Laparoscopic or Opened UP ?

I went to a meeting up @ UCONN on Monday. Was my 1st. They tell me Dr. Giles only opens you up - no Laparoscopic. I've had my gallbladder out laparoscopic. How do you go about choosing a Doctor/Which Procedure? Would love to know a % of which one is done most. Any help?

If you needed knee surgery, you wouldn't entertain a surgeon who would want to open you up, rather than perform it arthroscopically, right? Because we all appreciate with a knee that recovery time is much quicker with less cutting. Well, the exact same logic holds true for the laparoscopic versus "open" debate. So the relative percentages matter little because the laparoscopic procedure is simply better for the following reasons: shorter time under anesthesia, quicker recovery time, much smaller risk of incisional hernias and wound infections. First, let's assume that you have two competent surgeons who are relatively quick, who each have comparable experience and who both offer good after-care support for their patients. But given that the equally skilled surgeon must close a lengthy incision after performing the surgery, there is some considerable time spent in the OR for the open patient that is not needed for the laparoscopic patient-- -- that is more time under anesthesia (which translates to more risk) than if you had a laparascopic procedure. Secondly, the stapler that is most commonly used in "open" operations does not automatically transect the pouch from the remainder stomach. Not that many surgeons who do the operation "open" don't take the extra time to transect (which results in far fewer longer-term complications from staple-line disruptions), but it is important to note that, once again, the "open" procedure tends to result in a surgeon having to do additional work that lengthens the time of the average procedure. Thirdly, there is less blood to impair the field of vision for a surgeon who performs the operation laparoscopically-- therefore, combined with the magnification of the surgical field from the television monitor in a laparoscopic operation and you have minimized some of the risks associated with abdominal surgery. But, given that we've assumed you are compairing two equally competent surgeons, the field of view issue is not quite so important. However, what is most important is the appreciably higher rate of wound infections and incisional hernias among patients whose procedures were done open. Regardless of the skill of the surgeon, these complications are appreciably higher for "open" patients than for laparoscopic patients. Plus, given the length of the incision, there is more discomfort from the open procedure, typically longer hospital stays (although may only be a day or two) and longer recovery time. Although many who have had open procedures will offer their anecdotal evidence of speedy, complication-free recoveries, the fact remains that the recovery time from an open procedure is a lot longer as is the average hospital stay. These are the reasons why a recent NIH white paper described the laparoscopic procedure as the "gold" standard for weight loss surgery. Lastly, once again assuming equally skilled surgeons, you can rest assured that almost anyone can have their procedure done laparscopically (my BMI was 62 at the time of surgery and Dr. Crum also performed a laparoscopic RNY on someone with a BMI of over 80). But, as everyone will tell you, the most important factor is finding a surgeon with whom you have a rapport and with whom you will feel comfortable with the lengthy follow-up work that is required.

Each doctor has their preference to open or Lap, and you have to respect them for the choice they make. I knew I wanted the surgery lap - so I chose a surgeon (with my PCP's help) who had a great reputation with lap surgeries. I used Dr. Bell in New Haven, and he is wonderful. Many people on this board have had their surgeries open, and I know that they are very pleased as well. I'd bet there are more open surgeries performed than lap -- simply because lap is very specialized and more difficult to perform. I would only go to a surgeon who was highly skilled at laproscopic surgeries for Lap RNY. Best wishes to you on your journey. God Bless, Kathy Bilodeau Lap RNY 12/3/03 -98 lbs. Were you sitting in the front row of the meeting? I was there as well - did a lot of talking (I really needed to be there that night).

I am going to disagree with Steve. The Lap procedure actually takes longer than the Open Procedure. There are pro's and con's to both. I had the luxury of chosing my surgeon, and trust me I met with many surgeons. At the end of the day, it comes down to 1. making sure you have a competent surgeon and 2. that he or she is an expert and well versed in the procedure. Don't let the fact that he only does open detract you from chosing him as your surgeon. If you are comfortable and have confidence in him, and have researched him then go with him. The recovery for Open is typically longer than the Lap procedure. As I said, I had Open and no problems whatsoever and was back up and running full speed ahead in four weeks. Good luck!

