Question:
Which is better for internal reasons

I have a question, i know that for scarring, the LAP is better, but is it actually a better SURGERY? Is it done better? And is it exactly the same procedure as the OPEN? I would greatly appreciate any help you could give me! Thank you!    — Candace W. (posted on July 31, 2002)

July 30, 2002
Its the same surgery. Lap or open is only a difference in ACCESS! The big issue is that 30% of opens get incisional hernias that require another surgery. LAP is this a near zero risk because the stomach wall muscles arent cut. Lap also improves recovery time, lessens infection risk, aND IS A generally easier surgery since there is less overall cutting.
   — bob-haller

July 31, 2002
LAP is good for the reasons Bob stated. However I still think the Open is safer. I want a surgeon to be able to PHYSICALY SEE MY INSIDES, and NOT to have to rely on a tiny camera. Things can be seen and moved around better this way. I really wonder if 1/3 of the Opens have to have surgery for a hernia? I'm sure some do, but 33%? Well...... maybe. I did'nt have to though. And I did'nt have any problems related to the surgery itself.
   — Danmark

July 31, 2002
One advantage of Open vs Lap, and I could be wrong on this, is that in open surgery, the staple line can be oversewn by the surgeon to provide additional reinforcement to the staple joins. From the footage I have seen of LAP surgery, they don't do this. My surgeon did this, and I feel much better about the overall integrity of my pouch because of it. Is it necessary? Probably not required, since as far as I can tell, they don't do this LAP, and for all I know, most surgeons may not do it at all. Does it make me fell better? Definitley. I would like to think that my pouch will last a lifetime, and that extra oversewing of the staple line makes me feel that it is stronger, whether it is or not. If I am wrong in my assumptions here, someone correct me, as I certainly don't claim to be an expert.
   — Greg P.

July 31, 2002
Greg, you are partially correct. *Most* LAP surgeons DO NOT use the reinforcement of suturing. However, there are some LAP surgeons that DO use the reinforcement. My surgeon is one of those that do. He was the first in my state to perform this surgery LAP, and travels all over the world training others in this particular procedure. I too felt reassured knowing that the reinforcement is there. That is why it is SO IMPORTANT to research, research, research both the procedures and the surgeons. Ask lots of questions. And also, with the LAP, that 'tiny camera' projects the images onto a screen which is magnified so that the surgeon can view his field much better. And the same statistics have been told to me by my surgeon. About 30-33% OPEN's get hernias, and they are very rare with a LAP. I loved my LAP!!
   — Cheri M.

July 31, 2002
And I should also add that, even though everyone is different, I never had any pain. I had general muscle soreness, that felt like I had done way too many sit-ups. Out of 6 surgeries, this one was by far the easiest for me.
   — Cheri M.

July 31, 2002
Candace, I am a lap patient. I hear that it is better because of no incisional hernias, no big scar, and you don't live the rest of your life with a weaker than normal abdominal wall. As for oversewing the staple line, mine has been . (I guess all docs are different). Fortunately my doc is really a master of the lap procedure (not exaggerating). The only thing I really hated was the gas they inflated me with.
   — Tina B.

July 31, 2002
In truth, the one that is better is whichever one your surgeon is best at. If he/she is a lap surgery expert, I would go lap. If he/she has been performing open for a long time and is just now starting lap surgery, I would go open. I was on the table much longer because my dr was inexperienced with the lap rny. While I did not have any complications, had I known better I probably would have chosen open. Now he has hundreds of lap rny's under his belt and can do them just as quickly (and safely I would assume) as he does the opens.
   — ctyst

July 31, 2002
I agree 100% with Cheri Stewart's answer. My excellent surgeon, who I love, love, love will do the surgery lap. However, his preference is to do it open. He gave me a laundry list of reasons, which all made complete sense to me (they are posted in my profile), but the bottom line was if my surgeon preferred to do it open for whatever reason, that's the way I felt comfortable going. As far as the difference internally...I don't really think there is much. I guess there is less of a chance of having an organ or other essential intenal part nicked by instruments. The scar really doesn't bother me. It's a neat little 3 inches and when I am done with all the plastic surgery I am going to have it will be the least of my scar worries. Discuss with your surgeon to see what's best for you. Good luck!
   — PaulaM

July 31, 2002
Well I was transected, stapled, and sewen as well. My surgeon Dr Schauer does Laps as fast as opens. Its all about what you and your surgeon are comfortable with. But if you go open realize theres a big chance you will need another surgery and all that includes.
   — bob-haller

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