Question:
I am preparing for surgery. I just need to know if Lap is safer and easier than open?
I have spoken with a doctor that does Lap RNY and I have an appt. on Fri. 3/1 that does Open only. It seems lap is much safer and less healing time but, not sure. Can any of you tell me which would be best? — Robin B. (posted on February 23, 2002)
February 22, 2002
I'm not sure there is a "best" choice here Robin -- it's more
what's best for you. My surgeon did open and lap RNY. I chose open over
lap for a couple of reasons. First of all, my surgeon felt most
comfortable doing the open. It made it easier for him to view the entire
"field" of surgery. He also claimed that open recover was not
that much longer than lap, in his opinion. I do NOT sit behind a desk on
my job but was back to work 13 days post op so I can verify that claim --
at least where I am concerned. He told me for lap I would have 6 to 8
small incisions (approx. 1" in length). With open I would have one
incision 3" to 6" in length. My incision was 3 1/2" long.
I'm pretty sure incision length will vary depending on how obese you are (I
had 130 pounds to lose) and whether or not they will run into scar tissue
at the surgery site from any previous surgeries. I'm sure there are other
factors but those are the 2 that spring to mind. There are surgeons that
are extremely adept at the lap surgery and if that is what YOU want, then
stick to your guns and find yourself a surgeon that does this procedure
lap. Personally, if I were you, I would keep the 3/1 appt. with the
surgeon who does the open procedure and at least listen to what he has to
say about why he only does the open procedure. Something he may say to you
will make perfect sense and make you feel that open is the way to go.
Whichever you choose, best of luck.
— Pam S.
February 22, 2002
Hi. Before I say what I want to say on this, let me state that this is
strictly my opinion. I know others will disagree with me. That's what
makes this site so great! I feel that, IN MOST CASES, the open approach is
the better way to go. There are so many structures in the abdomen,
anatomically, that need to be visualized and "moved around"
during surgery so that the right parts can be reached and manipulated. The
tiniest nick on an adjacent organ can lead to major problems. Plus, when
it comes to rerouting the bowel and making the stoma and the anastamosis,
precision is essential. The end-to-side stitching of the intestine that
needs to happen must be precise. Now, I know that there are many, many
people who have had successful lap RNY's who did not have a single
complication, and that there are many open RNY's who did have
complications. My point is that you want the surgeon to have the best
"look" at what he or she is doing. Yes, the recovery time for
the lap approach is shorter, but the operative time is longer, and (some
sources say) there is a higher risk of complications compared to the open
approach. For a major surgery like this, I feel that open gives the
surgeon the "working room" necessary to do his or her best, most
perfect work. JMHO. JK, RN
— Joya K.
February 22, 2002
JOYA... you know NOTHING about what you are talking about! You have
believed your surgeons BS pitch as to why he doesnt DO lap instead of the
fact that he isnt QUALIFIED nor TRAINED to do the procedure
laparascopically. IT IS THE EXACT SAME SURGERY DONE VIA DIFFERENT 'HOLES'.
How dare you scare the crap out of someone because YOU dont understand.
That 'nicking organs','leaks' and complications are more prevailant with
open surgeries is the truth. To the poster asking the question... read the
message boards and do a count of people who have complications and notice
that its the 'open' procedures, not the lap. ANY surgeon must be researched
and pass the litmus test as to his or her experience whether lap or open.
The advantage to lap is that it is less invasive to get to the surgical
site...period. Lap surgeons didnt just decide to be laparascopic surgeons
last Tuesday... they have extensive additional surgical training and it is
rare for a 'regular' surgeon to stop practicing and get this additional
training to do any procedure via lap portals.
— [Anonymous]
February 22, 2002
I think open or lap depends on the surgeon's experience and what he
decides. My surgeon does both, we felt for various reasons open would be
best for me. Lap isn't the picnic in the park it sometimes sounds, but it
can lead to faster recovery in some people. Going under having your heart
set on lap can be a problem, because if something goes wrong the dr will
open you up. I know of a couple people in different parts of the country
who went in for lap and for one reason or another ended up having open. My
best advice is research research research. As for you Joyce, I hope you
don't take what anon said to heart, he/she/it didn't even have the courage
of their convictions to sign their name. You have every right to your
opinion, and what people are asking for on these boards is opinions.