WHY DO YOU DISAGREE WITH STEVE? MY LAPRASCOPIC WITH DR. CRUM WAS 1 1/2 HOURS, HOW LONG DOES OPEN TAKE? YES IT IS MORE SPECIALIZED BUT, THERE ARE DOCTORS THAT SPECIALIZE IN LAP LIKE DR. CRUM. THAT IS ALL HE DOES UNLESS ABSOLUTELY NECESSARY. I AGREE THAT YOU SHOULD HAVE A COMPETENT SURGEON. SO YOU HAVE TO DO YOUR RESEARCH THERE. FIND OUT HOW MANY THEY HAVE DONE. EVERYTHING I HAVE READ SAYS TO BE SURE THAT THEY HAVE DONE MINIMUM 100 WLS. I BELIEVE DR. CRUM WAS UP TO 450 OVER 4 YEARS WHEN I HAD MINE DONE. THAT IS WHY I WENT TO HIM. MY GENERAL SURGEON SAID IT IS VERY IMPORTANT TO ASK THIS, BECAUSE THE MORE EXPERIENCE THEY HAVE THE BETTER THEY ARE AT IT AND IT IS A VERY SPECIALIZED SURGERY. THE RECOVERY TIME I GUESS IS DIFFERENT FOR EVERYONE BUT, I WAS BACK UP AND BACK TO FULL TIME MOTHERHOOD AFTER ONE WEEK. I STILL GET TIRED SOMETIMES BUT, 6 WEEKS OUT I DON'T THINK THAT IS ANYTHING TO DO WITH THE OPEN OR LAP. I AM NO EXPERT BUT, THROUGH ALL MY "FINDING OUT", EVERYONE OF MY DOCTORS TOLD ME THE LAP IS WHAT THEY WOULD PICK OVER OPEN, IF DOCTOR'S SKILLS WERE EQUAL FOR MOST OF THE REASONS STEVE MENTIONS. DON'T CHECK WITH JUST ONE OR EVEN TWO, CHECK WITH AS MANY AS YOU CAN. THIS WILL ALLOW YOU TO MAKE THE MOST INFORMED DECISION POSSIBLE. MYSELF, LIKE MANY POST OP PATIENTS LOVE THEIR DOCTOR AND THINK THEIRS IS TOPS, SO LISTEN TO THE ADVICE HERE ON THE BOARDS BUT, MAKE YOUR OWN DECISION BASED ON YOUR OWN RESEARCH! GOOD LUCK

The Laproscopic procedure IS quicker than open. Not vice-versa. You are correct in saying thay recovery time with Lap is quicker, that is true. I was rearin to go in 2 weeks. I do agree that you must find a competant surgeon and that the fact that the surgeon of choice only does open should not deter someone. I think Steve has some great points. Also, it all boils down to an individual decision. My gallbladder surgery in '96 was lap and I am a big fan of my skin and little scaring, therefore, chose LAP RNY. Tara

In many many cases the Lap does take longer than Open. I had three surgeons tell me that, and I have no reason to doubt their word. My Open RNY only took 2 hours and that was because they took my gall bladder out.

Hi Sharon, You'll notice that the topic of open vs lap and what doctor to chose can become heated. We're all in favor of what WE had, both surgery type and we all love the Doctor WE had. With research, hopefully you'll love your Doc too! But there are other factors you need to look into, like aftercare program, the doctors training, accreditations, office staff and most of all you need to feel 100% safe and secure with the Doctor you chose. It's an individual choice, only one you can make. And I have to disagree with Steve too. I had open RNY done and was off pain meds in 3 days and driving in 5. I took 6 weeks off from work but could have easily gone back in 2. Because Lap is quicker with a shorter recovery time does not necessarily make it better for YOU, or me, or anyone else. My Dr does both but is more comfortable with open because he can see inside to make sure there are no leaks. Just hearing he was more comfortable with open was all I needed to hear. Best of luck on your journey, -Deb

Yes, I agree with a little of what everyone says here. I had incision...doc told me that Lap was longer too..but I have found conflicting opinons to that. He was more comfortable doing open. I do not feel like my incision hindered me any more than my GB lap incisions did a few years ago. I was back to work in 16 days. Like someone said..you need to trust what the surgeon you picked in comfortable with. 'Good Luck in your decision process. Joanie

With some of the statements that have been made, I would be remiss if I didn't do my part to clear up some common misunderstandings (acknowledging at the outset that I do volunteer as a facilitator of the new patient and early post-op meetings with Dr. Crum at Norwalk Hospital-- but, these opinions are my own). First, testing for leaks can easily done with a laparoscopic gastric bypass; a blue liquid is placed in the pouch and is readily apparent from the monitor if it leaks. Many surgeons, Dr. Crum (who performed my RNY) included, test for leaks while the patient is still on the operating room table so that they can be fixed and the patient can wake up able to sip water (without having to wait a day to perform leak tests by x-ray or CT scan). Secondly, although many people explained that their surgeons told them that it would take them longer to perform the procedure laparoscopically, no one can contradict that a laparoscopic RNY can be performed in less than 60 minutes; once again, closing the lengthy incision from the open procedure takes surgeons considerable time, a task which is not required in the laparoscopic RNY. There are simply no significant additional tasks required during a laparascopic RNY that counter the time expenditure required in making the lengthy open incision, keeping the field clear of blood and then closing that lengthy incision. Assuming that their are no health or physiological reasons to not have your RNY done laparoscopically, there is just one reason to have it done open: you prefer the surgeon who performs the surgery that way. And that, in and of itself, is a legitimate reason given how intensely personal the decision is to have gastric bypass.