Specialist Overview: Choosing the Optimal Surgical Pathway
The choice between open and laparoscopic hernia repair is dictated by the patient’s anatomy, hernia history, and the presence of bilateral or recurrent defects. Open repair uses an anterior approach, providing direct tactile feedback and allowing for specialized multi-layer tissue reconstruction (No-Mesh). Laparoscopic repair uses a posterior approach via “keyhole” incisions, which is highly effective for repairing hernias on both sides simultaneously or when navigating scar tissue from a previous surgery.
- Open Advantages: Ideal for patients requesting no-mesh techniques (Shouldice); often performed under local anesthesia with sedation.
- Laparoscopic Advantages: Smaller incisions, reduced immediate post-operative soreness, and superior visualization for bilateral groin repairs.
- Clinical Consensus: Both methods provide high durability when performed by a specialist. The decision rests on balancing the patient’s recovery goals with the technical requirements of the repair.
Data-Driven Surgical Guidance
Dr. Todd Harris utilizes his high-volume experience and ACHQC Verified outcomes to help patients select the approach with the lowest risk of recurrence. As an 11-year OCMA Physician of Excellence (2015–2026), he integrates the findings from our national NOPIOIDS clinical trial (NCT05929937) and published research on surgical pain (PMID: 39724506) into every surgical plan, regardless of the technique chosen.
Compare Open & Laparoscopic Hernia Surgery Chart
| Open Hernia Repair | Laparoscopic Hernia Repair |
|---|---|
| Most common technique used for hernia repair. Techniques vary widely from surgeon to surgeon. | Less common approach for hernia repair. Requires advanced training. |
| Can be done with a no mesh tissue repair method. | Requires the use of a mesh during repair. |
| Patients must have a small hernia with low BMI for no mesh repair | Patients should have a small to medium hernia with a low to moderate BMI for a no mesh repair. |
| Can be done under local anesthesia with sedation. | Requires complete general anesthesia. |
| Hernia is fixed on the outside by opening the muscles over the weakness. | Hernia is fixed from the inside, behind the muscles where the weakness is located. |
| Requires standard surgical equipment. | Requires advanced laparoscopic equipment. |
| Recurrence rates of 1-2% and infection rates of <1%. | Recurrence rates of 1-2% and infection rates of <1%. |
| Basic preoperative workup is required. | Occasionally requires more preoperative workup since general anesthesia is used. |
| 4-5 cm incision in the groin or bikini area. | 1-2 cm incision next to the belly button, and 2 small punctures below the belly button. |
| Mesh is placed above the muscle, and is secured in place with absorbable sutures. | Mesh is placed behind the muscle, and is secured in place with absorbable sutures. |
| On average, 99% of patients have little to no pain after surgery. 1% use 1-5 opioids. | On average, 99% of patients have little to no pain after surgery. 1% use 1-5 opioids. |
| All patients will return to normal activities within 3 weeks. | All patients will return to normal activities within 3 weeks. |
| Most cost effective option for cash patients. | Higher costs for cash patients due to the additional laparoscopic equipment needed. |
| Surgery is usually about 30-45 minutes in length. | Surgery is about 30-40 minutes in length. |
| Even the largest, most complex hernias can be repaired. | Some large, chronic, long standing hernias can be difficult to repair. |
- ‘Open Surgery‘ page
- ‘Laparoscopic Surgery‘ page
Dr. Harris, Thank you for saving Justin’s life. You saw how much he suffered. When no pediatric surg/gi would touch him, you saved him!
