Question:
Open vrs Lap
I had my consult with the surgeon yesterday and he refuses to do a Lap on me and said that he will only do the Open. He said that the only way that he would do Lap is if I were to lose from 308 to 250. I am so disappointed and more afraid considering that I will needed to recover a lot sooner due to being a single parent & also because of hearing about hernia's. Dont know if I should maybe find a new Dr. or what? — Deborah B. (posted on September 6, 2003)
September 6, 2003
Hi! I've seen people at much higher weight than yours and still have a Lap.
I am not a single Mom but a stay at home Mom so I wouldn't have done
anything other than a Lap (unless there was a problem during surgery and
the Dr. HAD to open me up). If you have the option, I would really try
seeing another doctor, if you don't feel comfortable with this one, that
isn't a good sign. You need to feel very comfortable with the Dr. and their
attitude, it can make or break your recovery (this was my experience from
my second c-section and an awful OB-GYN [she wasn't bad when we first
started with her but it got worse] and I didn't change, should have). I
weighed 268 at my first consult and was down to 255 on surgery date and my
surgeon did a lap, no problem! Try another Dr.
— Michawn
September 6, 2003
I too am a single mom who is getting ready to have surgery. My situation
was a little different than yours though beacause I initially wanted open
but my surgeon really did not want to perform the surgery that way because
of the recovery time. To make a long story short he strongly suggested the
lap procedure because of the fact that I am the primary care-giver of my 3
year old son. Us single moms have to be in tip top shape as soon as
possible. You might want to look into another surgeon. Just to get another
feel for other options that are out there. It might be worth your time.
— Teekay80
September 6, 2003
This just means your surgeon isn't very experienced. 350 isn't very high
for lap. I,personally would look for a more experienced surgeon. However,
if he was the only game in tow, who cares? In the 2-3 hours it takes to do
the surgery, you're life is going to change profoundly. I find it amazing
that we live with obesity for years, and in a few hours we can change it.
No problems, or minor problems and we are healthier, happier and complegely
changed. It's a total miracle, and everyone who has it should get down on
their knees, if not their whole bodies as I did, and thank tha Lord every
day that a cure has been found. It may not be the ultimate cure, but it is
a cure. I'm over 2 years out with only 60 cm bypassed, and I thank the Lord
every day for my surgeon. I can't believe I was so ignorant as to not to
listen to people who had had the operation done before, I thought I was
"too smart" for them (BA, Masters, MBA). I was not, I am thankful
every single day for the courage to go through with this, and even thoug I
didn't reach MY IDEAL WEIGHT (which was 110 on a 5'4" fram, which
OBHelp.com said should be 134) I am happy, healthy, and maintaining without
a problem at 127-138 depending on the time of the month (where, for the
first time in my life, I know what "bloated" is). Be realistic,
recognize that the heavier you are when you start is the heavier you'll be
when it's done. Do whatever you can to maximize the weight loss during the
first 6-12 months. (IE" STARVE yourself the first 6 months) You'll
thank me in the end, and it's not like you've never done it before. Go for
the MAXIMUM amount of weight loss during the first 12-18 months. This is
the BEST ADVISE, which is realistic, that you'll ever get. You can do
ANYTHING for 18 months, use it to its total potential. I lost 160 lbs. in
18 mos. I wish I lost 10 more. I should been better, but I'm getting old
(42) and I think that has something to do with it, along with the excess
skin I have ( at least 10 lbs), work towards having the excess skin paid
for by insurance and you will have done millions of people a favor. Your
mom was great, I expect at least the same from you. Good luck,your formerly
fat buddy, Sandie Guy
— sandieguy
September 6, 2003
Five of us in our family have had lap RNY surgery. Our weights ranged from
225 - 406 lbs. and our BMIs ranged from 42 - 70. Although there are risk
factors with any type of surgery, our lap surgeries were completely
uncomplicated and uneventful. The advantages, from our perspective, were
having significantly less post-op discomfort than with open surgeries; less
risk of hernia or infection; more rapid return to normal function and
return to work (within 8-14 days). In the field of laparoscopic surgery,
experience is everything. Our surgeon is one of the founders of today's
lap WLS techniques and routinely performs lap WLS on patients weighing in
excess of 500 lbs. Finding an experienced lap surgeon may require that you
travel to another city or state, and may present conflicts with insurance
providers. However, if you have the options and flexibility to search for
an experienced lap surgeon, I certainly would recommend it. If, as another
responder has said, your surgeon is the only option available to you, then
my advice would be to continue with your plans to have the surgery. It has
been a completely life-altering event for each of us, and the best decision
that we ever made. Best wishes!
— Diana T.
September 6, 2003
In my opinion the only thing that is important is how comfortable you are
with your surgeon. If he is the surgeon you really want, for whatever
reasons, then go with the open. I agree with everyone else that at your
weight a LAP should not be a problem although you are borderline with a
51.6 BMI. 50 BMI is where my surgeon draws the line for the most part.
There are surgeons doing LAP on people who were my size, 65.3 BMI but not
my surgeon.
<p>I really had my heart set on a LAP but my surgoen would not even
try it. So I had to make a choice. Bottom line is his skills, reputation
and being right in my backyard were way more important to me than having
LAP. Plus at my weight LAP was more iffy too and I could have waited a
long time to see a surgeon in Milwaukee who does LAP on SMO only to find
out he would not do it or to have him convert to open during surgery. It
was more important to me to have my surgery quick also. I do not regret it
one bit and I did have incision problems and ended up with a 2nd surgery in
order to get it to close. I had a hole for 4-1/2 months, but I'd do it
over in a heartbeat the same way. I do not care about the scar etc. I
care that I had total confidence in my surgeon and he brought me through
alive.
