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The pros and cons of laparoscopic surgery vs. open up surgery for hernia repair

Submitted by Bruce Abel on Tue, 2022-07-25 xvi:47

Surgical team performing open hernia repair surgery

Laparoscopic techniques accept been in use since the early 1900s, initially used only on animals, with the first laparoscopic process on a human conducted in 1910. Laparascopic techniques for a range of different types of surgery take been commonplace since the 1990s.

Today most operations to repair herniae are conducted using laparoscopic surgery, and the main reasons for this are...

  • Shorter recovery times (patients mostly able to render to normal activites effectually a week before than is the case with open up surgery)
  • Ordinarily no need for a infirmary stay at all after the procedure
  • Much smaller scars than in open surgery (1-2cm incisions as opposed to 4-5cm incisions)
  • Mostly, less pain afterward the procedure (~66% of patients with very little/no pain cf. open surgery at ~33%1)

However, the laparoscopic arroyo does have some drawbacks compared to conventional open up surgery. These relate to two factors in detail - firstly that the surgeon is using instruments operating at a distance and not using their easily for tissue manipulation, and secondly that visualisation via video camera does not requite the same depth of vision every bit straight eyesight. This tin can translate to an increased risk of inadvertent injury.

The choice of laparoscopic or conventional surgery is oft dictated by the blazon of hernia equally well as size and location of the hernia. In general terms, unless there are other factors at play, the post-obit types of surgery are employed for different hernia types...

  • Femoral herniae – open up.
  • Inguinal herniae – laparascopic or open.
  • Parastomal herniae – laparoscopic.
  • Umbilical herniae – open up.
  • Ventral / Incisional herniae – laparoscopic.

Notation - If a hernia is peculiarly large or has been present for a long menses of time, an open procedure may be recommended over the laparoscopic pick. Also, where deemed necessary, a surgeon will occasionally need to convert a laparoscopic procedure to an open up process, often to minimise the possibility of tissue damage or bleeding. This is a adequately straightforward process and this decision is often made due to inadequate visualisation of the organs via the laparoscopic camera.

The preference for the laparoscopic approach over conventional surgery (for inguinal hernia repair) is backed up by a number of studies between 1998-2008, listed in a 2022 Medscape article titled 'Laparoscopic Inguinal Hernia Repair'ii.

Another commodity in 20223 based on a randomised clinical trial of laparoscopic vs. open repair for incisional herniae constitute that...

  • Operating fourth dimension was a piddling longer for the laparoscopic approach (100mins vs 76mins)
  • Blood loss during the procedure was significantly less for the laparoscopic group (10mL vs. 50mL) although complications during surgery were college in the laparoscopic were college (9% vs. two%)
  • No statistically significant difference in terms of post operative pain between the two approaches
  • Recurrence rates were also like, with neither arroyo seeing specially better or worse outcomes

For these reasons, laparoscopic techniques are by and large regarded every bit the 'golden standard' for many hernia procedures today.

References

1 http://californiaherniaspecialists.com/compare-open-and-laparoscopic-surgery

2 http://emedicine.medscape.com/commodity/1534321-overview

iii http://jamanetwork.com/journals/jamasurgery/fullarticle/1670366