— Becky K.
February 22, 2002
Joya, called you joyce in my answer, I'm sorry.
— Becky K.
February 22, 2002
To the anonymous poster -- talk to Kara Adams. She just got out of the
hospital after spending an additional couple of weeks hanging out there
with her spleen bleeding. Seems her perfectly qualified surgeon nicked it
during lap surgery. Don't flame Joya for giving an RN's point of view.
Surgeon's are human and mistakes happen every day -- not because the
surgeon was intentionally negligent but because ACCIDENTS HAPPEN. They
happen to the BEST surgeons, the most well prepared patients and in all the
finest hospitals. Joya stated her opinion and PREFACED her post by stating
that it was just her opinion. Perhaps you need another cup of coffee, a
nap or prozac. Whatever it is, please get it before you decide to roast
anyone else for their opinion. Have a Nice Day...........:)
— Pam S.
February 22, 2002
Hi Robin,
From my research I personally chose the open procedure. If you look at
people who have needed transfusions from spleen nicks or other bleeds, you
usually find that the lap. procedure was used. It's of course not as easy
to get around other organs with the lap. as it is with open. Also, the
opening from the pouch to the intestine is left larger because they can't
get it to 12 mm in the lap. The smallest they can get it is 26mm. So you
don't have the "full" feeling as long as with the larger
opening.
My friend had lap. and has done wonderfully. She can take bigger bites and
swallow more than what I'll be able to, but she's not affected in an
adverse way because she's lost 125 lbs. since May. SHE LOOKS AND FEELS
GREAT. Her healing on the outside was maybe a little less time, but your
insides of course heal at the same rate. So you still have to be careful.
I think it depends so much on how much experience your surgeon has, but
because of the chance of nicks or bleeds I've opted for the open. I just
feel safer. I used to want the lap. but since my research, I did change my
mind. They don't cut through muscle, so the incision is going to heal
fairly quickly, provided no complications arise.
— lerli1
February 22, 2002
— Denise W.
February 23, 2002
Just another RN's opinion here: the critical factor in making a decision
between laparascopic and open surgery is the experience and the expertise
of the surgeon. It requires years of advanced training to develop the
skill to be an excellent laparascopic surgeon. There are many exquisite
surgeons who only perform open surgery because their established practices
are too busy to allow them to take the necessary time to learn the
techniques and develop the skills of laparascopy....or they're simply not
interested in learning the technique at all. Unfortunately, there are
also other surgeons who have begun to offer lap surgery because of its
growing "popularity", but who do not have adequate experience or
expertise in the field. In the hands of an experienced lap surgeon,
procedures are generally considered to be less risky in terms of infections
and other complications, and offer a more rapid rate of recovery with less
post-op discomfort. It is a false statement, by physicians or others on
this site, to categorically say that open surgery is "better because
the surgeon can see what they're doing". Having assisted with
laparascopic surgery, I can say that the cameras used during the procedure
enable the surgeon to see the surgical field much better than with the
naked eye....even the smallest nerves and blood vessels are clearly
visible. When "accidents" happen (and they happen just as often
in open surgeries as with lap surgeries), it is most often due to lack of
skill with the instruments or on the part of the surgeon....not poor
visualization. Length of operating time is another source of frequent
disagreement on this site. Four of us in our family have had lap WLS with
the longest operating time being 1 hour 10 minutes....once again, this is
directly related to the experience of the surgeon. Yes, lap surgery can be
successfully performed on patients weighing over 300 lbs.....my surgeon's
most obese lap patient weighed almost 600 lbs. Yes, lap surgery can be
successfully performed if you have had other major abdominal surgeries in
the past, and if you have adhesions or scar tissue resulting from those
surgeries....I had a belly full of adhesions from four other abdominal
surgeries, and the adhesions were removed during the course of the RNY.
