Question:
How did you decide between an open RNY and a lap RNY?
The surgeon I had my consultation was with the Bariatric Treatment Center in Langhorne PA and they only do open RNY there, I am now questioning whether this is the best way to go. I have had a Lap Gallbladder 10 years ago and was back to work in a week post-op. I wonder if this is the better way to go. Please give me your opinion about this matter. Thanks. — Denise J. (posted on February 16, 2003)
February 16, 2003
You will get almost as many opinions on this as there are people on this
site. And the real answer is: It depends. Are you comfortable with the
surgeon you have chosen? If so and he/she recommends open, then why not go
that route? I have had both (see my profile for details) and did not find
that I had much pain with either of them. I was able to be up and walking
soon after both surgeries. Lap may have a slightly shorter recovery time,
but with an open, the surgeon gets a better view of your insides and that
may be an advantage. The bottom line is that what they do to your stomach
and intestines is the same no matter whether you have it done lap or open
and the end result is what you're really after. As I said, if you are
comfortable with your surgeon and the facility you have chosen, I don't
think I'd change just to have it done lap.
— garw
February 16, 2003
You sound just like me when I was trying to convince the surgeon to do LAP
RNY on me. I also had my galbladder out LAP about 9 years ago and was back
to work in 4 days. However, my surgeon, who does both procedures, would
not do open on me because of my 64 BMI and 432 lbs. He felt he needed to
clearly see what he was doing and get in and out as fast as possible so
that I had the least amount of anesthesia. While not excited about the
open I could accept that answer because it was totally related to keeping
me alive. I'll be 2 weeks post-op tomorrow and have two small holes in my
incision that I must pack twice daily so they heal from the inside out, but
that's the only problem I've had related to the incision. Mine is about
6-1/2 inches and looks pretty good, except for the holes. LOL The other
comment my surgeon made is that gallbladder removal is WAY different than
RNY. It's not just removing one contained organ it's transecting your
stomach and getting that stapled off properly and then getting your small
intestine rerouted etc. My surgeon also does some extra things like
oversewing all the staples that would take a lot longer doing it RNY. You
have to decide, but I think having a surgeon that you have complete and
total confidence in is way more important and if he/she is most comfortable
doing open then go for it. JMO
— zoedogcbr
February 16, 2003
I kinda was the same as you, I had orginally wanted to have the WLS with a
lap rny, but the only surgeon in my insurance network does it open only.
Now that I have meant the surgeon and he explains why he likes open, that
if he is inside of you and there are other problems, he can handle them
right then. I have heard stories of surgies being cancelled at last minute,
for different reason being done by lap, like the last posted, it really
depends how comforable you are with the surgeon. I have not had my surgery
yet, I do not have my first consult with the surgeon until April 17th, I
meant the surgeon at the weight loss seminar. Hope this helps
— cindy
February 16, 2003
Please leave this decision up to what your doctor feels is best for your
outcome, if you aren't sure get a second opinion. A gastric bypass is a lot
more ocmplicated than a gall bladder removal.
— Sarah S.
February 16, 2003
The decision is really the doctor's and that mostly reflects his skills.
Some doctors only have experience doing Open. Some have had the
opportunity to learn to do it LAP. The real way to find out which is best
for you is to find a surgeon who does both. I happen to know the BTC in
Langhorne, PA only does Open procedures on everybody, so that doesn't
necessarily mean thats better or worse for you, its just all they offer.
Good luck!
— thumpiez
February 16, 2003
I decided by checking outboth procedures. I chose the open rny because of
the risk factor of leaks. I though that if they did this open they would
have more access to their work and would be able to see better what they
were doing and they could check out all their work during the procedure.
Peggy open rny 9/20/02 -96#'s
— Peggy A.
February 17, 2003
hi Denise=)
I had an open RNY on 09/30/02 and the reason I chose a surgeon who did open
was I didn't want anyone working inside of me doing such intensive work
through small holes. So I wanted them to have full view. I did have my
gallbladder removed by Lap and honestly those scars are worse then the Open
RNY scar! Depends on your surgeon but also weigh the pro's and cons. I
went to the movies with hubby 5 days post-op and was walking for excersise.
Good Luck! -100lbs to date!
