Question:
Which would you choose, Open or Lap RNY? and why?

The Cleveland Center for Bariatric Surgery, because of huge demand for WLS, has just added a fourth surgeon - a Dr. Ben-Meir. I have been offered an initial consult with this surgeon, who performs the RNY lap instead of open. This would speed up the process for me greatly. I would be looking at a date of late May or June (lap) as opposed to Nov or Dec (open). CCBS has just started offering the procedure laparascopically and I would be one of their first patients to have the surgery that way. I am excited, but worried. Excited that I may begin my journey "to the other side" earlier, but worried of added complications seen with lap RNY procedures.....any advice? or comments?    — Lynne277 (posted on April 18, 2002)

April 18, 2002
I can only judge the open which I had, only 2.5 hours on the table, NO drain tubes or NO leak test, all of this was done during surgery, I hear that lap recovery is faster, but my surgeon says he prefers to be able to see, plus I have a "ring" to help me not over eat, and to keep food in the pouch longer. I have read here, some have been on the table for as long as 7 hours. If I could choose again I would still choose open from what I have heard and read about. I am sure lap patients will say the same.
   — acluff

April 18, 2002
I had a Lap RNY and was on the operating table for 3 hours. I had 1 drain tube that wasn't a big deal and was removed after a week. I never had to take a leak test either. The main reason I prefer the lap over the open is the scar. I didn't want a scar running all the way down my chest to my pubic bone. As a matter of fact, the very first thing I did when I woke up was to look down my gown to make sure I didn't have a huge scar in the center of my chest!!! I breathed a HUGE sigh of relief when I didn't see that.
   — Patty H.

April 18, 2002
I chose the Lap, for a couple of reasons. The recovery is so much quicker. The scars are a lot smaller. I personally believe that the smaller the incisions the less chance for infection. Believe me you don't want am infection. When I had back surgery I got a Staph and group B infection. It had to be reopened, packed 4 times a day(OUCH, OUCH, OUCH!!!!!!!!!!) till it healed from the inside out. months!! Than I also had 8 weeks of pic line antibiotic. Long story short (a line directly to your heart). Nurses had to come 3 times a day to give the medication. This set me back over $30,000. I am not saying that lap incisions can't get infected, but the facts are the more area open the more chance for infection. I also would be weary if the Dr. hadn't done many lap procedures. Since he is new to the practice, is it possible he has lap experienc somewhere else? It's very hard to believe that they would have him as only lap with no lap experance. My guess is if he was new to lap, he would be proforming both lap and Open. Alot of prople say the legnth of the operation is longer with the lap. Not always. My lap DS was 8 hours, not because of the lap, because my spleen was adheared to my stomach and bleed like the dickens. The Dr. took his time and stopped all bleeds, thank G*D. I wouldn't want to lose my spleen. Well, I wish you the best of luck in what ever you choose. Oh, I only had one drain a JP drain. I know people who had open and had 4 tubes including down the nose. Yuck!!!! Again the best of luck.
   — Jody Diou

April 18, 2002
From the data I have seen and from talking with several of my friends and family members (who are surgeons), they indicated that though the Lap is a minimally invasive technique, there can be as many or more problems and complications associated with a Lap procedure. Because there is an extreme amount of manipulation of the laparoscopes, there is a higher incidence of bowel perforation, bleeding, etc. When the surgeon has a nice, clean open surgical sight, not only can he visually see the organs better but he/she can also look for other signs of disease while he/she is in there. Another thing to note is that if you happen to have a higher BMI, the likelihood of starting out with a Lap and in mid-operation, being switched to an open procedure is sort of high. Ask your doctor to see statistics regarding post operative complications associated with Lap RNY vs. Open. The previous poster indicated that the scars are smaller..which is true. But I personally, would prefer one rather long scar vs. 5 or 6 individual scars. As for Lap RNY cases having fewer wound infections, you will need to get some data from your doctor on this. Again, the previous poster indicated that she had back surgery and there were complications due to infection. Wound infections are much more prevelant with orthopedic (bone) surgery. Talk to your doctor. He will give you the pros and cons associated with either technique. Both have their good points and their bad. I personally want to have an Open...but then again, it is my preference after seeing the research and data available. Hope this helps!!! Good luck!
   — KathieInHawaii

April 18, 2002
I chose open 1 and 1/2 hrs start to finish . Six in scar from under my breastbone to my navel. I'm one of those people who is afraid of lap surgery. But if you are comfortable with it Your recovery time will be much less. Oddly enough I wanted a "sicker" longer recovery time , I knew it would keep me on the straight and narrow!(go figure!) If my doctor only did lap , I'd go for it . I wanted this weight off imediately , how it happened was really no big deal to me.
   — Rose A.

April 18, 2002
Personally, I would NOT be one of the first 50 people operated on laproscopically. When I first started doing surgery re: wls, I read somewhere that there is a learning curve to performing lap surgery and that there is a higher chance of complications if you are one of the first 50 done by a doctor. I had open surgery (I had no choice) and honestly, it was not a big deal. Of course, these are only my opinions :) Kristine in Toronto
   — kristinevok

April 18, 2002
errr make that " When I first started doing research" instead of "surgery." LOL
   — kristinevok

April 18, 2002
I personally am a fan of OPEN. With open, they can do a lot of "hand work". I like that safety margin, personally. My dh had a post-op leak, so that probably colors my opinion.
   — vitalady

April 18, 2002
I have a close friend who had a very serious tumor found on her ovaries during her open procedure. The doctor said he wouldn't have spotted it in a lap procedure. The surgeon I used prefers to do open for just that reason - so he can spot anything else wrong while in there. I am less than 6 months out and my scar is not really that bad....
   — Julie S.

