What Is Open Surgery? Is It Right for You?

There are pros and cons to any type of surgery

Surgery Images, Surgery Patients Images,
Abdominal Surgery Incision. © Getty Images/Barrett Forster

Open surgery is the traditional type of surgery in which an incision is made using a scalpel. The surgeon then inserts the instruments and conducts the surgery. Open surgery is usually compared to "minimally invasive" surgical techniques which may involve smaller incisions or even (in some cases) no incision at all. While minimally invasive surgery has become increasingly popular, there are a number of situations in which open surgery is still preferable.

Minimally Invasive Surgery Versus Open Surgery

Some surgeries are still performed using the traditional open incision, but many more are being done using minimally invasive techniques.  Minimally invasive may mean that the incision is smaller than the usual open incision, or it may mean there is no incision at all, depending upon the technique used during the procedure.

When the surgeons are equally skilled and a procedure is available as both an open procedure and a minimally invasive one, the minimally invasive technique almost always offers a lower risk of infection, shorter recovery times and equally successful outcomes.  

In some cases, a surgery may start out as a minimally invasive procedure, then convert to the larger open incision procedure if the surgeon needs more flexibility of movement.

Pros and Cons of Open Surgery

Open surgery is on the wane because of new technologies that make it so much easier to avoid large incisions and the risks that come with them.

For example, with an open approach, the incision for a typical appendectomy is approximately 4 inches long. But according to the Society of American Gastrointestinal and Endoscopic Surgeons, "In most laparoscopic appendectomies, surgeons operate through 3 small incisions (each ¼ to ½ inch) while watching an enlarged image of the patient’s internal organs on a television monitor." As a result, recovery time is quicker and pain is often reduced.

But that doesn't mean that open surgery is obsolete. In some cases, for example:

  • Repairs simply cannot be made effectively using minimally invasive techniques
  • Only open surgery provides the visual information required to completely remove tissues or accurately diagnose a condition
  • Some types of surgeries require access to larger areas in order to insert materials such as mesh for hernias

According to one analysis, minimally invasive surgery should be carefully weighed against open surgery based on the particular needs of the patient: "The introduction of MIS [minimally invasive surgery] has been a huge leap forward in the modern surgical era. It may be wise, however, to not let it become the focus of healthcare delivery to surgical patients. The principles of safe surgery and comprehensive perioperative care should take precedence over technical prowess. Surgical decision-making may factor in the use of MIS to the patient's advantage. However, it should be immune to the bias that may arise due to the appeal of MIS to the surgeon. The only safeguard to this at this time may be a conscientious surgeon who puts patient welfare above all else at all times."

Sources:

Dehn, Tom. “Incisional hernia repair – laparoscopic or open surgery?” Annals of The Royal College of Surgeons of England 91.8 (2009): 631–636. PMC. Web. 18 May 2017.

Nanavati, A. J., & Nagral, S. Why have we embraced minimally invasive surgery and ignored enhanced recovery after surgery? Journal of Minimal Access Surgery, 12(3), 299–301. Web. 2016.

Society of American Gastrointestinal and Endoscopic Surgeons. Laparoscopic appendectomy surgery patient information from SAGES. Web, 2017.

 

 

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