Keyhole surgery: what it means for you, in plain language

If your GP has mentioned "keyhole surgery" or "laparoscopic surgery" and you're now sitting at home googling what that actually means — this is for you. No jargon, no marketing. Just what to expect.

What is "keyhole" surgery, really?

Instead of one long cut across your tummy, we make three or four tiny openings — each about the size of a pea. A slim tube with a camera on the end goes through one of them, and shows the inside of your abdomen on a large screen next to me. Fine instruments go through the other openings, and I operate while watching the screen. The whole thing is done while you're asleep under a general anaesthetic.

That is it. Same operation as the old-fashioned "open" way — same organ, same problem fixed — just through much smaller cuts.

Will it hurt?

Honest answer: yes, a bit, but far less than most people expect and far less than open surgery.

Most patients describe day one as a dull, bruised feeling around the small cuts, sometimes with a shoulder-tip ache for a day or two (that's from the gas we use to inflate the tummy — it settles quickly). You will have pain medication charted regularly, and my anaesthetic team uses opiate-sparing techniques wherever possible, which means less nausea, less constipation and a clearer head when you wake up.

By day two or three, most patients are managing on simple painkillers like paracetamol and an anti-inflammatory.

How long will I be in hospital?

It depends on which operation you're having. Rough guide:

Gallbladder removal: home the same day or the next morning.
Appendix: usually one night.
Inguinal or small ventral hernia: same day, occasionally one night.
Larger or complex hernia repair: one to two nights.
Bowel surgery (colectomy, sigmoidectomy): typically two to four nights.
Reflux or hiatal hernia surgery: one to two nights.

Before you go home, we need three things: you're eating and drinking, your pain is controlled with tablets, and you've been up and walking. That's it.

When can I get back to normal life?

This is the question everyone actually wants answered. These are typical timings for a straightforward keyhole procedure — your operation and your body may push things a little either way.

Eating and drinking: the same day.
Walking around the house: the same evening.
Showering: from day two (dressings are waterproof).
Driving: once you can perform an emergency stop without hesitating — usually 7 to 10 days.
Desk work / working from home: most people are back within 1 to 2 weeks.
Physical or manual work: 3 to 6 weeks, depending on the operation.
Gym, running, cycling: gentle cardio at 2 weeks, full training at 4 to 6 weeks.
Heavy lifting (over 10 kg): avoid for 4 to 6 weeks, especially after any hernia repair.
Sex: when it's comfortable — usually within 1 to 2 weeks.
Flying: short flights from around 1 week, long-haul from 2 to 3 weeks.

You are the best judge. If something hurts, you're not ready for it yet — wait a few days and try again.

What are the scars like?

Each of the three or four openings closes with a stitch under the skin and a small waterproof dressing. Once it heals, you're left with faint marks — usually 5 to 12 millimetres long — that fade to pale lines over 6 to 12 months. Most patients tell me their family and friends can't find the scars a year later unless they're pointed out.

What could go wrong?

I'd rather have this conversation with you upfront than pretend nothing can. Keyhole surgery is very safe, but every operation carries some risk. The main ones are:

Bleeding or infection — uncommon, and much less common than with open surgery.
Injury to nearby structures (bowel, bladder, blood vessels) — rare, and usually recognisable and repairable during the same operation.
Conversion to open surgery — occasionally, if the view is unsafe or the anatomy is difficult, the safest thing is to make a bigger incision and finish the job that way. That is not a failure; it is good judgement. It's uncommon in planned cases.
Blood clots in the legs or lungs — we give you compression stockings and a small blood-thinner injection while you're in hospital to prevent this.
Anaesthetic risks — for a healthy adult, very low. Your anaesthetist will go through this with you.

You'll have my mobile number when you go home. If something feels wrong, you phone.

Is keyhole surgery right for everyone?

For most planned abdominal operations — gallbladder, hernia, appendix, reflux, most colon surgery, and even complex pelvic floor repairs — keyhole is the best first choice. It is also often the best choice for patients who are overweight, because a big open wound in that setting has a much higher rate of complications.

Occasionally the safer choice is a traditional open operation: severe emergencies with unstable patients, some advanced cancers where a bigger view helps, or extensive scar tissue from previous surgery. If that applies to you, I'll tell you honestly at your consultation and explain why. A well-done open operation is still a very good operation.

What happens on the day?

You'll be asked to arrive at the hospital a few hours before your scheduled time, having not eaten for 6 hours (clear fluids like water are usually fine until 2 hours before). You'll change into a gown, meet the anaesthetist, and I'll come and see you to answer any last questions and mark the site with a marker pen.

You walk into theatre. The anaesthetic works in seconds. The next thing you know, you're in the recovery area, feeling drowsy and sore but safe. Your family can usually see you an hour or two later, once you're back on the ward.

Questions worth asking me at your consultation

Print or screenshot this list and bring it in — I'd genuinely rather answer these than have you leave with unspoken worries.

Why do you recommend this operation for me specifically?
What happens if I don't have it, or wait six months?
How many of these do you personally do a year?
Which hospital will we do it at, and why?
What is the realistic worst case, and how would we handle it?
What does recovery look like for someone with my job and my life?
Who do I call, day or night, if I'm worried after I go home?

Where I operate

Consulting rooms are at Johannesburg Surgical Hospital, Room 21, Northcliff. I operate at Johannesburg Surgical Hospital, Netcare Olivedale Hospital, Life Bedford Gardens Hospital, and Cure Day Hospitals — we'll pick the location that suits your case, your medical aid and where you live.

If you'd like to talk any of this through in person, please send an enquiry or phone the rooms on 011 014 0414.