Question:
Should I have Open or Lap?

My doctor has been doing Open RNY for years and is very good I am told. He is now learning the Lap and will be starting to do this type in 2-3 months. I am ready to schedule my surgery now as Ins. approved it. Should I wait and have it Lap or do the Open now? Since this will be new to him it may be better to have Open but I heard that the Lap is so much easier on recovery. My Husband thinks I should wait. My friend who has had it done by him said open is no big deal and calls the scar her beauty mark. Please advise.    — Carolyn M. (posted on January 12, 2002)

January 12, 2002
I would wait a bit for LAP. Opens have a 30% chance of devloping a incisional hernis whereas Laps have a near zero chance of the same thing. Laps typically have shorter hospital stays, less pain and get back to work sooner.
   — bob-haller

January 12, 2002
I wouldn't wait 2 or 3 months for a lap procedure if the same doctor does an excellent job performing opens. Lap does have a shorter recovery period, but not by a whole lot. I had open, and aside from the pain relief I received in the hospital, I only took tylenol the first couple of days that I was home and nothing since then. It hasn't always been easy, I got tired easily for the first 3 weeks but now I feel great. I have the one incision that is just over 3 inches long, not huge or ugly at all. My doctor gives a MUCH lower occurance rate of hernias than this 30% that keeps getting thrown around. Many other doctors do as well. By the time those 2 or 3 months that you would wait for your doctor to start performing laps, you'll be feeling back to normal and weighing alot less. I'm guessing that you would be very happy that you had it done sooner rather than later.
   — Donna L.

January 12, 2002
I had Open RNY November 29, 2001 and I was released to drive and return to work on December 11. That's 12 days. After leaving the hospital, I took NO pain meds and had absolutely no trouble recovering from the surgery. I returned to work full days and haven't had a problem. By the way, I am 55 years old and I weighed 341 pounds when I had my surgery, so age and weight didn't make much of a difference either. I probably wouldn't have been a candidate for LAP, but my surgeon didn't do it anyway. I know this is very controversial, but he likes to see the entire operative field when he operates (he does LAP for other procedures, but not for RNY). He removed my gallbladder, did the WLS and repaired a hernia I didn't even know I had. So, if it were me, I wouldn't wait for LAP - especially with a surgeon who is just starting to do it. Patty
   — Patty_Butler

January 12, 2002
I did have the choice but chose open because it has less risk and shorter surgery time. My Doctor is very experienced in both and if you have a low enough BMI leaves the decision up to the patient. He does insist on keeping Lap patients in the hospital for 3 days instead of 2 days because of the increased risk. I too asked him about the hernia rate and he said 30% hernia rate and said it was untrue that a hernia is a rare complication of this surgery. He said it could only be that high if a surgeon didn't close the incision properly he said some surgeons use dermabond instead of staples or one woven stitch and he said that is not adequate for an obese patient. I had a complication from a lap gallbladder and ended up in ICU that would have been prevented if they had done it open they lost stones they couldn't find and it blocked my bile duct and I had to have a second procedure to get them out. If they had opened me they could have been able to retrive them. So they makes me more sure of my decesion. I would like to receive proof via scientific data that shows a 30% hernia rate since it seems many doctors say that it isn't true but statements keep being made like that. Why don't you ask your doctor if his patients have a 30% hernia rate.
   — Candace F.

January 12, 2002
Well around here Laps average hospital stay is 2 days, opens 3 to 5. Most incisional hernias occur in open patients, and the lifting restrictions tend to be longer for opens also.. I do admit thats its better if a LAP surgeon as lots of experience. But after having a open appendectomy and LAP RNY I would choose lap hands down.
   — bob-haller

January 13, 2002
There are pro's and con's on both surgeries. It is "The Great Debate." I would say stick with the open if that is what your surgeon in experienced most in. Lap can be very good (that's what I am having) but it needs to be with a very experienced lap surgeon to lower the risk of leaks.
   — emilyfink