The important thing is not open versus lap, or who is wrong or who is
right....the important thing is that we each have identified a need and a
goal in our lives....to be healthier and happier and more whole
individuals. How we get to the end of our journey is much less significant
than that we made a decision to start, and walked the path to the end. Do
all the research you can...find the best surgeon that you can...make the
best decision for YOU that you can....then be happy and confident in your
choices and get ready for the best ride of your life! Good luck.
— Diana T.
February 23, 2002
I had the lap and loved it! I was only sore, not in pain as far as the
recovery. My surgeon is a lap specialist and was the first to perform the
lap RNY in the state of VA and travels even overseas to train other
surgeons. Because of his expertise, I was really comfortable with the
procedure. He explained that he sutures the insides as if it were done
'open', my stoma is 8mm. And he has a 'magnified' view of the insides on a
video screen. My incisions look like mosquito bites, and I only have 4
that are visible, 1 hidden inside the belly button. I feel blessed to have
been operated on by a highly trained lap surgeon. I believe that you have
to choose the surgeon. Whichever one you feel the most comfortable with,
go with that one. You would rather have an experienced surgeon rather then
choosing the most preferred procedure. I would choose an open by a
qualified surgeon than have a lap by an inexperienced one. You definitely
should keep your appt., and then decide which one you feel most comfortable
with. And I didn't have pain from the 'insides healing'. And also, my
surgeon always tells his patients that if necessary, the lap could turn
into an open. I believe that would be the case with most surgeons though.
Good luck in your decision process.
— Cheri M.
February 23, 2002
My DR is very experienced in both. He explained the differences and said
open has less chance for complications because of the location of the the
stomach and intestines. Lap is a longer surgery and he said anytime an
obese person is kept under longer it increases the risks too. He charges
more for Lap because of the increased surgery time and he keeps Lap
patients in the hospital one extra day because of increased risks. He said
some surgies like gallbladder are better done lap but not this surgery but
he does it do to patient demand if you are under a certain BMI. He was just
featured in the Chicago Tribune and is reknown for his expertise in this
field. I chose to have open because I had a complication from a Lap
gallbladder removal and ended up in intensive care because they lost stones
in me they would have saw if they had done it open so I knew my DR was
correct. After surgery I found out even if I had chosen Lap they would have
had to open me up because of scar tissue from my previous sugery and a
hernia repair I didn't even know I had. You may want to find a surgeon who
does both so they have nothing to lose when advising you.
— Candace F.
February 23, 2002
Hi - I had my surgery Lap on Sept 7, 2001. I couldn't have been happier,
or felt safer. Just as you would do when research a good "open"
doctor, you research a good "lap" doctor. My Surgeon's group has
had ZERO leaks since they started doing the surgery and they have had ZERO
deaths associated with the surgery as well. Yes, there have been
complications...those due to normal situations of unhealthy morbidly obese
people. I think you just need to do your research and find a skilled Lap
surgeon if that is the route you want to go.
— Ilene M.
February 23, 2002
I would have to respectully disagree with anon's comment about
complications regarding open surgeries. MY research has indicated just the
opposite. The most severe life threatening complications seem to happen
most with the lap surgeries--the leaks, kinks, knicks, etc... Just my own
unscientific research. Whenever I read about someone with problems like
these, I will click on their profile and more often than not, they have had
lap surgeries. Just remember, poster, do your research. There are many
excellent and qualified lap surgeons out there. The deciding factor for you
may be your age and if you are planning to show your midriff regularly. I
am 37, mother of 5 and have no plans to be a bathing beauty. Although, my
open scar is very minimal and not much of an issue, only my husband and I
see it. My healing time was equivalent to a lap procedure, I have always
healed quickly and have a high pain tolerance. I was working (part time) 8
days post op and went to my son's basketball game at 6 days out. My life
returned to normal very quickly. (not sure this is such a great thing!! Ha
Ha!) Good luck to you in whatever you decide. Shelley
— Shelley.