April 18, 2002
I have a close friend who had a very serious tumor found on her ovaries during her open procedure. The doctor said he wouldn't have spotted it in a lap procedure. The surgeon I used prefers to do open for just that reason - so he can spot anything else wrong while in there. I am less than 6 months out and my scar is not really that bad....
   — Julie S.

April 18, 2002
The age-old debate continues... The bottom line truly lies in the experience and expertise of the surgeon. I personally would not wish to be among the first 50 lap surgeries performed by any surgeon or group. I would choose a surgeon with more experience, ask up-front questions about their mortality rates and incidences of complications with lap WLS, and inquire about their average operating times. In the hands of a skilled lap surgeon, incidences of complications and infections are generally lower....operating times shouldn't exceed that of open surgeries and can even be less....it is a MYTH that surgeons can visualize the surgical field more accurately with open surgery, because the lap cameras magnify the field many times greater than the naked eye....it is a MYTH that lap surgery cannot be performed on patients weighing more than 300 lbs. (Experienced lap surgeons have the correct instruments to perform surgery on patients weighing up to 500 lbs. or more)....it is TRUE that anyone planning a lap surgery, even with the most experienced lap surgeon, may end up with an open surgery, so it is wise to be prepared for that possibility....it is TRUE that the post-op recovery period will be much shorter and easier than with an open surgery, but both surgeries are MAJOR surgeries and you will need to give yourself plenty of time for proper rest and recovery. Four of us in our family have had very successful lap RNY surgeries....no problems or complications....no operating times longer than 1 hour 10 minutes....5 tiny incisions that can hardly be found at all after 2 years post-op...but as happy as we are with our surgeries, we are each in agreement that we would have had the surgery "open" in a heartbeat if we had not had access to a skilled and experienced laparascopic surgeon. Good luck!
   — Diana T.

April 18, 2002
I'm scheduled for a lap RNY -- but I've recently been having second thoughts about my choice of procedures, and I've been researching the BPD-DS like a mad woman. I talked with a well-regarded DS surgeon on the phone today, and he startled me by saying that the leak rate for his lap DS is SIX TIMES as high as his leak rate for the open DS (3% vs 0.5%). His explanation is that he reinforces each stapled connection with hand-sewing in the open procedures, but that's impossible in the lap. His comments really have me thinking -- not just about the DS, but about my lap preference in general, even if I do go ahead with the RNY. I think I will still go for lap, but with a little more anxiety than before.
   — Tally

April 18, 2002
11 months ago - I chose Lap RNY - and would not change anything for the world - of course what do I have to compare to? :) - I am happy with my decision and have lost 132lbs so far with 47 more to go - I had very little pain during my recovery period and my scars are great - so tiny - my surgeon had done about 60 laps before mine and he did an excellent job - he said it is the exact same procedure inside the only difrerenc is how they enter your body.....good luck to you and your decision :)
   — Sharon Jones

April 18, 2002
I posted before I fully read everyone else's answers. I was surprised that no one mentioned the dramatically reduced risk of incisional hernias with lap procedures. Very common in open, almost non-existent with lap. That's a big selling point for me. That and the shorter hosptial stay, the ability to get up and walking more quickly, and the shorter recovery time. Plus... there is no comparison between the scars. You can say that the one long scar is the same as the 6 or 7 tiny ones added together, but when you actually see post-op scar pictures, the cosmetic advantage of lap is obvious. Not that it's my TOP priority, but it's a consideration. On the other hand, anyone with a large panni will probably need a "T" incision when they get their reconstructive surgery, so a big abdominal scar could be in their future, regardless.
   — Tally

April 19, 2002
After my open I only missed 13 days of work. Recovery time is dependent on lots of factors not limited to whether you have open or lap. I asked for open since I wanted my surgeon to have a great view when he was working on me. Plus I don't see a two piece swimsuit in my future so I didn't worry about the scar. As far as being one of his first lap patients, he should take his time and do a great job on your since he wouldn't want to "screw up" at the first of a new job! Good luck no matter what you decide.
   — Frances B.

April 19, 2002
i have had numerous abdominal surgeries in the past & i knew that i had a scar tissue & adhesion problem from them. i am one of those people that have scars on my skin from simple scratches & every one of my past surgeries were extended because of the clean up the surgeon had to perform before he could do the actual surgery. so i knew i definitely wanted open rny to assure that my surgeon could get a 'birds eye view'& take care of any potential problems. as hubby & i expected, my open rny took an extra 1/2 hour because the surgeon had to 'clear the way' of adhesions. i, too, dont see crop tops or bikinis in my future so having a foot long scar doesnt bother me in the least. i am safe in the knowledge that my surgery was performed properly for ME. the decision to have lap or open is only urs & ur surgeon to make. good luck!
   — sheryl titone

April 19, 2002
I just had Lap rny on April 1st and I would recommend it to anyone. The Lap sites are healing well and the risk of hernia's from the surgery is next to none. I had two C-sections in the past and had trouble with both incisions healing properly. That is why I chose Lap and don't regret my decision at all. Good luck to you.
   — Leah H.

April 19, 2002
I don't think it's so important whether CCBS has just started offering lap. What does matter is much experience their new surgeon has with lap. Have you looked him up in Find a Doc? If he's there you could contact others whose surgery he has done to see what they think.
   — garw

Click Here to Return