Question:
What is the difference between open and Lap?

I'm confused about what the difference is between open and lap? And why some people get one versus the other...    — Kimberly S. (posted on December 11, 2002)

December 10, 2002
The only difference between open and lap surgeries is the approach. The work that the surgeon does on the inside is exactly the same in both instances. An open surgery involves having a single large incision, and a laparascopic surgery involves having 5-6 very small incisions (usually about 1/2" wide) scattered across the upper abdomen. Open surgeries carry a higher risk of infection and post-op hernia formation, and patients generally have more post-op discomfort, longer hospitalization time, and longer post-op recovery time. Lap patients have less discomfort, shorter hospitalizations and shorter post-op recovery time. Laparascopic surgery is an extremely specialized field of surgery, and there are far fewer qualified lap surgeons than surgeons who only do open surgeries. You will frequently read that lap surgery is more risky, that it cannot be done on patients weighing more than 300 lbs., that the surgeon can see much better with an open surgery, etc... Those statements may very well be true if using a surgeon with limited laparascopic training and experience; however, those statements are completely false if the surgeon is experienced in laparascopic bariatric surgery. If you are considering lap surgery, do your research well, and find the most qualified lap surgeon closest to you. The web site for the American Society of Bariatric Surgery has a list of bariatric surgeons who specialize in lap surgery...www.asbs.org. I would completely agree that it would be better to have an open surgery than to have laparascopic surgery with a surgeon who does not have extensive training in the field. Best wishes!
   — Diana T.

December 10, 2002
All of the previous poster's statements are true. I do want to add one thing. (I had lap RNY 10/29/02). My surgeon said that in open RNY, the stomach is sometimes stapled, not transected, but when lap is done, the stomach is transected because they can't get the stapler in the small openings. FYI: I was in surgery 2 1/2 hours, stayed 2 days in the hospital, was back at work on post op day 12, and went with a high school marching band and chorus to Florida (20 hours each way on a bus!) one month later! A lot depends on the skill of the surgeon, and who is available where you are.
   — koogy

December 10, 2002
Diana covered it real well. I will add the incisional hernia risk with open is 30% LAP its near zero. Those hernias, and some get more than one require yet another surgery. LAP is the way to go, see my rofile for my experience, walked 1.3 miles one week after suegery.
   — bob-haller

December 11, 2002
I actually had both. My original surgery in May was done LAP. Unfortunately, my surgeon made an error that had to be corrected by a second surgery in July. If he had done open to start with, he probably would not have made the error. However, the real point I want to make is that I did not have much pain with either surgery and was able to be up and walking within a day or two of each surgery. I had other complications too numerous to mention, but I would never say that LAP is the only way to go. It depends greatly on the skills of the surgeon you choose and sometimes, depending on your insurance, you don't get a lot of choices. That was true in my case. Two of the most experienced bariatric surgeons in the Denver area are not in my insurance network. One other is, but he is on the other side of the metro area from me, just too far away for me to want to travel. So, I went to a general surgeon who has a lot of experience in lap surgeries, although not necessarily with lap bariatric surgeries.
   — garw

February 24, 2003
Lap is laporascopic and is approximatly 6 small incisions(approx 1/4-1/2 inches long) versus Open which is one incision that is approximatly 4-6 inches long. There are many reasons why you would end up getting one as opposed to the other. Some surgeons only do LAP or OPEN and depending on you and your body, you may only be able to have the Open. That's all I know! :) GOOD LUCK!
   — Mary H.

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