Question:
DOES AN OPEN RNY POSE LESS RISK THAN A LAP RNY?
I have been weighing the option of a LAP RNY or OPEN RNY. I originally thought it would be better and safer if I had the LAP RNY because I thought it would mean faster healing time and less noticeable scars. I have read a few profiles where it was mentioned that a some were against the LAP procedure because there is a greater risk of complications like a knick in a bowel, etc and a greater margin for error. On the other hand I also read that it is easier for the surgeon to see with the LAP because everything is magnified. So what are your comments/thoughts/personal experiences? Please respond if you had either. Negative or positive--either way please respond. — ToriJ (posted on June 6, 2003)
June 6, 2003
The risk depends way more on your surgeon than on whether the surgery is
lap or open. If you find a surgeon you really like and feel comfortable
with, go with whichever they recommend. I've actually had both. My
original surgery, in May, 2002, was done lap. However, there was a problem
with it and I had to have a second surgery in July to correct that problem.
That surgery had to be done open. I really didn't have much pain with
either surgery and was able to be up and walking very soon after both
surgeries. There is endless debate on this topic and many, many opinions
in the library.
— garw
June 6, 2003
This is one of my big pet peeves-- but I will try not to rant. First, the
LAP RNY should be a shorter operation (there is less cutting and no need to
stitch up muscle, underlying tissue and skin). Secondly, because the wound
sites are much smaller in the LAP, there is far less of a risk of a
wound-site infection. Thirdly, with less cutting, there is less blood loss
in a LAP and a surgeon's vision is improved (w/ only minor exception for
one of the connections). Fourth, given the reduced incision site, recovery
time is vastly improved and post-operative movement can be commenced within
hours of surgery. Fifth, there is simply less pain and discomfort from a
LAP, less of a need for pain meds and, hence, in that regard alone, less of
a risk of the complications associated with the administration of pain
meds.
With an experienced and dedicated surgeon, the LAP procedure is safer for
the patient, carries less of a risk of wound infections and facilitates a
shorter hospital stay and faster recovery. And, by checking for leaks
before the patient leaves the OR, there is no need for a drain to be
inserted.
The risks of knicks to intestines, I think, is more an issue for an
inexperienced surgeon. Also, the allegations that LAP RNY's take longer is
only asserted because many inexperienced surgeons attempt LAP procedures.
Sorry, I guess I did rant on this one. But, I had my LAP RNY on 10/9/02
and at the time weighed over 500 pounds (w/a BMI of more than 61) so I also
don't buy the story that many patients are too heavy for the operation (nor
do I believe that patients with past abdominal surgery are necessarily
disqualified as I know of many such people who have had LAP RNY's at
Norwalk Hospital in CT). In short, find a surgeon who appreciates that
you'll benefit from a LAP procedure and who has dedicated herself to
securing the training she'll need to see you through.
— SteveColarossi
June 6, 2003
My BMI was 82 and at the hospital I chose I had no choice I was going to
have open. The surgeon checked for leaks during the surgery. And my pain
was not so bad I was even able to scooch myself over to my bed in the
recovery room. As far as developing a hernia, I'm defintely going to need
some type of skin removal surgery so I'm looking at extra surgies anyway
and I believe hernia repair can be done during skin removal. I had a
little it of drainage from my incision but by the time the staples were
removed it had healed completely.
— Sarahlicious
June 6, 2003
I agree with the others who said it all depends on the experience of the
surgeon. There is no better or worse. If you chose a surgeon who's done
100 surgeries vs. one who's done 1000, whether open or lap, the risk is
greater for problems. Just remember, lap requires more specialized
expertise, all the more reason to carefully check out the surgeon.
— Leslie F.