<p>So you need to decide why you chose this surgeon in the first
place and why did you want him, assuming you made the initial decision to
choose. You might end up delaying surgery quite a bit to switch surgeons
now, but only you can decide what is most important to you. Just know that
just because they start out LAP is no guarantee they will finish up that
way.
— zoedogcbr
September 6, 2003
My surgeon has an "if you're over 350lbs" rule about doing lap.
When I had my original consult with her, I weighed 362lbs and asked her
about losing that 12lbs so that I could have lap RNY. After her
examination she told me she thought she'd still do open on me since I was
"thicker" around the middle. My feeling at that time was YEAH, I
wanted the lap procedure, but who was the expert, me or my surgeon.
Obviously she was, so I went with her recommendations. Bottom line is your
surgeon is the best authority for how he or she would like to operate with
you as a patient. I have to respectfully disagree with the previous poster
who said it was inexperience. I'd say if a surgeon was inexperienced, he
or she wouldn't be doing the lap procedure at all. Anyway, as many of the
other posters said, if you have complete faith in your surgeon, I'd go with
his or her recommendations. God bless and I hope all goes well!! :-)
— Amy G.
September 6, 2003
Hun I'm sorry to hear that your surgeon is that strict. I went to a surgeon
who was covered 100% by my insurance and he also refused any type of
surgery on me because I weighed 320. He even suggested going to weight
watchers until I reached 290. I have been slowly losing weight for about a
year now.. I lost 30 in 7 months, but I did that for me, not for the
surgeon. Anyway, my opinion was, if he's not comfortable working on me,
then i'm not comfortable with his medical capabilities. Now I'm going to a
surgeon and I had to pay 80%, my surgery is tuesday, but I know I made the
right choice. The new guy only does lap. Maybe you can find one who also
specializes in lap surgery. Good Luck
— poohniki
September 6, 2003
Just to throw this out there, there's always the possibility that when they
start a procedure laproscopically they will still end up open. So you
should always have a back up plan. If you can go lap go lap but consider
what your doc thinks would be better for you. I had open surgery and I was
back to work at 3 weeks and taking care of my four year old from the moment
I got home from the hospital.
— Laurie B.
September 7, 2003
I was told that lap was the way to go, (haven't had it yet), but my doc
said that due to my body 'shape' and amount of middle muscle surrounded by
fat, open was a better way to go for me. He said that he would still be
using lap. tools, but in the essence of ease for his surgical team, and
weighing in the % of possible complications to my weight of 350 lbs, he
said he would go open. I don't really care all that much, I'll just have to
be more careful in the short term while healing. All in all, I would rather
have one wound to heal from rather than 4-5 small ones. He also mentioned
that even if he were to do lap, and there were complications, he would have
to revert to open and then I would have a stomach that looked like a road
map from conneticut to california!. Hopefully, after a year the map would
only extend to Kansas, but we'll have to check with AAA on that!
— track
September 7, 2003
I had open DS. I was back to wwork in 3 weeks, only needed help until I was
8 days out and had my staples removed. It is not that bad, this was easier
then both my C-Sections!!! Good Luck!
— Stephanie B.
September 7, 2003
2 weeks ago i had open RNY with a starting weight of 278. i'm also a mom.
the first week was the only time i needed help. 2 weeks down 21 pounds!
— franbvan
September 7, 2003
A doctor who only does open is a doctor who is not well trained or well
comfortable with LAP. There's nothing wrong with the OPEN procedure, but
it just lengthens recuperation in my opinion. Can you find a new doc? Can
you explain your concerns for a fast recovery and see if they can refer you
to another doctor who does it LAP?
— Cathy S.
September 7, 2003
Hi there, When I first read your question, I wasn't sure if you meant
Lap-band or Laparoscopic. I went for the Lap-band and because I weighed
379lbs the doctors told me I had to get down to 240. I did have the RNY
done laparoscopicly though and I've had no problem yet. I guess what I'm
wondering is if your're saying lap to mean lap-band?
— Yolanda C.
September 7, 2003
Keep in mind you might go in for a Lap surgery that the doctor has to
convert to an open surgery.
— barbara A.
September 9, 2003
Just because a doctor does only Open procedures and not LAP does not
necessarily mean he's inexperienced. LAP equipment and staff training is
VERY expensive and if it's a smaller hospital or if you don't want the
costs passed along to you with higher fees...etc. then sometimes the open
procedure is a better avenue to explore. There are pros & cons to both
procedures and it's really up to you - which method can you personally
tolerate better? The LAP procedure is much more expensive than Open -
especially a consideration if you have to pay for part or all of your
surgery. The open procedure will take approx. 1.5hrs in the operating room
while the laproscropic takes at least double that. The longer you're under
anesthesia, the higher the surgical risk. Surgeons can see better with an
open procedure as it's a direct hands-on method whereas with lap, it's a
surgeon viewing your insides through special headgear that takes time/many
procedures to proficiently estimate where your organs are. There is an
increased chance of leaks/bad staple line with lap vs. lower risk w/open.
Yes, there's one big scar with open vs. 5 or 6 small incisions w/lap. There
are usually more problems with hernias with an open and there are usually
more problems with proper incision healing/wound closing with open than
there is with lap. There are many things to consider with both procedures.
Take the time to research and educate yourself on what is truly best for
you. Good luck! (by the way, I'll be having an open RNY next month).
— Lisa B.
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