What is your current challenge

Tweedy, I had the open proximal and I was on solid, soft food at 1 week post op. There is a lot of misinformation about the open procedure. Everyone thinks lap is painless or even pain free, they think with the open procedure muscles are cut and with lap none are cut. NONE of the above are true! In my case I chose to have open because I wanted the procedure my doctor does, which can only be done open. I have had zero pain from the time I woke up in the recovery room. I was at my surgeon's support group 1 week post op. irene

Hey, It sounds like your recovery has been terrific! My recovery has been pretty amazing as well. I hope I did not offend you with my comment in regard to open verses lap. Now in regards to eating, the information that I received came from my surgeon. He does open and lap, and does not seem to be partial to either. He stated that his open RnY patient's tend to transitions slower to solid foods and the amount of food that they can eat tend to be less than those who have lap surgery. In fact, I was very scared I was doing something wrong the first few weeks because I could eat between 4-6 ozs of food. Now, in regards to recovery time etc., my information is taken right from the national association of bariatric surgery. I also found supporting data in JAMA (Journal of American Medical Association). Data reflects that Lap, rather it is for gastric bypass or any other surgery is easier on the body, recovery time and length of stay in hospital is shorter, less scaring, less complication, less time off from work, less chance of hernia's and so on. However, one must also keep in mind that research uses the statically formulation of the Bell curve, meaning this is about averages, not individual cases. There will always be outliers, meaning those *****bound very quickly from open (as in yourself) and then those who experience complications with Lap, but to be statistically significant a variable has to occur less than .05 % of the time. Tweedy

I was not offended by your post. I do find that there is a lot of misinformation about wls in general. Even the statistics regarding mortality. For example, I often see it quoted that the mortality rate is 1:200. Do you know where that number comes from? Those are the figures of the best surgeons voluntarily reporting their data. There are no groups that regulate this industry at this time. Rest assured if a surgeon has a poorer track record, they would not disclose it, and in fact some outright lie to their patients. As far as your mention of hernia, there are different types. It is true that incisional hernias are more common with open. But the more dangerous type of hernia is the internal kind, most often seen in lap surgeries. As far as being able to eat 5 or 6 ounces post op, this is because lap surgeons are not able to make the pouch smaller due to the instruments used. Plus they are not able to cut on the lesser curvature of the stomach. This means that the pouch is much more prone to stretching. VERY few surgeons are able to suture the stomal and intestinal connection, so they use staples instead. There is a much higher chance of ulceration with this method. I am not trying to offend or bash anyone's choice. There are great and important reasons to have lap surgery. I just find that so many people are afraid of open surgery and really, it is the skill of the surgeon and his use of pain control that make the difference for both surgeries.

