Question:
Should I have WLS open or laprascopic?
I have been to the consult with the surgeon last month and he said that I was a candidate for wls.He is going to begin performing this surgery laprascopically in the next few months.I originally wanted it done this way but now I am worried that the risk of complications may rise because of his inexperience doing the surgery this way.I have weighed the pros and cons and the open way sounds sooooooooo painful!!Can the doc submit my approval request before I decide which way to have this surgery done?How awful is the open procedure will I wake up yelling in pain like other people have? — natalie J. (posted on August 14, 2003)
August 14, 2003
I had my RNY open and I didn't find it particularly painful. There was
pain but the doctor made sure it was controlled. This surgery wasn't as
painful as my c-section and I went back to work full time at two weeks
post-op with no problems. By the way, I was 55 when I had surgery and
weighed 346 pounds so I would think that I would have had a harder time
than younger people who weigh less. If I had it to do again, I would and I
would go with open.
— Patty_Butler
August 14, 2003
My starting BMI was 57 and I had open (cut from sternum to just above the
belly button). Pain was minimal, never scream. Remember panting a bit to
take a bowel movement or when I moved to quickly, but pain killers worked
really well and I was in less pain than with my first c-section. Frankly,
I'd choose lap if I had to choose again, however, I'd choose open rather
than have an inexperienced lap surgeon working on me. Good luck - rough
decision!
— [Deactivated Member]
August 14, 2003
The reason I chose open vs. Lap is my surgeon said that the risk for a leak
is much lower. He said he can hand stitch the pouch rather than just
staples. Since infection from a leak is one of the major causes of death,
I chose the open. Also, time on the table under anesthesia is much less
with open. I am only 4 months out and can't even remember the pain,
morphine is great stuff!
— blank first name B.
August 14, 2003
I haven't had my surgery yet, but I've decided to go with lap RNY. My
surgeon has 400 LAP surgeries under his belt, though. He has taught the lap
surgery to other surgeons. He does lap 95% of the time, even when patients
have high BMIs. He can do the lap in 90 minutes. Believe it or not, I'm not
doing an infomercial (infopost?) on my surgeon. :) I'm just showing you
that the guy has plenty of experience. Just because your surgeon does not
have the experience does not mean he'll be bad at the surgery. In fact, he
may go on to be the Marlon Brando of lap RNY. But do you personally want to
be one of the first he operates on lap? If you don't mind, I say go for it.
If you hesitate, go for the open surgery. You'll still lose the weight and
10 years down the road you more than likely won't care which way you had
the surgery. Good luck to you!
— jenn_jenn
August 14, 2003
I had my surgery performed lap and I am very happy with it. However, it is
more difficult to perform lap and I think requires more experience. My
surgery took 1 1/2 hours, but you often read here about much longer lap
procedures. My surgeon, an experienced lap surgeon, said that when he was
first performing the rny it took much much longer. I think it is really
important to choose somebody with lots of lap experience if that's the way
you are going. There's lots of money to be made off of obesity and lots of
doc's are jumping on the money train, so pick your surgeon wisely. Good
luck. Lynda ME/FL
— [Deactivated Member]
August 14, 2003
Mine was open and I'm glad. I'd rather have them SEE what is before them,
in real time and size. Not a camera and have to use that to see behind body
parts. I hear they sometimes nick bowels in LAP. I'm sure it could happen
with Open too. There are advantages to LAP, and advantages to Open. Myself,
I personally feel Open is safer. I certainly would'nt want to have a LAP
with someone who is'nt to experienced with it. However I've had 14
surgeries in my life, with more to come. Some things have gone well and
others EXTREMELY bad. So I look at medicial procedures and such different
than most people. I'm looking for anything that hopefully is safer. My
"gut feeling" (pun intended-lol) is Open is safer. But LAP people
have good reasons for their surgery too. In the end, you must weigh out the
pros and cons and YOU make the desicion. Good luck!
— Danmark
August 14, 2003
The surgeons group that did my surgery make the decision for you. They
prefer to do 80% of theirs lap for various reasons but sometimes have to
open you up. Mine was open. They make the decision based on your previous
surgeries and etc. many factors weigh into whether you can have lap or
open.
— Delores S.
August 14, 2003
Lap surgery takes a HIGHLY skilled Lap surgeon and I would not opt for Lap
with someone who is just starting to do it. These days I think that there
are more complications than need be because of lack of experience. You
surgery with a new Lap surgeon could take many hours, like 5-6, as opposed
to around an hour for open or Lap w/ a highly skilled Lap surgeon. If you
want Lap I would look around, otherwise go with what your surgeon knows
best.
— Carol S.
