Question:
Have Surgery Date But Can't Decide Between Lap or Open
I have a surgery date and now I have to decide between lap or open. My surgeon is new to the center where I'm having my surgery and that makes me nervous as well. But one of the head dr's of the center always assists in the operating room. The dr's at the center have only performed about 100 lap procedures. I can't decide since either way there are possible complications. CAN ANYONE HELP ME??????? — Lacy L. (posted on January 5, 2002)
January 5, 2002
Wow! I can't believe you are left with such a tough decision! I had my
open RNY on November 19th, 2001 and would not have ever chosen a lap. Why?
I come from a family of surgical medical professionals. If someone is
working inside of me making my stomach smaller I want them to have full
view of what they are doing. With a lap, they punch holes in you and do it
through a scope. There is too much room for error if your surgeon does not
have enough experience. One surgeon I spoke to told me NEVER to allow a
surgeon to do a lap on you unless they had done at least 500 open RNYs and
about 100 laps. Seems like a lot but I want experience. This is my body
and I want to keep it pretty much the same. An open will hurt more and
take longer to heal but in the long run I think it is the better surgery.
Sorry to be on my soapbox, this is just a very serious issue and you need
to do some serious thinking about what you want. Get in touch if you need
any help! Amy
— purdue_1993
January 5, 2002
Well how many surgeries do YOU want? Opens have a 30% chance of devloping a
hernia and then requiring a second surgery, Laps have a near ZERO chance of
a incisional hernia. My job requires heavy lifting, and I certinally didnt
want another surgery, so I selected LAP. Of course Laps also have shorter
hospita stays, less pain, and faster recovery. This because very little
muscle is cut with the small incisions. This info from Barb Thompsons book,
she is a member here and wrote a great book about the entire process. You
can read my profile for a daily diary of my recovery. I wouldnt be over
concerned about your surgeon. As long as he is properly supervised you
should be fine. Surgeons at teaching hospitals often work side by side with
residents to get new surgeons experience. Incidently my surgeon says he can
see things better with Lap because of the magnified cameras.
— bob-haller
January 5, 2002
I asked my surgeon about the 30% hernia rate for open and he said that
wasn't true. He said the hernias are more about
how you are closed then about the surgery. He said some doctors don't use
staples with the stiches they either use one long stich (verses individual
ones that take longer) or use dermabond neither he thinks is adequate for
an obese person. He does a minimum of 30 RNY surgeries a month he will do
either open or lap if you are under a certain BMI but he said Lap's are
more risky because the actual time you are under is much longer and the
chances of complications are higher and he requires Lap patients to remain
in the hospital one extra day. Lap is also more expensive because of the
extra surgery time and hospital stay. I am going to one of the top rated
centers for this surgery and I completely trust my Doctor. Good Luck with
whichever one you decide to go with. I have my surgery a week from
Thursday.
— Candace F.
January 5, 2002
I had lap and I have no regrets. It is a decision that only you can make
but I chose my dr specifically because he did the lap. I travel over 4 hrs
to see him each visit but no regrets at all. I have teeny tiny little
scars, not one huge one all the way down my stomach. I went back to work
at 4 wks, no problems. I am 15 wks post op and have had no problems
w/hernias,etc. It was great. Just one thing, I am afraid of being put
under. I kept telling myself it was no big deal, I could do it. Then when
I was on that bed getting pre-prep for surgery they put the iv in and
laying there I started to get really antsy, like a panic attack must feel.
I began telling my daughter I wanted to go, I couldn't go thru w/it. The
nurse came in and I told her and she suggested a sedative which I agreed
to. Well, she was still injecting it when it began taking effect. I calmed
down and when they wheeled me into the operating room I just told them I
was closing my eyes cause I didn't want to watch them getting the
instruments ready and next thing I know I was waking up in recovery. Don't
be afraid to ask for a sedative if like me you are a little apprehensive
about surgery. I am very glad I did it. I'm almost my old self again. Good
luck to you. My thoughts are with you.
Rachel
— Rachel F.
January 5, 2002
Lap vs. Open..... Hmmm.....I chose lap because it is less invasive,less
blood loss, less pain, less recovery time, less scaring, and YES, less ,
much less, next to ZERO chance, of getting a hernia. My Doc ONLY does open
if Lap is not possible.
— [Anonymous]
January 5, 2002
I am a big fan of OPEN. I want the doctor to be able to see EXACTLY what
they are doing. I also was concerned about time on the table... less is
better, and lap takes longer. Especially if you have asthma or sleep apnea,
every minute under general anesthesia is a risk.<p>I recovered very
quickly from my open RNY and haven't developed a hernia. I was lifting my
28 lb daughter six days post-op and felt fine and ready to return to work
seven days post-op. I think this is a hard decision but I encourage you to
make it based on scientific/medical reasons rather than on vanity (wanting
a smaller scar, for instance)... if you have a tummy tuck down the road,
your plastic surgeon will make you a much prettier scar anyway. Good luck
with your surgery!! @3.5 months post-op, down 87 lbs and 68"!!
— Julia M.
January 5, 2002
Hi Lacy... I am pre-op but in the exhaustive research I came up with, it
appears to be a decision of preference between the surgeon based upon your
medical history, current physical condition, previous surgeries and you.
My surgeon does the Laps but let us know that he strongly felt that many of
the complications (other than hernias)might have been avoided if an open
where more visualization is possible had been done. It has been said to me
it is like operating in a full closed suitcase with a flashlight. I have
had Lap surgeries before and they went well but as this one carries so many
possibilities with it as it is, I've elected for Open just for the surety
of a full view. Good luck in your decision and with your surgery. You'll
do great either way!