February 23, 2002
Dont you just love when people post anonymously, I just wonder how it is
they manage to talk such a STRONG opinion and dont have the balls to say
who they are.....I think its called an extensive case of candyass. I think
what ever you decide for whatever your reasons are is what is BEST for
YOU> I chose open. Thats just me~~~
— Sassy M.
February 23, 2002
Although the prev anon posted in a harsh tone, I do have to agree with the
point she is trying to make. There are doctors that will say that open is
the better way to go because they are not experienced with the lap. They
are not comfortable with the lap because of the lack of training. And you
should take what is said here with a grain of salt, do your own research,
and form your own opinion. What is said here is strictly opinion. And to
all of you anon bashers, I prefer not to get the hate mail resulting from
posting against the opinion of others. People get so wound up with what an
'anon' says, if they left their name, they'd never be forgiven. So that is
what the anonymous option is for, let people use it, and either take it or
leave it. Don't stoop to their 'bashing level'. Ignore it if it bothers
you. To the poster, good luck in whatever method you choose.
— [Anonymous]
February 23, 2002
This controversy will rage forever, but you asked for opinions, so here's
another. I was done open, both times. 2nd time was my choice. I'm getting
older, here, and I sorta preferred the panoramic view of everything. I had
just observed two of our surgeries a month before my revision and I was
astounded at the hand work & detail that went into each step. It was
the hand work that sold me. Being utterly ignorant, I asked how they did
that lap & they said (of course) that they cannot do it lap. If one is
young, healthy and all that, lap may be a better option because you're up
& running fairly quickly. I was old & in poor shape when I had my
original, yet was back at my desk job part time in about 10 days. For my
revision, since I work from my home, I guess I was back at work as soon as
I got home!
— vitalady
February 23, 2002
This controversy will rage forever, but you asked for opinions, so here's
another. I was done open, both times. 2nd time was my choice. I'm getting
older, here, and I sorta preferred the panoramic view of everything. I had
just observed two of our surgeries a month before my revision and I was
astounded at the hand work & detail that went into each step. It was
the hand work that sold me. Being utterly ignorant, I asked how they did
that lap & they said (of course) that they cannot do it lap. If one is
young, healthy and all that, lap may be a better option because you're up
& running fairly quickly. I was old & in poor shape when I had my
original, yet was back at my desk job part time in about 10 days. For my
revision, since I work from my home, I guess I was back at work as soon as
I got home!
— vitalady
February 23, 2002
Hi again. Thank you to all of the cool, level-headed people who so kindly
reminded Anon poster #1 that I was stating strictly my opinion. I feel no
need to further acknowledge this poster's attack on me. To the person
asking the question: I would like to echo the suggestion made by others
that you do your research and make the decision with which you feel
comfortable. The only other thing I would add is that you *might* want to
*consider* viewing a video of an actual surgery. Someone posted a link
once to a site that had some excellent video of an open RNY. (Sheesh... I
hope I don't get flamed for making this suggestion!) Again, JMHO. JK, RN
— Joya K.
February 23, 2002
If you want a 30% risk of a follow up surgery get a open... They tend to
get incisional hernias. Done by a EXPERIENCED LAP surgeon I think lap is
safer since you tend to be up and about sooner, reducing the most common
killer of post ops blood clots.
— bob-haller
February 23, 2002
Lap vs Open, boy if there is one thing that will bring out strong opinions,
that is a major topic!
One thing I considered before opting for Lap (03/08) IF my doctor goes in
and finds additional issues, my Lap could very well convert to Open. Also
the Lap is a longer surgery, therefore more time under anesthesia, I
discussed that at great legnth with my surgeon before making my decision.
The decision, and the opinions are very personal, and I am sure any poster
would expect to get "opinonated" responses. I have to admit
though I do take offense to anonymous posters who attack (in my opinion)
other posters who are trying to respond. I appreciate the openess of this
board allowing responses, and posting with minimal restrictions, guess we
take the good with the bad.
Take care,
Denise
— Nene B.
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