August 14, 2003
Laparoscopic surgery is a truly wonderful option if you are in the hands of
an experienced, trained laparoscopic surgeon. If your surgeon is
relatively new and inexperienced in this technique, then the risk factors
of longer anesthesia time and operative complications are significantly
increased. As a critical care nurse who has observed and assisted with
lap surgery, I did alot of research for myself and the other four members
of my family that ended up with lap RNYs. Although surgeons have to start
somewhere, I personally would not have chosen to have lap surgery with a
surgeon who is new or inexperienced in the techniques, unless he/she could
provide proof of extensive training or internship with an expert in the
field. There are a number of "myths" about lap surgery that seem
to surface from time to time in this group....that lap surgery takes much
longer than open surgery....that the surgeon can't see as well....that the
risks of complications are greater. All of these statements are basically
false IF the surgeon has extensive experience. In reality, an
uncomplicated lap RNY generally takes about an hour....red flags should go
up all over your world when you read about a standard, uncomplicated lap
RNY taking 3-8 hours. In addition, the surgeon can see the operative area
much more clearly with the lap cameras than any surgeon can see with the
naked eye....the smallest nerves and blood vessels are exposed to
view..."nicks" to other organs and structures unfortunately
happen during any surgery more frequently than most folks realize,
irrespective of whether the procedure is lap or open. Lastly, the risk of
complications (hernias, wound infections, etc...) are dramatically less
with lap surgeries. The issue of post-op pain should not really be your
primary concern since current pain management protocols in most hospitals
have improved significantly over past years. However, less post-op pain
and more rapid post-op recovery and return to normal day-to-day function
are also strong selling points for lap surgery. The bottom line for me was
always that I and my family would choose lap surgery if we could have the
services of a highly trained and experienced lap surgeon. If not, then we
would all have happily had open surgery. After all, it is the final result
that is most important, not necessarily how we achieve it. Best wishes!
— Diana T.
August 14, 2003
First of all...good luck with either choice you choose. When I had my
procedure done, it was done via Lap. That night I had severe gas pains
from the procedure (and I was on morphine too). The gas pain I'm talking
about is from the air they fill your belly up with to do the Lap procedure.
The following day they found a leak and I then had an open procedure done
to correct the leak. There was very little discomfort following this
procedure. If I had to do it all over again I would have preferred to have
the open procedure done the first time. But that's just MY opinion.
— John B.
August 15, 2003
When all is said and done, the biggest difference is the insicion. My
surgeon does both open and lap, but prefers open just because he likes to
be able to see things for himself. My RNY was done open, and I have no
regrets. My pain was easily managed, and I have had no
complications.<p>While there are risks associated with all surgeries,
the risks and complications are higher with lap than open. Granted, the
numbers are small, but they are still higher.</p><p>The main
thing is to find a surgeon who is competent and whom you trust. Search for
and talk to their patients and see what they have to say. Go to their
support group meetings. Your research will pay off!</p><p>Good
luck!</p>
— Rachel T.
August 15, 2003
I absolutely have to agree with Diana! There are those "myths"
about lap surgery. Do be aware that even when surgeons have completed
extensive training to do lap surgery, they most always have another surgeon
who has even more experience there with them. And as far as using the
camera, that can give the surgeon a magnified view of a single stitch, if
need be, far more definative than simply what the human eye can see. Plus,
with all the trocars in the abdomen, the surgical field is actually bigger
than on open incision with retraction. I found all the arguments for open
pretty groundless. I am very fortunate that my surgeon is the head of
endoscopic and laparoscopic surgery at a major teaching hospital! My
recovery was blessedly short and uncomplicated with lap RNY. The bottom
line is that you have to go with what you (and your surgeon) think is best
for you.
— koogy
August 15, 2003
I had surgery 8 days ago.I had it Lap and wouldn't go any other way.I had
the choice of three,Lap Band or Open I chose the Lap and it was the best
choice for me.I had very little pain,my C section was much worse.I was the
18th person my surgeon had done Lap.He is starting the band and asked if I
wanted to go that way,I would have if I didn't live so far away from him.It
ment more office visits until they got the band adjusted.I'm 57 years old
went in weighing 230 came out 222.So far no trouble at home and I don't
forsee any.
— Gussie
August 15, 2003
I would ask your doctor and then it is your choice. Those who have had an
open say it is better; those who have had a lap say it is better. I
personally had a lap. I left the hospital the next day and was only on pain
meds the first night. In 4 days I was totally pain free. My sister had a
lap with a minor complication and they went back in through the same LAP
inscions and she is doing great. Hers was last May(02) and mine was
8-28-02. I am down 112 lbs. I am for anything less painful providing the
doctor has the qualifications for it. Good Luck!
— Linda K.
August 15, 2003
I have had both open and lap surgeries before and by far, the lap is the
way to go. The scaring is minimal, the recovery time is quicker and the
complications, such as hernia's, are more prevalent in open than lap. I
100 % agree with Diana's assessment. Once I decided I wanted lap, I went
out and researched my area to find a good lap surgeon-experience was key.
Altho my surgeon did not have extensive lap RNY experience, he had
performed hundreds of other types of lap surgeries. He was a lap expert.
That was good enough for me. He also told me that with lap, they have
magnification of the insides, which is preferable to what the naked eye can
see, so when surgeons who do open surgeries say they prefer to
"see" what they are working on, a trained lap surgeon can
"see" 1000 times better.
— Cindy R.
August 16, 2003
See 1000 times better? Hmmm. Can't be that good as the chances of nicking
the bowel is greater during LAP. ;)
— Danmark
August 17, 2003
Open surgery is sometimes required, and the way my doc stated it, after you
take the length of the 4-5 smaller cuts, they just about add up to the same
length as an open. He prefers open, because he likes to see in real time
what he is doing, but he uses lap tools to do the detail work (stiching,
etc.) As far as the pain is concerned he wonders if the pain from one long
incision is better than 4-5 incisions. Plus he said that if anything else
needs to be done, it can be taken care of right away, while you are still
there, whereas in lap there are quite a few steps to go back and do
something else.
— track
August 18, 2003
I would really like to see the statistics for how often the bowel is nicked
during lap RNY as opposed to open. I think that has something to do with
the skill of the surgeon rather than the method of surgery. Any links to
research?
— koogy
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