— EMN
February 17, 2003
When I first started looking into rny I signed up for the informational
session for a doctor that only did opens, then a friend of mine had hers
done lap at another hospital in the area...that mostly does lap on smaller
(under maybe 300ish depending on height) so, I too started looking at the
pros and cons of each. I called the center that did the open surgery and
asked a nurse exactly how "open" is open and she said if you are
small maybe as little as four inches but usually at least six...she also
said that the open really isn't as much "opening" as someone who
has lap with 7-11 one inch "port holes", if I really thought
about it. Which did made me think even harder about the whole thing. Then
I talked to my friend that had lap and she said that she only had seven
holes and most of them were under one inch. So, being that I too had had
my gallbladder out lap I figured at least with the lap I knew what I was in
for. Well, I had my surgery on 1/31/03 and have six holes from the surgery
and one from the drain. My largest hole is 1" the next is 3/4"
followed by three 1/4" and one 1/8". Honestly, the drain tube
hole is the worst of all! As far as recovery, as of one week I was feeling
back to about 75% and started walking 40 minutes a day at day ten. By day
15 I could easily hold a 20+ pound infant without a second thought and now
at day 17 I would say I am at around 95%. For me, lap was definetly the
way to go. Some things to think about though are how big are you to start
with (could a doctor realistically do lap) and is there a doctor in your
area that regularly performs lap sucessfully with a low complication rate.
Hope this helps and good luck with what ever you choose!
— eaamc
February 17, 2003
My surgeons perform open almost exclusively. They would do LAP if I wanted,
but I didn't see the point of being under the anesthetic for twice as long
and still have the possiblity of having it done open. Also, my scar is 4
inches exactly. I weighed 304 at the time of surgery. My recovery has been
easier than vaginal births with my 3 children. I have had no pain, no
inscisional problems, nothing. I would do it open again if I had too!
— SarahC
February 17, 2003
I had surgery Lap on November 11,2002 and was back to work in 2 weeks. If
lap was not an option for me I probably wouldn't have had the surgery. I
just felt more comfortable with the lap procedure. I've been doing great
and have lost 54 lbs since then. I have no problems with any foods! I
suppose it's all about what you want. I was looking at the end results and
the amount of hospital/recovery time. Lap was the ticket for me. I'm right
over the bridge from you in Burlington!
— Colleen S.
February 17, 2003
I had had both lap and open procedures in the past, and knew from
experience, that the recovery from the lap was much quicker, less painful,
less scaring than the open. So it was an easy decision for me. I
researched until I found a lap surgeon in my area that was very experienced
with lap surgeries (not necessarily the WLS) but with lap surgeries. I
found that, and have been very happy with my decision.
— Cindy R.
February 17, 2003
I'd had an exploratory Lap procedure in the past, and I knew that it
resulted in a very quick recovery. Plus, the scarring is MINIMAL.
Additionally, less muscles are cut and less damage is done to your body. I
chose a surgeon with a lot of lap experience, and I was and am VERY happy
with the results. Why have 6+ weeks of recovery and a huge scar, when you
can have tiny scars and a 2 week recovery? That being said, not everyone
can have a lap (due to preexisting medical conditions, for example).
You'll have to check with your surgeon.
— Kathy J.
February 17, 2003
My opinion is that both are the same surgery but one is less invasive. I
chose the Lap RNY so that I would have less of a recovery period and so I
can get back to work soon! My surgeon told me that she used to always do
Open RNY but now when it is possible she prefers the Lap RNY because she
can actually see better with everything being magnified for her. She only
does Open for certain body types, or when someone may have a lot of scar
tissue. I have had an open surgery in the past as well and I think I am
feeling better sooner. Just my opinion.
— Peggy B.
February 17, 2003
very simple...my insurance decided for me. they would only pay for open.
— Jennifer S.
February 17, 2003
See my profile at the very bottom theres a link to a book by barb thompson
that discusses this. Open leaves you at a great risk of devloping a
incisional hernia, has increased risk of infection, and a longer recovery
time.
— bob-haller
February 18, 2003
If they only do open, and you like and trust that surgeon go for it. I
personally would choose LAP again. I had LAP for my RNY 8 1/2 months ago
and healed wonderfully, recovered pretty fast. Whereas I had open for an
ulcer surgery to repair a hole in my stomach, and that was 2 months ago,
and I'm still recovering I feel like. My incision is still red and very
raised, and once in a while would get little blisters (i'm seeing my
surgeon and a dermatologist soon to check it out). I know some people feel
more safe with open, and some doctors don't even know how to do LAP. There
is a long learning curve with it, and it takes time, but I believe LAP will
eventually become more and more popular b/c of the technology and less
invasive. Just make sure to take care of your incision post-op! Goodluck
to you!
— Lezlie Y.
February 18, 2003
Hi-- I had a lap RNY 2-10-03. My surgeons start out almost everyone as lap,
and then convert to open if needed. If a person is very large (I don't know
what the cutoff weight is) they will just do an open procedure. For me, I
could not imagine having this surgery open (I'm a wuss)and now I have five
3/4" incisions. There are a lot of factors that can influence which
type of approach you will prefer. Good luck!