Hey Irene, The 1:200 statistic is what the National Bariatric society reports. However, the statistics are based on what is reported by whatever respective surgeon. When I did my own research I was much more interested in actuary data for my surgeon. In fact, I contacted my state's medical board to see if there had been in claims filed against him, which there had not been. I also found that he has never had any complications or deaths with Bariatric surgery. I encourage everyone to thoroughly research your physician. Now, I try my best to identify the source of my information. Would you please identify the source of your information in regards to the number of ounces a person can eat (as a whole), curvature of the stomach, prone to stretching, and higher risk of ulcerations. Many of these occurrences were nowhere to be found in any of the medical journals I reviewed (which were many). Nonetheless, information approximating what you listed I did take the liberty of posting. In addition, I think you made a very good point when you said that each surgeon is going to be different in his or her technique, which will also dictate what type of problems you will or will not have. Now I know several people who had lap who could only eat a small amount of food 2-3 ozs. I am not sure if that is a question of what the technique could do or not do, or what the surgeon prefers. Since individuals are going to be different and you will always find anomalies, I tend to stick to research based information (which is published in a national and recognized journal....reason, because these journals are bound by regulatory boards and will be severally reprimanded not to mentioned publicly embarrassed by publishing faulty data). Suturing of the stoma- When a person has the lap procedure, the instrument makes a different shape, which does not gap and will heal fine without being sutured, which is not so with the open procedure. Now there is another procedure, popularized my Dr. Fobi, which is when a silastic ring is used. Now there is research that appears to support some differences with this procedure, but no data was found in what you were citing. I only published the abstract and not the article in its entirety, but this article compares Lap and Open. The article is objective as well. In fact every article I found listed common differences, again many of the differences you mentioned in your post were not included as such. However, wound problems (abdominal wall hematoma which I think you were referring to occurred more in Lap patients, well data reflects that as little as 1.5% of patients who have lap have such occurrences. Anyway, the statistical differences are listed below in the abstract. The overall conclusions is as follows: Each operative approach has associated problems.Wound care problems and ventral hernias are more common in Group B (open) and anas tomotic stenoses are more common in Group A (laparoscopic). Anastomotic leaks and small bowel obstruction are troublesome but not statistically different in occurrence. With this said, both procedures have positives and negatives. It is a question of what is more conducive to your lifestyle. For me, I needed something that was not so invasive, and rebound time relatively fast. I have a 17-month-old child that after 3 weeks I could lift and care for, which was very important. I am in private practice and needed to be able to go back to work, because I am not paid otherwise....so this was very important. Well the abstract is as follows and thanks for the dialogue, Tweedy Abstract: Background: Open Roux-en-Y gastric bypass (RYGBP) has proven to be an effective method for weight control for the morbidly obese patient. With technologic and surgical skill advancement in the application of laparoscopic surgery, laparoscopic RYGBP has also been found to be of value in surgical control of obesity. Risk/benefit ratios in comparison of the 2 methods are undergoing definition by experience. Methods: 779 patients who underwent RYGBP between March 1, 2000 and June 30, 2002 were evaluated retrospectively. 328 patients underwent laparoscopic RYGBP (Group A) and 451 underwent open RYGBP (Group B). All charts and hospital records of these patients were reviewed. Questionnaires were mailed to all patients who had undergone RYGBP. Follow-up was 5-29 months. Results: 89 patients in Group A and 162 patients in Group B experienced significant morbidity. There were no surgical deaths in Group A and one surgical death in Group B.Weight loss profiles were the same. Significant differences in morbidity were noted with respect to gastrojejunal stenosis (Group A = 11.6%, Group B = 4.7%, P=.0012****urrence of ventral incisonal hernia (A=0%, B=10%, P

oops, sometimes I get long winded...all of my post did not post, so here is the rest! Tweedy Significant differences in morbidity were noted with respect to gastrojejunal stenosis (Group A = 11.6%, Group B = 4.7%, P=.0012****urrence of ventral incisonal hernia (A=0%, B=10%, P

I give up it still did not post for some reason! If anyone cares the rest of the article can be found: Obesity Surgery 1 August 2004, vol. 14, no. 7, pp. 1008-1011(4)

I am 3 weeks out yesterday. My biggest challenge is getting enough food in and also not drinking while eating. I get so thirsty while eating, and I too watch the clock to see when I can drink again. I have to take the drink off the table or I will drink it without even realizing I am doing it. I am struggling with the exercise thing too. I was going to the YMCA 4 days a week and working unloading food at the food bank one day a week. Then I fell down the steps and tore a groin muscle. It is not healing, and my doc just referred me to an ortho doc for evaluation. It is painful to walk, so I am having to do less than I would like too. I hope it gets better soon, but it has been several months now and is still a nagging injury. Jules

Julie I am sorry to hear about your unfortunate injury. Try not to be too down on yourself. You sure do not want to start doing anything too early and reinjure the area. I hope you get some good information from your ortho evaluation so that you can better gauge how and what you need to be doing. You will be in my prayers, Tweedy

What a great post, Tweedy! today I am 3 weeks post op and have lost 28.5 lbs. I am still on protein shakes so my biggest challenges are staying on the protein shakes for another week and getting all my liquids in and exercising! I'm thrilled with the weight loss but at times I really want to eat and others I have absolutely no interest in food. For the first time in my life, I love getting on the scale and seeing the numbers 1 to 3 lower then the day before. Good luck with the trainer, sounds like terrific motivation. CJ 246/217.5/138

Thanks for the support CJ! I have a schedule I keep right now, which is kinda funny, but it helps me make sure I have taken all of my vitamins (goodness there is a lot) and got in enough protein! Oh yes, for the first time I love getting on the scales too! Good luck with the protein. I am soooooo happy that I was only on liquids for 6 days before moving on to a soft diet. I was so hungery on that 6th day that I did not know what to do! Tweedy