Question:
Why would anyone do a open when Lap is so much easier
It seems to me that most of the complications come from the large incision they do, infections, etc. I Lap you are out of the hospital faster and just seems better all around — Ann C. (posted on February 1, 2001)
February 1, 2001
I am no doctor, but I play one...Kidding. When a patient has an extremely
large abdominal area, it increases the risk of having problems with the lap
procedure. There are pros and cons to both. In the open it is easier to
take the gall bladder if it is necessary. In the lap, the utensils are not
positioned optimally for the removal and can be problematic. It can still
be done, just not as easy. Sure there is a large risk of incisional
hernias for the open operations, but my doc does a skin removel for free
when he goes in to repair the hernia so the open procedure can be nice from
that standpoint if you have a large amount of weight to lose and expect
loose skin.
— Perri T.
February 1, 2001
My wife had an open RNY and she was out of the hospital the second day
post-op. How much shorter can you get out with a lap? Although the amount
of pain is highly subjective, if the correct pain medication protocol is
used, there's little difference between a lap and an open. And the time off
from work isn't any different. Either way you're having extensive abdominal
surgery done. Personally, I wanted an open to give them all the working
room they needed to get the job done right and for them to be able to look
around for anything else that needed some fixing. I asked about gall
bladder removal during wls and was told it was possible, but they would
check it first and if it looked o.k., they'd leave it alone. They picked
mine up, flipped it over, gave it a peek, then put it back in bed. I don't
think you can do that with a lap. I'm a little over a year and the scar is
barely visible.
— blank first name B.
February 1, 2001
My doctor says having Lap done is like working on your car with your hood
down! In my city there isn't a hospital that allows the Lap yet because
the cost is greater and the insurance co.'s are more reluctant to allow it.
— michelle M.
February 1, 2001
I both agree and disagree with some previous statements. It is very true
that whether the procedure is open or lap, WLS is still a major surgery
with risk of complications. That is why no one should make this decision
lightly. Infections can occur with either approach, however the odds are
less with lap because it is a much less invasive procedure in terms of
surface surgical area...and generally no tubes or drains post-op. Post-op
recovery time is much faster with lap because patients experience less
discomfort and do not have a large incision that requires a longer healing
period. There is a hidden danger here, however, because lap patients tend
to over-do postop...they feel "functional" so much quicker.
Every post-op patient, lap or open, needs to remember the toll that a major
surgery and (more importantly) general anesthesia take on the body. The
rule of thumb for complete recovery is generally considered to be about six
weeks...give yourself plenty of opportunities for rest and sleep, even if
returning to work in a week or two after lap surgery. If you over-do in
the early stages, you will only pay for it later in terms of excessive
fatigue, irritablity, depression, etc... I would like to argue the
information that surfaces from time to time that "lap cannot be
performed on patients weighing more than 300 lbs." or "open is
better because the surgeon can see more clearly, or has more room to work
if there are adhesions or the gall bladder needs to be removed,
etc..."
As an RN who has assisted with laparascopic procedures and had the lap RNY
myself, I need to say that in this field, experience is everything.
Experienced bariatric surgeons who specialize in lap WLS will have the
instruments to deal successfully with patients as large as 550 lbs. These
same surgeons also historically complete their "uncomplicated"
lap surgeries within a 1-2 hour time frame...not 5-8 hours. They are also
skilled in resolving adhesions that they find as well as removing gall
bladders, correcting looped or kinked bowels, etc... As far as visualizing
the operative site, the camera utilized during lap surgery magnifies the
surgical area much more clearly than it can ever be visualized by the naked
eye. It seems to me that the decision rests primarily on availability and
expertise. There are fewer experienced lap surgeons available...many
patients simply are not willing or cannot afford to travel out of state or
out of network with their insurance providers. Just because a particular
surgeon does not offer lap as an option, absolutely does not mean that that
surgeon is not an exquisite practitioner...it may simply mean that he
already has an overwhelming practice and cannot or is unwilling to take
time away from that practice to get the intensive training required for
laparascopic expertise. Do your research carefully, don't rush into any
decisions, then do what you can do within the framework of choices
available to you. All of us believe that our surgeon is "the
best", and our chosen procedures are "the best"...once you
make a carefully researched and informed decision, that will be "the
best" for you. Good luck!
— Diana T.
February 1, 2001
There is always the potential that a lap procedure will have to be
converted to open. I know of one AMOS member whose surgeon found some
problems when she was opened up that would have otherwise been overlooked
in a lap procedure. She had considered lap, but was grateful she chose
open. The decision is very personal, and I agree with the person who told
you to research, research, research. It boils down to what is best for
YOU. Best wishes.