— AJC750
January 5, 2002
Wow!! You have opened the great lap vs open debate once again. You will
find many differing opinions and not a lot of hard evidence that one is
better than the other. I feel that it will be your personal preference. For
me, I chose open. I wanted the doctor to have the BEST view. I am sure that
doctors that do lap have great instruments that provide a wonderful view,
but it still can't be BETTER than seeing personally. I have said this
before on this board, but since you've asked I will repeat it. I have
noticed a TREND. Again, it is only my unscientific research here...If you
follow those people that have post op complications ( I am talking the life
threatening leaks, etc... )The greatest percent will be lap. I can only
speculate that this is because the view and maneuverability is decreased
during surgery. Again, this is my research only. When I read about someone
with a leak, abscess or peritonitis, I will click on their profile and find
that they have had the surgery done lap. I, too, find the 30% hernia rate
extremely high and can't seem to get my hands on the actual data that
supports this. If given a choice between the risk of a hernia (open) or a
life-threatening complication (lap) I would choose the hernia any day!!
Again, only you can decide what is best for you. I am 37 and don't intend
to be a "bathing beauty" so my open scar doesn't bother me most
of the time. Only 2 people see it and it is rather small and fading
rapidly. Research, research, research...Shelley
— Shelley.
January 5, 2002
My surgeon was a board certified laparoscopic surgeon who then became board
certified in LAP RNY...I would never ever have gone to an "open"
doc no matter how good he was, for a LAP surgery. Lap surgery, any kind,
requires special skills...Most LAP complications and problems that I have
heard of from patients I have chatted with occured with surgeons who were
open docs but performed a LAP procedure. Be very careful and please dont
allow yourself to be a LAP "guinea pig" or practice case for an
otherwise highly skilled surgeon. BTW I developed a hernia which I need to
have repaired. I too was told that with LAP there is much less of a
chance of a hernia but my doc said basically if youre prone to it youre
going to get one no matter if you were lap or open. Also...the only
difference between the recovery between the 2 is that your incisions heal
much faster with LAP. Insides still need 4-6 weeks to heal...Having your
incisions heal so fast can give you the false sense that youre healing
faster but trust me.... thats not the case and if youre not careful you can
hurt yourself. Good luck to you.
— darcieleigh
January 5, 2002
As everyone has said, it is really your decision if your doctor offers
both. I, personally, have chosen the open because that is the one with the
long time success. It is strictly personal -- maybe you can ask your
doctor to surprise you...? Nina
— [Deactivated Member]
January 5, 2002
This is the great debate! My personal opinion is that it depends on the
surgeon's experience. Mine does both, but I have elected to go lap due to
less recovery time. My doc is very specialized in the lap but performs
open on the candidates he considers too large for lap. I think the main
thing is the surgeon's experience. From what I have learned, lap does NOT
require more time in the hospital and is NOT more expensive.
Good luck!
— [Anonymous]
January 5, 2002
Well, that's an easy one. I'm a big chicken ANYWAY so I purposely searched
out a surgeon who is an expert in the field of Lap. I don't think I would
have had the nerve to go with the open. If you have a choice, go with the
lap. Less recovery time, easier on the body, same great results. My
surgeon told me the only way he would do open is if he got started on me
and for some reason he had to do the open. Thank the good Lord when I came
to, he had done the Lap. It was a no-brainer decision for ME.
— [Anonymous]
January 5, 2002
My surgeon had less that 100 laps under his belt when I got mine and it was
smooth sailing. If they have problems they can always open if necessary
but WHY oh WhY would you want that huge ugly scar if it isn't necessary?
— Tina C.
January 5, 2002
If we are going to speak of misconceptions, please know that not all open
procedures end up in a huge ugly scar. My incision is 3 1/2 inches long and
healing into a pencil thin line. Hardly huge. And I'm far from the only one
with a minimally invasive open incision. As far as postop pain goes, I
haven't needed to take as much as a Tylenol since my 6th day postop.
Surgical expertise is the number one consideration in my opinion. I've said
it before, the outside heals relatively quickly; its whats done on our
insides that really makes the difference. Good luck in whatever you decide.
— Donna L.
January 5, 2002
Lap vs Open...my goodness has this been on my mind a lot lately too. I am
pre op, and in the beginning had my heart set on a Lap, I am determined to
get back on my feet as soon as possible!
After reading all the post, the comments, the research, I have decided I am
going to go with the decision of my surgeon. Besides if I say I want Lap
because I want to get out of the hospital quicker, he aint going to go with
that, or if I say I want open because I want him to have the best view,
regardless of any other complications, I dont think he is going to go with
that either.
When I am laying on that bed just before the surgery, I want to fee 110%
confident my surgeon is going to do the most excellent procedure ever
performed, and I dont care how he gets it done, just DO IT, and DO IT
RIGHT.
So while all these comments are valuable, and really help me make my list
of questions to ask my doc, and things to be aware of... the ulitimate
decision is just to have the procedure done right!
Thanks for all the post ops comments, wishing all the pre-op the best,
— Nene B.
January 6, 2002
Laproscopic surgery is so much easier to recuperate from... but it is your
choice. I checked out my doctor throughly before my lap rny. I was
confident in him because I knew if there were any problems, he would go
ahead and do it open. He did not have to do it open after all, and at three
weeks post op, I am swimming and having a wonderful time losing weight! At
2 weeks I had lost 54 lbs!
Check out your surgeon and go with your comfort zone.
— Sharon H.
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