Types of Hernia Repair: Open, Laparoscopic, and Robotic Surgery

Hernias are a common condition where an organ or tissue pushes through a weak spot in muscle. Left untreated, hernias can worsen and be potentially fatal. For symptomatic hernias and those with an increased risk of complications like strangulation, surgical repair is often necessary.

What Are the Different Types of Hernia Repair?

Hernia repair (Herniorrhaphy or hernioplasty) aims to return the protruding tissue to its correct place and reinforce the weakened abdominal wall, preventing recurrence and alleviating symptoms.

Various surgical approaches are available for hernia repair—each tailored to the patient's specific case. These include traditional open surgery, minimally invasive laparoscopic techniques, and robotic-assisted surgery. The most suitable approach is determined by factors such as the hernia's location, size, and type, as well as the patient’s overall health and age.

Open Hernia Repair (Traditional Surgery)

Open hernia repair is the traditional method, which involves a single, larger incision directly over the hernia.

During the procedure, a surgeon creates a large incision. The herniated tissue is returned to the abdominal cavity, and the weakened area is typically reinforced with a synthetic mesh to reduce the risk of recurrence. Finally, the incision is closed with sutures, staples, or surgical glue.

Open hernia repair is a versatile option for different types of hernias and may be performed under local, regional, or general anaesthesia.

Pros:

• Cost-Effective: It is generally less expensive than laparoscopic or robotic surgery, as it requires less specialised equipment.
• Versatility: It is effective for a wide range of hernia types and sizes, including very large or incarcerated hernias.
• Direct Visualisation: The surgeon has a direct, unobstructed view and tactile feel of the tissues, which can be advantageous in complex cases or when significant dissection is required.

Cons:

• Larger Incision: It results in a more significant scar compared to minimally invasive techniques.
• Greater Postoperative Pain: Patients often experience more discomfort and pain after open surgery due to the larger incision and greater tissue disruption.
• Longer Recovery Time: Typically requires a longer recovery period and a more extended return to normal activities and heavy lifting.

Laparoscopic Hernia Repair

Laparoscopic hernia repair is a minimally invasive alternative to open surgery.

Through three to four small incisions, a surgeon inserts a laparoscope—a thin tube with a camera—to guide the repair using specialised instruments. This "keyhole" approach typically results in less pain, smaller scars, and a quicker recovery.

Minimally invasive laparoscopic surgery is especially beneficial for patients with obesity, chronic health conditions, or those needing a faster return to daily activities. However, because it usually requires general anaesthesia, it may not be suitable for everyone. Your surgeon will assess whether laparoscopic repair is the right option based on your health and hernia type.

Pros:

• Faster Recovery: Patients generally experience significantly less post-operative pain and discomfort, leading to a faster recovery and a quicker return to normal activities, including work and light exercise.
• Lower Risk of Wound Complications: It often leads to reduced incidence of wound infections, haematomas, and seromas due to smaller incisions.
• Bilateral Hernia Repair: It allows for the repair of hernias on both sides (e.g., bilateral inguinal hernias) through the same set of incisions without requiring additional large cuts.

Cons:

• Higher Cost: It is generally more expensive due to the specialised equipment and technology involved.
• Potential for Visceral Injury: Although rare, there is a potential risk of injury to internal organs (bowel, bladder, blood vessels) during instrument insertion.
• Gas-Related Discomfort: Some patients may experience temporary shoulder pain or abdominal bloating from the carbon dioxide gas used during the procedure.

Robotic Hernia Repair

A robotic hernia repair is a more advanced approach to minimally invasive hernia repair.

Similar to laparoscopic surgery, robotic hernia repair uses several small incisions to insert instruments and a high-definition 3D camera. The key distinction lies in these instruments being attached to robotic arms, which the surgeon precisely manipulates from a console. This system translates the surgeon's hand movements into scaled, delicate actions inside the patient, providing a magnified, three-dimensional view of the surgical field.

This approach allows for extremely precise dissection and meticulous mesh placement to reinforce the hernia defect. Like laparoscopic repair, this procedure is performed under general anaesthesia.

Pros:

• Enhanced Precision and Dexterity: The robotic system offers a greater range of motion and fine motor control than human hands, allowing for highly precise dissection and suturing.
• Minimally Invasive: It shares the advantages of traditional laparoscopy, including smaller incisions, reduced postoperative pain, and a faster recovery compared to open surgery.
• Suitable for Complex Cases: The enhanced capabilities make it particularly well-suited for challenging or recurrent hernias and for performing intricate repairs.

Cons:

• Higher Cost: This is generally the most expensive hernia repair method due to advanced instruments and robotic systems.
• Specialised Training: It requires extensive training and experience from the surgical team, which means these advanced procedures are not readily available in most clinics.
• Setup Time: The initial setup and docking of the robotic system can add to the total operating room time.

Conclusion

There is no single "best" approach to hernia repair, as the ideal choice is highly individualised. A thorough discussion with your surgeon is essential to weigh the benefits and risks of each option.

If you are experiencing hernia symptoms, do not delay seeking medical attention. Your hernia surgeon can best define the most appropriate treatment plan, including the most suitable surgical method for your specific case. For a detailed evaluation, please contact our team today at +65 6262 1226.