— [Deactivated Member]
February 2, 2001
Ann ... great for you, if you were able to have lap, or will be able to
have lap, but some of us didn't have a choice. My surgeon's upper weight
limit for lap surgery was 300-310 pounds, and I weighed 350, so it wasn't
an option. As an aside, I didn't have one second of complications from the
surgery ... I had more trouble with my arthritic knee and ankle (from
having to lie in a hospital bed) than I did from the incision, IVs, NG
tube, or whatever. As well, my surgeon makes no promises to his lap
patients that their surgery will end up being lap, even if they meet the
weight requirement. Things just happen. I would have preferred lap, but
couldn't have it -- and open, for me, was a breeze. I'm not going to be
wearing thong bikinis anytime soon (even if I reach goal weight, at 44
years of age gravity was bound to win sometime)my scar isn't an issue. I'd
do the open surgery again in half a heartbeat. Good luck and warm
thoughts,
— Cheryl Denomy
February 2, 2001
My own experience was this: I chose the doctor, not the surgery. His
expertise was open and I'd rather have an expertly done open, with a
comprehensive aftercare program than a not-so-expertly done lap with no
post-surgery support - please don't slam me on this...this was my
reasoning, not a blanket statement that 'my surgery is better than yours'.
If I had lived in California, I may have gone to Alvarado. Anyhow, there
are not a lot of (if any) lap options in Michigan. I'm six months post-op
and never wished that I had a lap...I don't even think about it.
Especially since the internist missed my appendectomy scar when she
inspected my tummy. I expect this one will fade just as well. I recovered
without any complications and, since about 5 weeks post-op, don't even feel
like I've had surgery.
— Allie B.
February 2, 2001
Some people don't qualify for a LAP surgery. I was 243 lbs. and would have
been a good candidate for a LAP but I had previous abdominal surgery so it
was not an option. The good thing was the doc used my old scar for the
incision & even prettied it up. Also, the LAP procedure takes longer
so you are under anesthesia longer, in the operating room longer, the
surgeon is operating longer...this adds up and many insurance companies
will not foot the bill for this more expensive procedure.
— Lisa B.
February 2, 2001
My Dr. only does open rny.
— peaceangel58
February 2, 2001
I just have to put my two cents in here! I agree with an earlier post that
the expertise of your surgeon is THE most important factor in the decision
(or at least it should be!) I had a Lap RNY, and contrary to other posts,
my surgeon had absolutely no trouble seeing everything he needed to see
while he was in there. He checked my gallbladder [was just peachy keen :)
], and even biopsied my liver! He was able to do this even though I've had
two previous abdominal surgeries. There were adhesions, but he still
managed to get the job done and check everything. Also, since he is very
experienced in Lap surgery, my surgery only took a total of three hours.
His average is about two hours, but he told my husband he wanted to be
extra careful with mine because of the previous surgeries and other medical
history. If this same surgeon had to convert mine to open (as he mentioned
was a possibility), I would have been just as happy, knowing that I had the
best surgeon I could in my area. If you truly trust your surgeon, the type
of surgery he does will not matter a bit. Maria
— Maria H.
February 2, 2001
I'm sorry, but I simply have to add one more comment. Please do not make
an across-the-board assumption that all laparascopic surgeries take longer,
that the patient is under anesthesia or in the operating room longer,
making it a more expensive procedure for which many insurance companies
will not pay. Again, the experience and training of the surgeon is
everything here. My daughter's lap RNY took one hour; mine took just 10
minutes more than that due to extensive adhesions from previous surgeries;
the all-inclusive fee for this procedure was $18,500 (irrespective of
complications or hospital length of stay) which is certainly on the low end
of fees that I have noted from many other surgeons. Our insurance provider
was very comfortable paying for a 2 day hospitalization at that fee.
Please do a great deal of comparative research and talk to as many post-ops
as possible before jumping to conclusions which may not be completely
accurate. One individual's experience may not always reflect the
experiences of others.
— Diana T.
February 3, 2001
My personal experience was that initially, I was firmly convinced that I
wanted lap RNY. However, my first consult was with a surgeon who only
performed open. However, he was extremely experienced in the procedure and
has had hundreds of excellent results with only a very few having problems
or complications. I felt so comfortable with this surgeon regarding his
skill and his personality, that I knew after the initial consult that he
was the one I wanted to do my surgery. I had open RNY on 11/17/00 and have
never regretted it for even a second. I do have a big scar, but it doesn't
bother me at all. I already had 4 previous abdominal surgeries, so scars
are nothing new to me. At 43, no matter what I weigh, I will not be
wearing a bikini. If I were in my 20's, I might feel differently.
— Lynn T.
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