Lap Vs. Open bypass
Hopefully you will get someone that has had open to respond. I'm actually surprised that they are offering you the option. It seems like they would only do that if needed.
Good luck.
Hello! Welcome! :-) Good questions!
You will receive various personal opinion undoubtably, what is best for YOU is individual and very personal and is based on YOUR research, comfort and choice. Making the best decision comes typically from being educated, informed and personal decision making/choices after some self reflection. REMEMBER THERE IS NO RIGHT WAY, NO WRONG WAY, NO BEST SURGERY ONLY THE RIGHT WAY FOR YOU AND YOUR SURGEON AND THE BEST SURGERY FOR YOU, all the rexst is others opinions! ;-) I had lap based on my needs and my research. But if open was all I could have I would of done it that way vs not at all. Sometimes the typical is not your experience we have similar OR tines open or lap in skilled surgeons so length under andesthesia is not always a big thing these day. happy researching! :-)
RNY done OPEN or done LAP is same surgery. Difference being HOW they complete the surgery.
SOMETIMES we want lap and get open always have to consent to both incase of complication and if they can not proceed lap....alot OF CHOICE OPEN VS LAP IS THE SURGEON YOU FIND, LIKE ETC. tHEIR EXPERIENCE IS A MAIN POINT OF CONSIDERATION!
Surgical Risks for open and lap know that....Some complications are common to all abdominal operations, while some are specific to bariatric surgery.
Weight loss surgery is MAJOR ABDOMINAL SURGERY. There are many important and potentially lethal complications known to be associated with this operation, and surgery in general. Some of the dangers are the same that are present in any operation that includes sedation of the patient. These operative risks are therefore not unique to this surgery, however, it is still important to review these risks. Following is a short list (NOT ALL INCLUSIVE!)
|
Complications |
Description |
|
Allergic Reactions |
From minor reactions such as a rash to sudden overwhelming reactions that can cause death. |
|
Anesthetic Complications |
Anesthesia used to put you to sleep for the operation can be associated with a variety of different complications up to and including death. |
|
Bleeding |
Surgery involves incisions and cutting that can result in bleeding complications, from minor to massive, that can lead to the need for emergency surgery, transfusion, or death. |
|
Blood Clots |
Also called deep vein thrombosis and Pulmonary Embolus that can sometimes cause death. It is imperative that you get up and walk around the evening of your surgery day to help prevent clots from forming in your legs. |
|
Infection |
Including wound infections, bladder infections, pneumonia, skin infections and deep abdominal infections that can sometimes lead to death. |
|
Leak |
After an operation to bypass the stomach, the new connections can leak stomach acid, bacteria and digestive enzymes causing a severe abscess and infection. This can require repeated surgery, and intensive care and even death. |
|
Narrowing (stricture) |
Narrowing (stricture) or ulceration of the connection between the stomach and the small bowel can occur after the operation. This can require emergency operation, intensive care and can sometimes lead to death. |
|
Indigestion, Reflux or Ulcers |
The operation can sometimes lead to severe nausea, vomiting, indigestion, abdominal pain, gastritis or ulcers. This can be severe and can last for days, weeks or possibly even longer. This is especially likely if you have had previous problems with nausea, abdominal pain or ulcers. Bile reflux is also a possibility, and may necessitate additional surgery. |
|
Dumping Syndrome |
Dumping Syndrome (Symptoms of the dumping syndrome include cardiovascular problems with weakness, sweating, nausea, diarrhea and dizziness) can occur in some patients after gastric bypass. This can be so severe that the surgery may have to be reversed. |
|
Bowel Obstruction |
Any operation in the abdomen can leave behind scar tissue that can put the patient at risk for later bowel blockage or obstruction. The bowel can twist, obstruct or even perforate leading to serious complications and even death. |
|
Laparoscopic Surgery Risks |
Laparoscopic Surgery use*****tures to enter the abdomen and this can lead to abdominal injury, bleeding and even death. |
|
Side Effects of Drugs |
All drugs have inherent risks and complications and in some cases can cause a wide variety of side effects, reactions and rarely cause death. |
|
Loss of Bodily Function |
The performance of surgery and anesthesia can stress the body’s systems leading to a variety of complications including stroke, heart attack, limb loss and other problems related to operations and anesthesia. |
|
Risks of Transfusion |
Including Hepatitis and Acquired Immune Deficiency Syndrome (AIDS), from the administration of blood and/or blood components. The illnesses are serious and can be fatal. Hernia Cuts and incision in the abdominal wall can lead to hernias after surgery. Hernias can lead to pain, bowel blockage, obstruction and even perforation and death in some cases. Treatment of hernias usually requires another operation. |
|
Hair Loss |
Many patients develop hair loss for some period of time following an operation. It usually occurs 3-4 months following surgery, and resolves at 7-9 months. This usually responds to increased oral intake of protein and vitamins, but it may be permanent. |
|
Vitamin and Mineral Deficiencies |
After gastric bypass, there is a malabsorption of many vitamins and minerals. Patients must take vitamin and mineral supplements forever to protect themselves from these problems. You also need to have yearly blood tests to measure the blood levels of these vitamins and minerals. Common deficiencies that can occur after gastric bypass include iron and calcium deficiency, B12 and Folate deficiencies.This is very important: Patients must take vitamin and mineral supplements forever. In some cases the deficiencies are so severe that they can lead to nerve and brain damage and the bypass must be reversed! |
|
Excessive Weight Loss |
