“Complications are known to occur at each and every step of hernia surgery. Applying caution while performing each step can save the patient from a lot of morbidity. One starts by applying strict patient selection criteria for endoscopic hernia repair, especially in the initial part of ones learning curve. A thorough knowledge of anatomy goes a long way in avoiding most of the complications seen in hernia repair. This anatomy needs to be relearned from what one is used to, as the approach is totally different from an open hernia repair. And finally, learning and mastering the right technique is an essential prerequisite before one ventures into inguinal hernia repair.”

“The most important preoperative precaution is proper patient selection prior to surgery, especially in the initial part of the learning curve. Ideally, direct or small indirect hernias are best. Large hernias, obese patients and irreducible, obstructed hernias are best avoided. An absolute contraindication is strangulated hernia. Also a detailed work-up of elderly patients to assess cardiorespiratory status is mandatory to ensure a safe outcome.”