Question:
should I have my rny open or laproscopic?
My insurance approved my rny surgery. My doctor is covered under my insurance. The hospitals that are covered under my insurance are not surgically equipped with the equipment for a laproscopic procedure. If I go to the hospitals that are covered....and my doctor practices at them, I will have to have the open procedure...which I do not want. The hospital my doctor can perform the laproscopic procedure at is considered a non-ppo....so benefits would only be paid at 65% to the hospital even though my doctor is covered. I can't afford to pay the difference, and can't really afford to take the additional time off work that the open procedure would require. The insurance company said I could appeal the decision but needed a doctor's note stating why we are going to a non-ppo hospital. The doctor's office called me back, and said they didn't know what to write, and that the doctor said there really wasn't much difference between the 2 procedures. I think there is....and really DO NOT want the open procedure!! Any suggestions? — Melannie W. (posted on June 22, 2005)
June 22, 2005
What insurance company do you have? If you really want Lap I would double
check first all of the hospitals in your area even in Ohio that your
insurance allows. Find the hospital with a bariatric program that performs
lap first, then you may have to choose a different surgeon if your doc
doesn't have privleges there.
— Miss KJ
June 22, 2005
I heard from someone that a doctor started the surgery as an open with a
smaller incision than normal open surgery and then used the laproscopic
instruments to complete the procedure. Don't know if this would be
something you or your doctor would consider.
— one twenty five sixty to go
June 22, 2005
There is a difference in the procedures. If your roux-en-y is done
laparascopically you will have 6 tiny incisions. The recovery time is less
as well as the pain afterwords. You will be in the hospital less time also.
Your time off of work would also be less. It would be worth looking into.
Mona
— monymony
June 22, 2005
I am here to tell you that the only difference is the incision. I had open
Rny almost 3 years ago. No complications. I was in surgery 1 1/2 hours
and in the hospital 2 1/2 days. I went back to work at 2 weeks out. My
scar is about 4 inches long and barely noticable.
Your choice. But the recovery time is up to you also. Everyone is
different and everyone recovers differently. I have seen where lap
patients stay out of work for 6 weeks.
I am absolutely sick of people saying lap, lap, lap. People should be more
realistic. Open is fine and sometimes even better because you don't have to
deal with the gas pains. Major surgery hurts, that's a fact. I have
always wondered what these people, who are so concerned about scars, do
when they decide to have a tummy tuck. I have gladly exchanged a 4-inch
scar for my health.
Patty
— Patty.W
June 22, 2005
Have you considered perhaps going to another Doctor? Cause frankly any
doctor that would try to say there isn't much of a difference in the two I
think is incompetent. I know for a fact there is a huge difference between
the two since I have had two friends that have had each. My one friend was
down much longer, was in much more pain and had more complications and had
to have a drain as well. My other friend who had it laproscopic, she was
hardly in any pain and was feeling near to normal on the 3rd day!! She
didn't even take pain meds on her 2nd day. Now I have found many people
that have had open will tend to try to tell you that they are the
same...but they aren't. Or they will also try to tell you its better. And
it isn't. I have talked to a number of doctors on this fact. The risks are
higher for infection as well as hernias and other problems. I have also in
my own research noticed many open patients don't seem to loose as well as
the laproscopic. Its not a proven fact but it is just what I and many
others have seen. I would perhaps try to look for a doctor that strictly
does laproscopic procedures. That is what I have done myself. I know there
is always a risk you might have to have it open if there is a problem. but
more than likely all going well I wouldn't have too. That's my advice, it
just doesn't seem that your doctor is much interested in helping you out
and that he is just wanting to do it open. That is the vibe I got. I might
be wrong, but best of luck to you!
— lorie_nicole
June 22, 2005
Thanks so much for all of your advice! First of all....to answer the
question, my ins is GEHA. Quite a few people have had both the open and
lap procedure at my work....so I am kind of familiar with both. The people
who had the open...their incision is much longer than 4"....it is
about 8"...and they were off work approx. 6-8 weeks....v/s 2-3 weeks
with the lap. Several who had the open procedure had to have hernia
surgery afterward. I only know of a couple of people I work with who had
the lap.....but after you mentioned that some laps seem to lose
faster....but that may just be coincidence? I also wondered if it is easier
to recover from the open if you are younger than me....I am 46.....so that
was a worry also. Yes I worried about incompetance when the doctor's office
said there wasn't any difference between the 2 procedures. Internally I
think they are about the same....but externally...I know they are very
different. I am just trying to weigh all of the pros and cons...and your
comments and thoughts help a lot! I live in Northern Ky, and the hospitals
close to me aren't surgically equipped for the lap procedure. Those in
Ohio are equipped but not covered. I am just trying to weigh all the
options....thanks for your help!
— Melannie W.
June 22, 2005
I tell anybody that asks me to have it open! I am 45 and I had mine open
with no problems. Sure, you are sore for a few days, but non unbearable.
