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Open Vs. Laparoscopic Surgery Techniques

Laparoscopic techniques require the use of general anaesthesia which in itself has its own well recognized risks. Although this method is marketed by those who use it as “minimally invasive”, in reality, it is more invasive than “open” techniques as it involves penetration of the abdominal cavity. It is well recognized that Laparoscopic methods have their own associated risks, which include intra-operative complications arising from damaging internal organs during surgery, bleeding as well as leaving trochar incision scars, that in turn can become incisional hernias (fatalities have been recorded in rare circumstances).

In addition, laparoscopy is expensive and is difficult to perform. Experts have indicated that it can take doing over 600 repetitive procedures to master the technique, and few surgeons have that level of experience repairing hernias using this technique. Although laparoscopy is successfully used in many surgical areas (for example, gall bladder) it is estimated that after 25 years from its introduction that only 10-15% of hernia surgery is done laparoscopically, and many surgeons are abandoning the procedure.

The New England Journal of Medicine concluded in 2004 that “the open technique is superior to the laparoscopic technique for mesh repair of primary hernias.” (NTD – link to Article). In that article, recurrence rates for primary hernia repair, using laparoscopic techniques, were over 2 times higher than when an open technique was used. Related post-operative complications were also higher in the laparoscopic group. It is fair to note, regarding both techniques, that these results would vary in the hands of surgeons specializing in hernia surgery.

Open repairs have been associated with slightly more pain immediately after surgery and producing unsightly scarring. However, this pain, if any, quickly subsides, and when performed by an experienced surgeon, open repairs leave little, to no, permanent scarring.

Today, much is being made of new “robotic” techniques. None of these have been proven to be better than the skilled hands of an experienced surgeon, all remain extremely expensive, and all come with the same associated risks of traditional laparoscopy.