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




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