Some patients sustain excessive weight loss after the operation and may require reversal of the bypass to prevent severe malnutrition, nausea or vitamin and mineral deficiencies or death. |
|
Complications of Pregnancy |
Vitamin and mineral deficiencies can put the newborn babies of gastric bypass mothers at risk. No pregnancy should occur for the first one to two years after the operation. Gastric Bypass has been shown to cause multiple types of vitamin and mineral deficiencies including: iron, B12, Folate, calcium and many others. Many of these deficiencies have been shown to cause birth defects or are suspected to cause birth defects. We also know that many patients who lose weight feel that they are well after surgery and forget to take their vitamins. Patients MUST be certain not to miss any of their vitamins if they decide to go ahead with pregnancy later. Unplanned Pregnancy Warning to women using oral contraceptives (birth control pills): More than 80 million women worldwide take “the pill" to prevent pregnancy. Studies have shown that oral contraceptives affect a woman’s hormones. This surgery also affects hormones, and interferes with the bodies ability to regulate hormonal levels. Thus oral contraceptives or other hormonal types of birth control (i.e. Depo Provera) are NOT RECOMMENDED as a reliable prevention of pregnancy following a gastric bypass. A barrier method is recommended, but be aware that your body changes rapidly during the initial weight loss period, and a diaphragm would not be especially reliable, either. |
|
Other |
Major abdominal surgery, including the Laparoscopic Gastric Bypass, is associated with a large variety of other risks and complications, both recognized and unrecognized that occur both soon after and long after the operation. There is also a risk that you may not lose all of your excess weight before your body adapts to the bypass, and causes your weight loss to slow or even to stop prematurely. |
|
Depression |
Depression and anxiety are common medical illnesses and have been found to be particularly common after gastric bypass surgery. You must have a mental health plan in place, and make your family or support system aware of the signs and symptoms of depression, so that they can get you the help you need. |
|
Death |
This is a major and serious operation. It may lead to death from complications in some cir****tances, despite our best efforts on your behalf. |
Open the surgeon makes an incision (may be as small as 4-5 inches of some as long as 18+!) this is individual based on what surgeon needs to operate on YOU...He then performs the operation with his hands and has full access visually open to your abdominal cavity.
OPEN TYPICAL (your mileage may vary) benefits:
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
lower incidence of a leak
lower risk of internal hernia
SOmetimes shorter OR time although note: ***With experience, a skilled laparoscopic surgeon can perform most procedures as expeditiously as with an open incision!!!
many have stated personal comfort having surgeon see and use hands for operation decreasing risk with lap equipment (although in a very skilled Lap surgeon the debate is this is just as safe/effective even more is able to be visualized in this manner in a Morbidly obese person when they use the camera after inserting the gas intocavity..)
LAP TYPICAL (your mileage may vary) benefits:
The Laparoscopic Gastric Bypass, Roux-en-Y, first performed in 1993.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
lower wound infection rates
lower risk of abdominal adnesions
lower/almost non-existent hernia rate
typcially less pain than open
typically shorter hosptial stay than open
typically shorter recovery to return to life than open
4-6 small incisions 1/2 inch +/- than larger one with open
Benefit of limitation on handling and feeling tissues, decreasing trauma/swelling etc.
Mortality and complication rates
A recent large multi-center study[
citation needed]http://win.niddk.nih.gov/publications/gastric.htm#laparoscop reported that, in experienced hands, the overall complication rate of this type of surgery ranges from 7% for laparoscopic procedures to 14.5% for operations through open incisions, during the 30 days following surgery. Mortality for this study was 0% in 401 laparoscopic cases, and 0.6% in 955 open procedures. Similar mortality rates – 30-day mortality of 0.11%, and 90-day mortality of 0.3% – have been recorded in the U.S. Centers of Excellence program, the results from 33,117 operations at 106 centers.http://en.wikipedia.org/wiki/Gastric_bypass_operation
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
Jamie Ellis RN MS NPP
100cm proximal Lap RNY 10/9/02 Dr. Singh Albany, NY
320(preop)/163(lowest)/185(current) 5'9'' (lost 45# before surgery)
Plastics 6/9/04 & 11/11/2005 Dr. King www.albanyplasticsurgeons.com
http://www.obesityhelp.com/member/jamiecatlady5/
"Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"
I had moderate pain at the incision site, but I felt the same pain at the small incision where the drain was as well.
For me the hardest part was lying down to sleep once I got home. I wasn't able to fully lie down for a few days, so I slept propped up on the couch.
I took 3 weeks off work, but I could have gone back to work after a week and half.
Yasmeen
5'6.5" - HW 239.4 / SW 226.8 (Feb 5, 2010) / GW 120 (Jan 6, 2011) / LW 116.8
I had open and I was up and around in no time at all. All people are different in recovery time though. I opted for open because I liked and felt comfortable with my surgeon and it was less time I was on the table which was alright with me since I have asthma and he didnt want me on my back for along period of time but having 300+ lbs is alot to be bearing on your back. But its what you feel comfortable with and your intuition will let you know. I wouldnt change my decision for all the money in the world. I healed very well with no signs of infection my scar isnt that bad anymore and Im glad I had opened. BUT not everyone is the same just remember that just because this procedure went well with me doesnt mean it well for someone else. Go with what you want and feel is best...I based my decision on the surgeon and what he performed and went from there!! Good luck with your choice!!
Good Luck
Tressa
