open or laproscopic?

One more article on lap vs open (Lap had shorter time, less complications/reoperation (half!) ....
News Author: Laurie Barclay, MD
CME Author: Désirée Lie, MD, MSEd

April 5, 2004 -- Laparoscopic gastric bypass is better than open gastric
bypass for morbid obesity, according to the results of a randomized
prospective trial published in the April issue of the Annals of Surgery.
The editorialist calls this procedure a major advance in bariatric surgery.

"Gastric bypass is one of the most commonly acknowledged surgical
techniques for the management of morbid obesity," write Juan A. Luján, MD,
PhD, at Hospital Universitario Virgen de la Arrixaca in Murcia, Spain, and
colleagues. "It is usually performed as an open surgery procedure, although
now some groups perform it via the laparoscopic approach."

Between June 1999 and January 2002, 104 patients diagnosed with morbid
obesity were randomized to treatment with gastric bypass via the open
approach (OGBP) or gastric bypass via the laparoscopic approach (LGBP).

Mean operating time was shorter in the LGBP group than in the OGBP group
(186.4 minutes [range, 125-290 minutes] vs. 201.7 minutes [range, 129-310
minutes]; P < .05), but 8% of the LGBP patients required conversion to
laparotomy. There were no significant differences between groups in early
postoperative complications occurring before 30 days (22.6% vs. 29.4%).
Compared with the OGBP group, the LGBP group had a shorter mean hospital
stay (5.2 days [range, 1-13 days] vs. 7.9 days [range, 2-28 days]; P < .05).

Late complications at 30 or more postoperative days occurred in 11% of the
LGBP group and in 24% of the OGBP group (P < .05), primarily because of a
high incidence of abdominal wall hernias in the OGBP group. During a mean
follow-up of 23 months, evolution of body mass index was similar in both
groups.

"LGBP is a good surgical technique for the management of morbid obesity and
has clear advantages over OGBP, such as a reduction in abdominal wall
complications and a shorter hospital stay," the authors write. "The midterm
weight loss is similar with both techniques. One inconvenience is that LGBP
has a more complex learning curve than other advanced laparoscopic
techniques, which may be associated with an increase in postoperative
complications."

Disadvantages of laparoscopic surgery include higher costs in the operating
theater because of nonreusable instruments and longer operating times if
the surgeon is inexperienced.

"This increase in intraoperative costs may be compensated by a shorter
intensive care stay during the first hours or days of the postoperative
period, a shorter hospital stay and a lower incidence of incisional hernias
that require subsequent reoperations," the authors write. "Operating time
decreases considerably as the surgeon's experience progresses. In our
experience, operating time is longer in OGBP, probably because of the time
spent during opening and closure of the laparotomy and because to create
the gastric pouch we perform dissection, probably excessive, of the angle
of His and the greater curvature of the stomach."

In an accompanying editorial, Robert E. Brolin, MD, from the University of
Pittsburgh Medical Center in Pennsylvania, compared this study to an
American study, and calls laparoscopy a "major advance" in bariatric surgery.

"It is my belief that the greatest beneficiary of laparoscopic Roux-en-Y
gastric bypass (RYGB) is the bariatric patient," Dr.Brolin writes. "After
more than 20 years of guiding patients through the occasionally perilous
perioperative period after open RYGB, I derive great pleasure from seeing
my patients walking in the hallways one day after undergoing laparoscopic
RYGB and writing the discharge order on postoperative day 2."

Ann Surg. 2004;239:433-437, 438-440

Make the light which is always upon your head a teacher, and acquire it for
yourself as a friend. (R. Eleazar Azikri)

I am waiting for Dr. Lelito's paperwork to get to the Docs. I am anxious to get this going. I was wondering the same questions you were and was happy to see that it was for the same doctors. Good Luck and it sounds like we will be hopefully close in surgery date!

How long have you been waiting? He told me it would take about 2 weeks. It will be 2 weeks on wed. He said it is that long since he has to wait for my drs. to submit records. Are you waiting for that too?

Well, it's the same surgery inside.  Many people say that it's a longer recovery time if you have it done open, but I can't agree.  Everyone is different and my surgery was done open.  I was back to work exactly two weeks from the day I had my surgery and was feeling good except for a small amount of fatigue.  It really is personal preference.  My decision was made when I met my surgeon...experience (that of the surgeon) made a big difference for me and that's why I made my decision.  My surgeon only does open and I only wanted that surgeon....easy decision to make!  There is a pain buster that my surgeon used that helped alot with the pain and healing...you can find info about the pain buster at askyoursurgeon.com.  Check it out and good luck to you.