Do I choose Lap or Open WLS?

How did the ones of you that have already had your surgery decide on which procedure? Or to have to done lap or open? Every doc does a different version it seems. My one friend who had Opened gastric Bypass got a terrible hernia. She said she couldn't exercise or anything..Now maybe that was her excuse NOT to..I just don't know. I was thinking I would have to Lap procedure to restrict and malabsorb..but Dr Clark does it open. Did any of you have more problems healing with open? How does the scar look compared to laproscopic? He seems like such a great doc so I hate to find another MD just because I think laproscopic may be better. Any input will be appreciated !! Dana

Dana, Many of the reasons why someone goes for one procedure versus another is based on what the doctor does. Also, some doctors prefer to do open procedures on patients who are larger and/or if you have had previous abdominal surgery. But I think the laproscopic doctors are getting more skilled and are doing more patients these days. In my husband's case, the doctor he was referred to only did open procedures. He had done them for well over 30 years. My husband's scar healed just fine and no hernias to date and he is 18 months post-op. He had to wear a binder (elastic strap on band) around his middle for a few weeks after surgery. He was restricted from heavy lifting and certain exercising for a while. I forget how long but he was encouraged to go out and walk for exercise. I chose to have laproscopic surgery. Figured it was less invasive. I went to a surgeon who did both laps and opens. I do know a few lap patients that have hernias now too so don't assume that if you have lap you won't get one. I would assume that the risk of hernia is reduced with lap surgery. My lap scars are tiny and well healed. I also had to have follow-up lap surgery (gallbladder removal) a few months post-WLS and those have healed well too. No hernias. I am 8 months post-op. One procedure isn't necessarily better than the other. You probably want to ask if the open procedure "transsects" the stomach from the pouch. This means that the remnant (remainder of the big stomach) is surgically separated from the new pouch. Many of the older open surgeries didn't do this. It is better because it eliminates the risks of staple line disruptions where the line of staples between the pouch and old stomach wears out and stomach acids can get into the new pouch. That can cause ulcerations but also the food you eat can go into the old stomach and you won't end up feeling full for long. To me, this is more important than whether there is a big incision or several small ones. Kathy

Thank you Kathy.. You brought up some great points to bring up with my doctor. He does the VBG and the gastric bypass...so I think he does transect the stomach. Also..he said he takes the gallbladder out while he is in there. Dana

There is a difference between the VBG and RNY. The VBG does not have malabsorption issues. You keep the same entrance and exit from the stomach but the stomach is cut to be long and narrow kind of like a banana and then a band is put around it to keep it from stretching out. The remaining stomach is physically removed from the body since it is no longer attached to anything. The RNY you bypass part of the intestines so malabsorption of fats as well as vitamins occurs. You don't produce stomach acids anymore in your new pouch since the pouch is made from the very top of the stomach so you have to be careful what vitamins you take (do not take the kind that need stomach acids to breakdown). You will have to take vitamins for the rest of your life. You don't have a pyloric value at the exit of the stomach so food can wash right through if you drink when you eat and some foods that hit the intestines fast can cause things like dumping syndrome. The remnant stomach is usually left inside and these days is usually transsected (separated) from the new pouch so it is just sort of hanging there. It still produces acids which meet up with foods much further down the intestinal path. Weight loss from VBG is usually slower than RNY because of the malabsorption of fats and such that RNY has. Still, many folks lose very well with VBG and get to goal. I had to have my GB out 5 months after WLS. Luckily it was done lap and was pretty easy on me. Glad to have it gone! Take care! Kathy

Dana , I had no choice but to have it open . And I am glad I did . My surgeon goes in and looks at all of your organs . Not to mention he can get in there and do it all !!! I have no regrets ... you can read my profile .. if you wish.. I am 20 months out .. No hernias .. and I was running my 2nd month out from surgery .. Best of luck to you on your decision . Hugs, Nat

Hi Nat , LOVED your profile !! WOW !! Thanks for your input. Dana

Dana: It really comes down to what YOU decide. I went into my journey wanting the very best surgeon available - period. I have a medical background and my wife is a nurse. Her worries kept me from having the surgery for about 2 years but during that time many advances took place and the number of procedures grew. I researched it very well and knew the risk but wanted to have the procedure and as few complications as was possible. I went to my first session convinced that I wanted Dr Hutcher. His reputation is the greatest and he only does open surgeries. However, I met Dr Bautista (who does lap and open) and was convinced that he was the right man for me. The risk of surgical complications (just from not being open and the quicker healing period) swayed my mind. I had open heart surgery 2 years prior and I wanted to prevent having that kind of pain and uncomfortable recovery again. I could have honestly returned to work with 4 days of my surgery via lap. I may be a rare case but there was no question that recovery from lap beats open hands down. I want to give you more of a reply but my board meeting is now starting and I have to get out to the meeting. Feel free to send me any questions or concerns you may have but the decision is YOURS alone. Weigh your choices and make a decision to stick with it. You will not regret it whatever your choice is! Good luck! Dave

Dave, Thank you for your response. I loved your journal. All the pics were great. Yeah..I think I chose a great surgeon but I was kind of hoping for the lap procedure due to the amount of downtime. Oh well..there are pros and cons to both as I have seen here and by reading about other procedures. Thanks again !!! Dana

Hi Dana! I had my surgery 6 weeks ago and it had to be done open, as I had alot of scar tissue...in fact, there was so much scar tissue around my liver (it was flattened) that the dr spent the first 1 1/2 clearing that away...I went to him today and I finally had my "G" tube taken out. What a relief. Now I go back in 3 months....I have lost 38 pounds and he wants another 30 off when I go back. My scar is 13 1/2 inches long and has healed beautifully. Either way, this is a magical tool if you work it right and do what the doctors tell you. My doctor laughed at me today when I told him I was dancing with the best of them this past weekend at the conference...with the tube just a flapping... Anyway, this is a decision that the dr usually makes. I am moving and walking better than before surgery! Watch out...this butterfly is getting ready to spread her wings and fly....what a journey. Good luck on you journey. HUGs.. Betsy

WHAT IS A G TUBE AND WHAT IS IT CONNECTED TO? WHY DID THEY KEEP IT IN SO LONG?