Question:
Is it better to do open surgery vs. lap?
I have the names of three surgeons who to open and one who does lap. Is it worth the extra time, effort and expense to do lap? I know that recovery is quicker but is it really that much better or is it a cosemetic thing? In a year it won't matter anyway? Isn't the incision for open fairly small? — Miguel M. (posted on May 12, 2001)
May 12, 2001
I had an open VBG and my incision is from my chest to my bellybutton.
About 12" long.
— William T.
May 12, 2001
I had the DS open and my scar is also from breast-bone to belly button. It
is definitely NOT a small scar, but a small price to pay for my new life!
As for Lap VS open, There are a lot of things to research and think about
before making a decision. While lap works well for a lot of people, usually
in larger, or super morbidly obese people, the risks are greater because
some of the tools they use during surgery may not be long enough. I know
there are several surgeons who will not do lap on someone over 300 lbs, but
there are some who will. If I were you I would research carefully and check
your surgeons credentials, no matter which decision you make. I personally
felt safer with the "open" procedure, but I did start off with a
BMI of almost 69. I hope this helps. Good luck with your decision.
— Kim B.
May 12, 2001
Miguel, this question always seems to open the door not only to a great
deal of controversy, but also to a fair amount of misinformation. You
asked in a laparascopic surgery was worth the extra time, effort and
expense. Experience and expertise are EVERYTHING when choosing a surgeon
to perform laparascopic WLS. If the surgeon has those qualifications, then
the time, effort and expense are non-issues. My daughter, husband and I
have had lap RNY surgery. The operating times ranged from 60 minutes to 1
hour 10 minutes. The "effort" was minimal: we had 2 day
hospitalizations, no ICU, no tubes, no drains, no external sutures or
staples, and we were back to full-time work in 8-14 days. The
"expense" was an all-inclusive cost (surgeon, assistant,
anesthesia and hospital) of $18,500, regardless of length of stay. Our
surgeon is internationally recognized for his expertise in this field, and
has performed over 600 lap surgeries, some of which have been for patients
weighing up to 600 lbs. (my daughter's BMI was 70). There will always be
cases where an open surgery is the only option for patients, and I would
have immediately accepted an open surgery by an experienced bariatric
surgeon before I would have undergone a lap surgery with an unexperienced
surgeon. Continue to do all the research possible, be a well-informed
consumer, and then make a choice that meets your specific needs. Good
luck!
— Diana T.
May 13, 2001
From all of the information I was able to gather, the concensus has been
that the best operation for you is the one that your surgeon feels is best.
I know that you may prefer one surgery over another, but the surgeon, who
has done a comprehensive physical on you, evaluated you for the
appropriateness of surgery, and knowledge of their own skills should be the
person to decide. Best of luck!
— [Anonymous]
May 13, 2001
From my own perspective...I feel having the LAP(keeping in mind that I was
willing to go across the country for the best LAP surgeon) was one of the
smartest decisions I made in regards to my surgery....I was a selfpay
however(even though I have double insurance coverage..still iritates me)
and didn't have any insurance co telling me where, when, how and with whom.
I would now choose a LAP surgery ove an OPEN surgery any time I could.
— Debora H.
May 13, 2001
When lap surgery was first started for Gall Bladder removal there was this
same controversy. Now its done 95% of the time for GB removal.
The only real barrier to lap over open is the skill of the surgeon as
minimally invasive surgery will in the future if not now be the gold
standard.
Its not just cosmetic, it is much less traumatic on the body. Bottom line
is post op... the less pain and discomfort you have the easier it is to get
up and walk and deep breath.
... and if you've done any research about surgery at all you know the key
to a successful recovery is the avoidance of clots and emboli... the more
coughing and deep breathing, and walking you do, and the earlier you can do
them the faster and less complicated your recovery.
"The advantages of laparoscopic surgery come from minimizing the
trauma of access to internal organs. By avoiding a long incision through
the muscles, many post-operative problems are eliminated and pain is
markedly reduced. This enables you to breath and cough better. Use of
strong pain medications is drastically reduced so the drowsiness, fatigue
and unsteadiness they cause is minimized. Most patients have a shorter
hospital stay and recover within days instead of weeks.
What are the risks of Laparoscopic Surgery?
Risks of any operation include: infection, bleeding, hernia, pulmonary
embolus (blood clot to the lung). These complications tend to be less
frequent in laparoscopic surgery compared to open surgery. Remember that
each procedure has unique complications that occur whether it is done open
or laparoscopically." Dr Jossart
http://www.pacificsurgery.com/About_Us/Lap_Surgery/lap_surgery.html
— X X.
May 14, 2001
I had Open. My incision opened up and took 5 months to heal. But, I could
have died if they did it Lap. Plus, Medicare doesn't pay for Lap. I'm glad
I had the surgery with all the complications. Good Luck --
— CohenHeart
May 18, 2001
Miguel, although I haven't yet had my surgery, my surgeon has explained the
type of surgery he does and the reason for his choice. He only does open
RNY and told me that my incision will be from the bottom of my breast bone
to the belly button. He prefers the open surgery because he can see
everything more easily and has more room to "work". He also said
that with the lap, it's easier to "nick" other body parts that
are very close to the stomach and intestines. With the open, he can more
easily move those other parts out of his way and it makes the surgery less
risky. Also, my particular surgeon checks out everything in the abdominal
cavity while he's in there. He's actually found cancers in a few patients
that probably would have otherwise gone undiagnosed for quite a while.
Because of the open RNY, they received treatment at a very early stage and
are currently survivors of both cancer and obesity. As others have said,
there are good points and bad points to each type. The decision ultimately
is between you and your doctor. I personally wanted the lap because of the
scar and recovery time. However, after talking to my surgeon and really
thinking about it, I'm happy with the open procedure. I wish you luck!
— Nancy L.
August 14, 2001
From what I have read on the internet and from several people in our local
(independant-not sponsored by any single Dr. or center) those getting open
RNY seem to do better in the long run. I think this is due to more thorough
operation and several Lap RNY's only had the pouch stapled and not
completely disected from the rest of the stomach and staple lines can rip
out easier than completely disected and seperately sutered portions.
I am scheduled for open RNY next week (aug 20, 2001). My wife Susan had
sugery 4 months ago by Dr. Pilkington and has done great with no
complications and healing great.
— Dell H.
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