I know a lot of people have had lap but I have noticed most people that
have complications are the ones that had it laproscopic. I have also had
several people tell me that if they had to do it over again, they would
have the open procedure. Whichever way you choose, I'm sure you will do
great and I wish you all the best.
— pghires
June 22, 2005
OK, just for the record, the surgical procedure of RNY is the SAME
regardless of how the doctor enters your abdominal cavity. Whether he makes
6 little incisions or one large incision, once he's inside he's still doing
an RNY. If the hospital he practices at does not have lap equipment, that
means he is probably not skilled enough to perform lap surgery - does he
have privilages at the hospital you are considering? If the hospital he
practices at does not have the lap equipment how does he stay sharp on his
lap skills? There is a learning curve there. It's not like if the hospital
got the equipment delivered tomorrow he would suddenly be able to do your
surgery laproscopic. I had open RNY, was in the hospital 2 days and back at
work 2 weeks later. Why do you not want the open? Is it because of the
larger scar? Cause I have to to say, there are a lot of people that post on
the message board that are really baffled that they don't feel 100% back to
normal at like a week post Lap. For some reason they think that just
because their incisions heal fast, the inside heals just as fast and it
kinda suprises them that it doesn't work that way.
— Ali M
June 23, 2005
My doctor has been performing lap procedures for 3 years, and open for
about 5. He performs the lap procedure at the hospital that is equipped
but not covered by my ins. He can perform the rny at 3 different hospitals,
but the 2 that are covered aren't surgically equipped for the lap
procedure. Those who said they were back to work in about 2 weeks after
the open....WOW! Most of the people I know were off at least 4-6 weeks
minimum....so I was surprised to hear that I could be back to work possibly
sooner....and never got the impression from my doctor that I could be back
to work sooner than 6-8 weeks. I am feeling more hopeful after hearing how
soon some of you went back to work! As far as the scar....yes it is a tiny
worry....but I never wore a bikini in my life....or belly shirts....and
don't plan on starting when I lose the weight. My hubby said the scar
wouldn't bother him...he just wants to see me healthy. If my ins wont
cover the hospital where I can get the lap procedure....I may just not
worry about it....and get the open. Thanks for all of your advice....I am
learning more every day!!
— Melannie W.
June 23, 2005
Open about 1/3 get at least one incisional hernia, LAP the rate is near
zero. Most hernias require a follow up operation. Something to consider.
Open has a greater risk of infection since your body cavity is opened to
room air LAP uses sterile nitrogen, so theres fewer infections. This all
from my surgeon Dr Philip Schauer, a world leader in bariatric surgery. I
walked 1.3 miles exactly one week after my LAP RNY, and was back to work
part time in just over a week. best wishes on whatever you decide
— bob-haller
June 23, 2005
appeal to the hospital board of directors of your choice hospital that
takes your insurance that they are loosing your business because they lack
laproscopic equipment and see if they can get some, MONEY TALKS,
ESSPECIALLY WHEN THE COMPETIION IS GOING TO MAKE IT.
— walter A.
June 24, 2005
You have three choices - do not have surgery, have it open and fully
covered or have it lap and cough up a chunk of $'s. To me this is a no
brainer. You obviously feel you need and want the surgery or you would not
have gone this path. You also state you cannot pay the 35% of the hospital
bill, which I fully understand. To me, choosing to not have WLS because
you cannot have it lap is unthinkable.
<p>I was hell bent on having my WLS lap. This was 2-1/2 years ago
when not a lot of docs would take on a 65 BMI lap. The surgeon explained
to me that due to my size etc., he wanted me under anesthesia the shortest
amount of time and an open would provide that. I had decided I wanted that
surgeon and it was clear his only goal was to bring me through alive, so I
went for it and have never regretted it. The incision I was left with
wasn't a big deal visually. I did have some healing problems but it did
not prevent me from going back to work at 2-1/2 weeks PO. I went back part
time and spent the next 2-3 weeks working up to full time. The bottom line
is I now have about 140 inches of incisions from all the PS I had. My WLS
scar is gone and replaced with a very fine, barely seeable scar. I have
zero problems wearing something that exposes my midriff as someone has to
look fairly hard to tell I am cut there. The incisions that run from groin
to knee and all the way around my body at the hips and the bra line, are
much more noticeable, but totally covered by even fairly skimpy clothes. I
have a modest two piece swimming suit and not a tankini and all scars are
covered.
<p>I would never have a surgery as a facility that you know is not
geared up for what you are having. I'm not willing to gamble that much.
People die in those situations was too easy. I wish you luck in raising
the money to go lap, it sure isn't easy. Just remember that you could put
out the money for lap only to wake up from surgery with an open. Just
because a doc is willing to go in lap does not guarantee he is going to
finish lap. So keep that in mind also. Granted most docs are able to
complete lap these days and on even fairly large people, but it is no
guarantee. Personally I'd work on saving money for PS and get the open.
JMO
— zoedogcbr
Click Here to Return