General and Gastrointestinal Surgery

Open Surgery Versus Laparoscopy

A hernia is a hole through the muscle layers in the abdominal wall. Therefore, surgery can be performed from either the abdominal side, as in the laparoscopic approach, or through the skin, as in a traditional, open approach.

Why is there an open approach and a laparoscopic approach?

The laparoscopic approach was introduced in the early 1990s based on the success of laparoscopic gallbladder removal. Studies to date have shown less pain, earlier return to normal activities and earlier return to work as a result of the laparoscopic approach, as compared to the open approach. It is important to realize that these differences are measured in days or weeks, not months. For example, patients undergoing a laparoscopic hernia repair are back to normal activities, on average, 8 days earlier than those who undergo an open repair. It is also important to recognize that everyone is different with regards to the perception of pain and their occupation. One person may undergo an open hernia repair and be back to work in a week while another person who undergoes a laparoscopic repair returns after 6 weeks.

Are there advantages to the open or laparoscopic approach?

Each has advantages. The advantages of one approach are the disadvantages of the other. To a large extent, which procedure a patient chooses should be based on what aspects are most important to him/her. As noted, the laparoscopic approach usually results in less pain, earlier return to normal activities and earlier return to work than the open approach. On the other hand, it does require general anesthesia and it costs more than the open approach. The open approach, on the other hand, is less costly to the insurance provider and can be performed under local anesthesia, while the patient is awake.

Which is a better approach, the open or the laparoscopic?

Once again, the answer to that question depends on what the patient's endpoint is for success. The answer is different if he/she is interested in cost, pain, recovery or anesthesia. If the ultimate judge of superiority for one procedure over the other is preventing recurrence of the hernia, both procedures are equal, based on current research. It is important to note that long-term recurrence rates of 5 to 10 years are not available yet for laparoscopic hernia repairs.

It is also important to note that some doctors recommend only the open approach because of the greater cost associated with laparoscopic repair. Others recommend the open approach for unilateral hernias and the laparoscopic approach for bilateral hernias. These surgeons reason that the pain of having two open hernia repairs at the same time balances the difference in cost. Finally, other surgeons recommend the laparoscopic approach for most cases and reserve the open approach for the few patients who have an increased risk from general anesthesia. They reason that reduced pain and earlier return to activities outweigh any difference in cost.

Do all surgeons perform both the laparoscopic and open approaches?

No. All surgeons perform the open approach but only some surgeons perform the laparoscopic approach. It is important when getting an opinion regarding the surgery to determine if the surgeon performs one or both approaches, and how many of each he or she has performed.

More about these procedures

Learn more about laparoscopy

Learn more about open hernia surgery