Keyhole versus open surgery for groin hernias

If you have a groin hernia, and you have decided with your surgeon that the best way forward is to surgically repair this, then one of the crucial steps is to agree on the way it's going to be repaired.

There are two ways to surgically repair a groin hernia:

1)            Open conventional surgery

2)            Keyhole surgery

Briefly explained, the open conventional approach is where a cut is made, just above the skin fold in the groin, approximately 6-7cm in length to access and repair the hernia. With keyhole surgery, 3 small incisions are made in the tummy, measuring between 5-15mm, and then keyhole instruments are inserted through these holes to access and repair the hernia.

So which of these 2 approaches is better?

That's not an easy question to answer, but I'll address 3 important factors that help to determine which of the two techniques is best for you.

1)      Your general health

Keyhole surgery can only be done through a general anaesthetic whereas open surgery can be performed through a general or local anaesthetic. So, if you're not fit for a general anaesthetic, then you may only be offered open surgery to repair the hernia.

2)      Surgeon’s experience

Some surgeons are more comfortable performing the repair through the open approach. Others are more comfortable with the keyhole approach, and some are comfortable with either technique, so is it important that the surgeon chooses an approach that they are comfortable doing.

3)      Outcomes

Lets explore some of the main differences in results between keyhole and open surgery. If we look at the risk of complications after the operation, we'll find that no study has identified any difference between the two approaches. Equally when it comes to the success of the operation and the potential for the hernia coming back in the future, again, no study has found one or the other technique to be superior.

But there are some areas where differences in outcomes have been shown between the two techniques. Some studies have shown that keyhole surgery reduces the risk of long term pain after hernia repair. That isn't surprising considering that there are 3 nerves that you'll have to identify and preserve when you repair a hernia through the open approach. When it comes to keyhole surgery, there are nerves that a surgeon should avoid, but these are a bit further out of the way, and can be avoided with relatively less effort.

The other difference that studies have shown is the recovery time after the procedure. Keyhole surgery offers a slightly quicker recovery rate in comparison to open surgery.

You also have to look at other considerations, for example, where the wound is going to be placed. If you're planning to sit for a prolonged period of time shortly after surgery (e.g. as a driver or passenger on a long trip, or if you wish to return early to your office job), you may want to consider not having a wound in the groin but rather in a higher location.

I always argue that keyhole surgery avoids creating a wound in the groin, which is a slightly more contaminated area, but there hasn't actually been any evidence to show that infection rates are higher with open repair in comparison to keyhole surgery.

So there are lots of factors to consider when deciding between keyhole and open surgery, but the important thing is to discuss these options with your surgeon so that you can both agree the best way forward for you.