I prefer non-mesh hernia repair techniques and laparoscopic hernia repair requires the use of mesh. I do believe that in select cases it may be the best choice when a non-mesh anatomical repair is not possible. I would not do enough laparoscopic cases to keep up my skills so I refer them out. I have chosen to focus on my non-mesh anatomical hernia repair skills. For uninsured patients cost is a very important factor. Laparoscopic hernia repair is by far more expensive than other hernia repairs.