June 6, 2003
I fully support Steve's response. Everything depends on the experience and
expertise of the surgeon! In the hands of a qualified laparoscopic
surgeon, an uncomplicated lap RNY should not take more than 1-2
hours....with few exceptions can be successfully performed on patients
weighing as much as 500-600 pounds...allows much greater visualization of
the surgical field than any surgeon can see with his/her naked
eye...diminishes the frequency of post-op complications such as pneumonia
and blood clots, because the patient is up and moving so quickly after
surgery and requires so much less pain medication. Unfortunately, there
are alot of "myths" that circulate about the disadvantages of lap
surgery....even more unfortunately many of these myths originate directly
from the mouths of surgeons who only perform "open" surgery in
their practices. Just because a surgeon only performs open surgeries does
NOT mean that he is a less qualified surgeon...it only means that he has
not had, or does not choose to take the time away from an already
established practice to take, the highly technical and specialized training
required to perform laparoscopy. Please remember that the
"internal" work is exactly the same with either open or lap...it
is only the external access to the internal organs that differs. If the
five of us in my family who have had lap RNY had not been able to locate
our highly trained bariatric/laparoscopic surgeon, we definitely would have
researched surgeons who perform open surgeries, and chosen one with whom we
were most confident. Having the surgery itself, and being able to look
forward to a new/active/healthy life was the primary goal...how we made the
journey, either open or lap, was important to us, but still secondary.
Make the choice that seems completely right for YOU....best wishes!
— Diana T.
June 6, 2003
Wow, Steve! Is there anyway we could just cut and past your answer whenever
this question pops up?! There is no greater margin for error in lap WLS
surgery than in in other laparoscopic surgery. There, is, statistically,
a greater chance of developing an incision hernia with open. My husband
had lap RNY and came home from the hospital the next day. (I had to stay
until the second day after mine.) Like the other said, in a nutshell: it
depends on the skill of the surgeon doing the surgery!
— koogy
June 6, 2003
Open has a large risk of incisional hernia LAP near zero. Opens risk of
infection is more too, because more of your insides is exposed tto room
air. This directly from Barb Thompsoms weight loss surgery book. It all
depends on the skill of the surgeon. Pick the surgery you want then find a
surgeon who does it.
— Sam J.
June 7, 2003
With all due respect to Steve, I had BOTH and had none of those 'bad'
things happen to me either time. I had my second surgery, open, at 4 in
the afternoon and was up and walking by 10:00 pm. I had NO drains, no pain
meds (and did NOT need them) and a year later, no hernia. I still say you
are best off to find the surgeon you trust and go with whatever he/she
recommends. The one question I wish I had asked my surgeon pre-op was how
many RNY procedures he had done Lap. The people I knew of who had used him
had all had open precedures. I'm guessing (and this IS a guess) that he
had not done very many when he did mine. Had I know that ahead of time, I
probably would have chosen to have him do an open to start with.
— garw
June 9, 2003
Very good question that warrants an answer...IMHO, it largely depends on
the experience and skill of the surgeon that performs the RNY~whether it's
open or LAP. In many of our cases, our surgeon(s) chose to do one or the
other. Mine, incidentally, is known for his expertise and skill in the Lap
RNY. I see other posters that agree that it depends on the surgeon. There
is a risk of kinks or "knicks" in the bowel and MANY other
complications. As with ALL surgeries, there is the risk of bleeding,
infection, bowel obstructions, pneumonia, pulmonary embolus, and the list
goes on...and on...and on. You're absolutely right, everything is
magnified. I will say this, the surgeon originally that was to do my
surgery did not do it. There wasn't a specific reason why other than I was
offered a more "inexpensive" price and I could get it done sooner
if his partner did it. Well, his partner performed my LAP RNY with no
complications to date related to the surgery. I'm doing very well, down 105
pounds, (but recently discovered I have gained a couple pounds) and I'm not
real concerned about it! BTW, I was my surgeons' very first patient. So I
feel kinda special. In answer to your question though, on a serious note,
go with the surgeon YOU feel comfortable with, but be sure to check out his
credentials~thoroughly. His skill, and ask questions. I didn't check out
the surgeon that ended up doing my surgery, BUT, I had faith, trust and
confidence in him because the surgeon under which he was training/working
with is held in my highest regards and known all over the world. The
decision is yours alone. Best wishes in your search and your journey
towards WLS!! LAP RNY 9/3/02 265/158/115-126
— yourdivaness
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