, lower than any other technique including the conventional suture repairs, (TENSION REPAIR), or the Laparoscopic "Keyhole"Approach. WE FIRMLY BELIEVE THE TENSION FREE APPROACH IS THE MOST EFFECTIVE METHOD AVAILABLE.

The ETHICON Prolene Hernia System® (PHS)
OUR TENSION FREE METHOD ETHICON Prolene Hernia System is our preferred mesh
ETHICON Prolene Hernia System is our preferred mesh

Several Mesh Systems" are available. We feel that no two patients are alike and therefore no two hernias are alike either. All hernias differ from patient to patient, often quite significantly. We therefore feel that no one single TENSION FREE operative approach nor single mesh product system is suitable for all patients or all hernias. However, The ETHICON Prolene Hernia System (PHS) is our preferred choice for the repair of both primary and recurrent adult Inguinal Hernias.

The ability to tailor the mesh or mesh product to the exact dimensions and needs of the patient is critically important in an effective and safe hernia repair in our view. Many mesh products are not amenable to such tailoring however. We chose only those mesh products that permit us to provide exact, yet completely effective mesh coverage for hernia repair. The ETHICON Prolene Hernia System® allows us to do just that. We therefore utilize this superior product in the overwhelming majority of Inguinal hernia repairs, including all primary (first time) repairs in adults, and over 95% of recurrent inguinal hernia repairs. Its safety, utility and effectiveness cannot be overstated in our opinion.

Surgery at NORTH PENN HERNIA INSTITUTE is tailored specifically to the individual needs of each and every patient. We are expertly familiar with the various advanced Tension Free repair techniques commonly in use today, and all of these mesh system methods and diverse products are fully available to us. Rather than utilizing the same mesh product for all hernias, we individually select the precise mesh product (selecting the precise size, shape, configuration and manufacturer) at the time of surgery that is best suited for each hernia. This selection process, which is the foundation for what we call the "Benchmark" approach, is based on our extensive experience, developed by performing nearly one thousand various hernia repairs annually and "specializing" in hernia repairs for over 20 years. This expertise in both routine and complex hernia surgery assures that all of our patients receive the most satisfactory, safest and importantly the most effective repair available.

Recovery is therefore more rapid! Pain is minimal, since muscles not cut and are neither pulled together nor sewn under tension. Post-operative restrictions are few, if any, and our patients can actually return to NORMAL activity in DAYS! This includes resumption of work and recreational activity when desired.

This fully effective contemporary repair technique allows for your comfortably rapid recovery. The advanced techniques we utilize are associated with the Lowest Risk of Recurrence when compared to most other older surgical techniques which place extreme tension on the muscle and the repair by simply cutting and sewing muscle together. Our BENCHMARK technique is equally safe and the fully effective for "Recurrent" Hernias as well.

In addition, and equally important, Hernia repair with this advanced "Benchmark" approach is:

for NPHI Patients

While the over-whelming majority of hernias are both safely and effectively repaired using just local anesthesia and mild sedation (over 95% of our patients here at NPHI), on extremely rare occasions, because of hernia complexity, multiple recurrence, extreme obesity and even patient comfort, conversion to a safe, light form of mild general anesthesia under the supervision of a Certified Anesthesiologist may be required. This need can at times be anticipated on initial physical examination. Our Anesthesiologists, therefore, must reserve the right to such a conversion during surgery if in their opinion, patient safety so dictates.


  • 1. Koning, de Vries, Borm, Koeslag, Vriens, and van Laarhoven.(2013). Health status one year after TransInguinal PrePeritoneal inguinal hernia repair and Lichtenstein's method: an analysis alongside a randomized clinical study. Hernia. Jun;17(3):299-306. Available at: http://www.ncbi.nlm.nih.gov/pubmed/22872429.

    For Specific Questions on Inguinal or other Hernia Repairs


    or Call 215-368-1122

    Thank You,
    James A. Goodyear, M.D., F.A.C.S.
    Surgeon and Director

    Surgery is performed at
    Abington Health, Lansdale Hospital