Question:
Open vs. Lap ?
I couldn't find this in the Q&A's, sorry if it's a duplicate. I'd planned on having RNY laproscopic, but am considering changing to a surgeon who only does the surgery with the full open incision. What and how serious are the additional risks? — Lisa R. (posted on July 31, 2004)
July 31, 2004
Whats up with the original LAP surgeon? Did they loose a patient or are
they under a official investigation? LAP vs OPEN is a favorite topic here.
One major downside to opens is that my surgeon says about 1/3 of opens get
at least oneincisional hernia because the muscle wall is cut. Something to
think about. Bigger risk of infection because room air rather than sterile
gas enters your insides, longer recovery time and more pain from the added
trauma. ll this from dr philip schauer a world leader in bariatric surgery.
Please tell us more about whats happening with your original surgeon...
— bob-haller
July 31, 2004
Ok here's my opinion. I had my surgery done Lap, same group as Bob, and
they are wonderful skilled surgeons. I originally thought lap was the way
to go, but on the other hand if you were wanting to get a tummy tuck later,
having a hernia is pretty much a guarantee that you would get it approved.
I was unable to get mine approved, no hernia or other serious problem, and
my insurance kept saying "no, cometic", although I had
documentation of treatment for rashes, letters from surgeons, etc. So,
after going through all the appeal process and an appeal hearing, I almost
wished I would have had my surgery done open and wouldn't have had to go
through what I did to still get a no from my insurance on the tummy. Just
something to think of if you think your journey won't end with the wls.
— Dee ,.
July 31, 2004
My surgeon is new to NYS. She had 150 surgeries under her belt when she
came here to start a Bariatric Center at a nearby hosp. Since here, she has
had 2 leak+complications in 10 surgeries. The hosp. is now having her
surgeries 'observed'.
I'm still trying to find out just what is meant by 'observed' i.e.
monitored? supervised? Assisted? etc?
It has made me a bit leary.
The surgeon I'm most interested in other than her, only does the surgery
open.
There is one other local pratice that does Lap, but I've chosen not to use
them. (long story)
Risk vs. Risk "Between a rock and a hard place"
— Lisa R.
July 31, 2004
I have had 3 open surgeries. No complications with any of them. The first
two were WLS, back in '95 my surgeon was not experienced with lap (couldn't
even tell you if any of the WLS' were done lap back then) then when I was
revised in'02, my surgeon (same guy) was concerned with adhesions so he did
that one open also. With both of these I was back to work within 2 weeks.
My third was a gallbladder removal & small bowel obstruction. It
happened 3 weeks after my daughter was born in May so I was on maternity
leave. Didn't go back to work for 6 weeks buts that's just when my leave
was up. I felt ok about 2 weeks post-op. I think I'm just a fast healer.
— Ali M
July 31, 2004
I had 2 lap surgeries---one was my RNY 18 months ago, and the other was my
gall bladder, 1 month ago. No difficulties from either one. As far as
having open surgery goes, I was so confident with my surgeon that if he was
only doing open, in the middle of Grand Central Station, I would have done
it. However, don't count on a hernia getting you automatic approval for a
TT. I went for my PS consult at 1 year out, and the paperwork was
submitted for approval. My hernia was approved, but the TT was denied. I
fought the denials twice, then appealed to the NY State Insurance board
through an external appeal. I finally got it and am having the TT on 8/17.
Go with your instincts and a Dr. you have faith in. Some of the risks of
open have been described to you, but they are not all that frequent and
from what I have observed managable when using a good surgeon. Good
luck!!!
— Fixnmyself
July 31, 2004
I have had 2 surgeries, one lap and one open. Me personally...I would have
open again in a heart beat. My Rny was open....out of bed the night of
surgery walking, I was uncomfortable, but never had what I would call PAIN.
I had my gallbladder done lap....SEVERE PAIN for 3 days, could not stand up
straight for 3 days, never again. Both surgeons were excellent no
complaints there. I was back to work fulltime as a nurse on postop day 10
from the RNY, and no pain meds for the RNY after day 2. I did end up with
lortab because I hurt my leg while shopping on day 4. I severly twisted a
muscle, I had to have a muscle relaxer and lortab. Everyone is different
on what surgery they want, but as said, don't use the getting approved for
a tummy tuck to make that decison.......Good luck
— jennap
August 1, 2004
I guess it all depends on your insurance because with mine I was told that
it would have been approved if I had a hernia. just my experience so you
can't totally dismiss as others have stated it's not guaranteed approval.
It may not be for their insurance but was in my case. I think your decision
for wls should solely be based on the confidence you have in your surgeon,
his/her skill, and what you feel comfortable with.
— Dee ,.
August 1, 2004
Open incision - greater chance of incisional hernia, slightly greater risk
of incisional infection, increased post op pain, slightly greater chance of
embolic event (DVT, PE), longer recovery period. The myth that the
surgeon an "see better " with an open inciosion is just that - a
myth. Lap surgeons have light and magnification in the surgical area.
Smaller incision mean less pain, increased movement post op, faster
recovery and virtually no chance of incisional hernia, less chance for
embolic events. Not sure why you would choose open over lap if lap is an
option. Let us know!
— koogy
August 1, 2004
I had my RNY open, and wouldn't change a thing about it. My scar is 3 1/2
inches long. I had the surgery 10:30 Wed am and at 2pm Fri I was leaving
the hospital. The worst day was the day after the surgery, but after that
I was fine in regards to the incision and pain. I was out walking around
the stores on Sat (3 days postop) and other than some tiredness and
"soreness" you never would have guess I had major surgery.
Everyone is different though, but I keep hearing people who didn't have an
open procedure talk about the longer recovery time...wheras my friends who
had lap had a much rougher time with postop pain due to the trapped gasses
used during their procedures.
As far as "observed" to whomever asked that question...the
surgeon is required to have another surgeon with them during all the
procedures until they are taken off this probationary status. It's not
uncommon to do, especially with new surgeons (not just WLS related).
Good luck to you, whichever route you choose. I am thrilled I had mine
open!
— M. Me
August 1, 2004
i had a lap rny in dec and have a few tiny little scars which are fading
already some of the girls from my support group say they don't wear clingy
shirts because their scars from the open show so badly through clothes. lap
is less recovery time also.
— Kris C.
August 1, 2004
I had laproscopic RNY in Nov. 2003. I was driving in 5 days. Actually, I
drove from my driveway to my sister's driveway, about the distance of 2
blocks, on the 3rd day after my surgery. I was standing up front in my
church singing with my sister 5 days post-op. I felt great and recovered
very quickly. I have 2 friends that had open RNY, and they both had a very
painful and longer recovery. I am so glad my surgeon specializes in lap.
My sister also had lap in Dec. 2003. She did very well also. Good luck on
your "journey". God bless.
— Iris P.
August 1, 2004
Thanks everyone for your candid answers.
The "observed" concerns me, because the hospital is saying tht
she must now be observed by a Bariatric Surgeon. She has a partner, who
happens to be the head of the department. He has always assisted her in
surgery. He is a good surgeon, but not a bariatric surgeon.
I meet with my PCP this afternoon and will be taking the info. that I have
learned from you all, ask her opinion, based on Open vs. Lap and my
specific health, healing abilities etc.
I'm trying (not very successfuly) to not be too anxious about this. Sept 7,
my surgery date, if I keep it, is not that far away! I'm sure I will feel
better after speaking with my PCP. She is excellant & very thorough.
Lisa RP
— Lisa R.
August 5, 2004
The old saying two heads are better than one. Sounds like you can be EXTRA
safe.
— bob-haller
Click Here to Return