Question:
Advantages of Laparascopic VS Open RNY

I am approved for an OPEN RNY for 4/6 and terribly excited about beginning my new life. My husband is very against it. He would feel better if I considered the laprascopic method, which is supposed to reduce the amount of recovery time. My concerns are: is there any medically documented /known increase of complications/leaks due to the lap method (it must be harder to sew you well up using the lap method) and why isn't it more readily available to patients? It seems that most have the open RNY, so if the lap method is "better" why aren't more using it? Also, what is the weight lifting limit for the lap method? I understand the open RNY restricts you to lifting no more than 5# for 6 weeks! I have a small child, so this is a critical issue. Any help or answers from people who have had the lap method and/or who have very young children who need to be picked up? Please give me your thoughts. If I'm going to change to the lap method I need to do it ASAP.    — Bobbi K. (posted on March 5, 2001)

March 5, 2001
Bobbi, I am no expert and cannot provide you with any data about prior research concerning the two surgeries. However, from my personal point of view (based on what I have seen) the Open RNY just appears to give the surgeon a better surgical setting. There are two sites that you can go to in order to judge for yourself. Share them with your husband. First, www.bannerhealthaz.com (and when you get to the home page, type in obesity surgery) and Second, Carnie Wilson's sight. The first is a slide show of the open surgery and the second is a video of a lap. Fortunately, my doctor only does open RNY and when I shared this with medical associates, for some reason, they said that was better. I just was glad to hear their affirmations and didn't bother to push the matter further. Just keep looking until you can make a decision you are satisfied with.
   — Marsha N.

March 5, 2001
Bobbi, I had open RNY on 1/8/01. My surgeon prefers to do the procedure open due to having a better view of things. Now, some that prefer to do lap will differ with me, I'm sure. However, I wanted to respond to your lifting question. My surgeon restricted me to a 15 pound limit for 8 weeks. I have a 23 pound 9 month old. It was quite challenging. My recovery was extremely quick and I was right back into "mom-mode" the day after I came home from the hospital. However, the lifting was an issue. Fortunately, my mother lives close. She would come every morning and bring him downstairs. After he was downstairs, I could pretty much transfer him to his walker and exersaucer. I always did it sitting down and really didn't "lift" him. I would never have dreamed of actually carrying him. I was also able to do this drag maneuver to get him out of his walker and onto the coffee table to change his diapers. Sounds gross, but it worked for me. Then my mom or my husband would come and put him back in bed for a nap.I felt like a real burden. But I knew it was necessary. I was realistically able to keep from lifting him for about 5 weeks. Then I would hold him very close to my chest as to not put strain on my abdomen. I still do not carry him indiscriminately. I let my husband or my 13 year old do it. Another area of challenge was feeding him. I would just feed him in his walker. Also, I could not put him in/out of his car seat. So, while I felt great, I could not go out by myself or take my 4 year old twins to preschool. My husband had to come home and drive them. While, I admit this time period was a pain, it really doesn't last long and even though I am only 8 weeks post-op I really don't remember it too much. Hope this helps.
   — Shelley.

March 5, 2001
I am an RN who has assisted with laparascopic procedures and chose to have a lap RNY. One of the primary reasons that more people have "open" surgeries is that there are far fewer qualified laparascopic surgeons than surgeons who exclusively perform open surgery. In addition, many patients feel that they are unable to travel out-of-state, or may have insurance providers who are unwilling to provide out-of-network coverage. Unfortunately, there are some surgeons who continue to promote the myth that open surgeries enable "a better view". The laparascopic cameras magnify the surgical area many times more than the naked eye, enabling the smallest blood vessels and nerves to be seen very clearly. The bottom line: experience and expertise are everything. Many exquisitely talented surgeons do not have the time or the desire to leave their already overwhelming practices in order to obtain the education and training that would enable them to add laparascopic surgery to their practices. It would be better to have an open surgery than to have lap surgery performed by a surgeon with limited experience in this highly specialized technique. Research the available lists of qualified bariatric surgeons who specialize in lap surgery, and explore your travel and insurance options...then make a decision that feels right for you. In the end, it's not HOW we make the journey, but that we made it at all. Good luck to you!
   — Diana T.

March 5, 2001
Bobbi, I had Lap surgery almost three months ago. My surgeon only does laps, unless there is a problem. Then he will convert to an open procedure, for example if there is an excess number of adhesions from previous surgeries, if there is a major liver problem or some other such complication. I was glad I had it done laproscopically for several reasons. 1. My surgeon is VERY skilled at lap procedures. 2. The camera magnifies certain images and the surgeon actually gets a BETTER view, IF he knows how to use the instruments and has has plenty of experience with the procedure. 3. My apparent recovery time was shorter. I felt like myself again very quickly. I have had two open abdominal surgeries, and I had fairly long recovery times for each. Now as far as the lifting, I was told nothing heavier than five pounds for the first 2-3 weeks, then nothing heavier than 10 pounds for another 2-3. My doctor did give me the OK to go bowling after about 4 weeks. I use a 12 pound ball, and he said it would be fine, but he didn't want me to start weight training until at least 8 weeks out. Because of the possibility that my insides still took as long to heal. Your outer abdomen heals faster, and there is less pain, but your insides have still been moved around, and it takes 6-8 weeks to recover fully from ANY surgery. As a previous post mentioned, more doctors aren't using it because the amount of time required to become trained in lap procedure, and from what I understand the equipment can be very expensive, so many hospitals won't invest the money at this point, because the open procedure will accomplish the same goal. Good luck in whatever decision you make.
   — Maria H.