Laparoscopic or open surgery: how the surgeon chooses the method

Laparoscopy is a way of operating inside the abdomen without a large cut. Through several small cuts the surgeon inserts a thin camera and instruments. Before that, the abdominal cavity is gently inflated with gas (carbon dioxide) to create space to work and a clearer view. The surgeon operates while watching a magnified image on a screen.

Laparoscopic surgery is usually done under general anaesthetic. At the end the gas is released and the small cuts are closed with stitches or adhesive strips.

In open surgery the surgeon reaches the organ directly through one larger cut. The length and position of the cut depend on the type of procedure. Open surgery is still the standard method for many procedures and in some situations it is safer or more suitable than laparoscopy, for example when the findings are complex or there are many adhesions from earlier operations.

Some procedures, such as inguinal hernia repair, can be done as open surgery under local anaesthetic or sedation.

Rough differences, which do not apply equally to every procedure:

• Cuts: laparoscopy has several small cuts, open surgery one larger cut.
• Pain and recovery: after laparoscopy, pain around the wounds is less for many procedures, and the return to light activities is often quicker. However, internal tissues take a similar time to heal, so heavy effort is avoided after laparoscopy too, for as long as the surgeon advises.
• After laparoscopy, bloating and shoulder pain may occur in the first days because of the gas used during the procedure.
• Anaesthetic: laparoscopy is usually done under general anaesthetic, while some open procedures can be done with other types of anaesthesia.

Both methods have their own risks, which the surgeon explains at the examination.

Laparoscopy is not always possible or not always the best choice. The surgeon more often chooses open surgery when:

• there are many adhesions from earlier abdominal operations,
• the findings are complex or extensive, for example with a large hernia or widespread inflammation,
• some heart or lung conditions make working with gas in the abdomen difficult,
• the open method is needed because of the type of procedure or anaesthetic.

During laparoscopic surgery the surgeon sometimes decides it is safer to continue as open surgery. This conversion is not a mistake but a decision in the patient's interest, and the surgeon discusses this possibility with you before the operation.

In the general surgery price list of Maja Hospital several procedures have both an open and a laparoscopic item:

• appendix removal (appendectomy),
• gallbladder surgery,
• hiatal (diaphragmatic) hernia repair,
• inguinal and ventral hernia repair,
• segmental resection of the large bowel (colon),
• rectal prolapse surgery and laparoscopic rectopexy,
• release of bowel adhesions (adhesiolysis),
• adrenal gland surgery.

Prices for both methods are in the general surgery price list. The surgeon decides which method is suitable in your case.

The surgeon chooses the method after an examination and a review of results, taking into account:

• the type of condition and imaging findings,
• previous abdominal operations,
• general health, heart and lung conditions and the medicines you take,
• body build,
• whether the procedure is planned or urgent.

At the examination feel free to ask why a particular method is suggested, what recovery after it is like and what happens if the method needs to change during the operation.