— lizinPA
February 18, 2003
I chose my SURGEON, not my procedure...I originally only wanted Lap, but
after attending the surgeons informational seminars I really did not like
the doctors who were doing lap, but felt much safer with the doctor who did
open. Chose the <b>doctor</b> you are most comfortable with, I
know people who have had tough recoveries with either procedure, as well as
people who have had no problems open or lap.
— Linda 1.
February 18, 2003
I was drawn to my surgeon because of his devotion to perform the
Rous-en-Y's laproscopically; this was a concern for me because I was
starting out at about 500 pounds with a BMI of over 60 and I knew that many
surgeons would only consider an open procedure for someone of my size.
However, as a stay-at-home dad, I knew that it would very tough to recovery
from an open procedure (it would very tough to avoid holding and picking-up
my little girls). Dr. Ralph Crum was able to perform my surgery
laproscopically; recovery was relatively easy (I was actually able to do
some modest lifting and yard work about 8 days post-op). He instructed me
to abide by a very low fat program in the week prior to surgery to reduce
the size of my liver (which would provide him more room for the procedure)
which I gladly followed. Also, pain was practically non-existent with the
LAP procedure.
Having researched the operation for over 12 months (like just about
everyone else considering it), I have yet to find a compelling reason why
all Rous-en-Y's shouldn't be planned as LAP procedures.
— SteveColarossi
February 18, 2003
I no longer support LAP RNY. Sorry all you Lappers. I don't care how much
of a specialist the surgeon is in LAP, I just believe there is too much
room for error. Read my profile. I am still an advocate of the surgery
after almost dying, but never will I agree with LAP again. And not just me,
I know so many people who had LAP and there pouch is too big or too small
or had many complications. I know there is still a good percentage of LAPS
that came out ok, but after what I went thru...never will I support it
again!
— Karla K.
February 19, 2003
I am 1 1/2 weeks post op Open RNY. I had a choice between the Lap and the
Open and when I really thought about it I was more comfortable with the
Open. I just wanted the doctor to have the best field of vision possible
to work with when he was "rearranging my insides!". There were a
lot of factors on both sides, recovery time, scarring, safety, time under
anesthesia... but all the thing that were on the side of the Lap just
seemed so minor in comparison with safety. Also, the recovery for the
surgery might be less, but our bodies still need so much time to recover
from the new nutritional intake that my surgeon's office said recovery time
was about the same with both. My incision looks to be about 5 inches, not
too bad. There was a lot of pain initially but at about 1 week out it's
more of a soreness than pain and I am up walking around and doing pretty
well. Best of luck to you as you make your decision.
— Janet S.
February 19, 2003
Sorry some of you had complications and feel the way you do. Personally, I
did not want to have to deal with another long scar, (I'd already had
several from 3 C-sections and I almost died) infection and leaks nowhere
near the open procedure. I would say that I ditto Bob, Peggy, Beth, Cindy
and Colleen as well as others who have had the Lap procedure. Believe it or
not a SKILLED surgeon can see inside just as well as a surgeon doing open
RNY. As another poster mentioned, I think it's best left up to the doctor,
BUT the patient has to deal with the emotional adjustments afterwards as
well. I especially liked that fact that I could get back to work earlier. I
say do you OWN independent research and don't let ANYONE else try to
persuade you. I'd do it LAP over and over again if I had to...and like
Forrest Gump says "and that's all I have to say about that"....
— yourdivaness
February 19, 2003
Boy howdy..this is a debate that will go on forever. I have had three C
sections, a tubal ligation, LAP gallbladder removal and an appendectomy
prior to my WLS. My surgeon did open so open it was for me although the
shorter recovery time of the LAP was appealing. In my case, it turned out
to be a very good thing. From prior surgeries, I had so much scar tissue
that I wound up with a 12 inch incision from my RNY. The next year, I had
to have exploratory surgery that turned into a total hysterectomy. I
advised my gyn about the scar tissue and he, thankfully, did that procedure
open, too. Afterwards, he told me I was so right about not doing it lap,
because I have so much scar tissue that my intestines were adhered to the
lining in my abdomen (and to some other organs) and an attempt at lap would
have likely ruptured my intestines. So, that's just me. That said, WLS is
about the improving your health...if you have no significant prior medical
concerns and you feel confident in your doc...follow his advice. It is
worth noting, however, that some laps are converted to open in the
operating room because the surgeon finds it necessary. Again, that's not a
bad thing, just something to be prepared for. Best wishes whatever you
decide.
— Sharon L.
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