Question:
Is there more risk in being put under anesthesia during LAP?

Being "under" for Lap vs Open... Hi: First, I want to THANK everyone who reponded privately about my earlier question regarding my $30,000 limit, and wondering what to do if my secondary didn't kick in... I WAS APPROVED by my secondary Yipee. No worries. Anyway, I have another question. With WLS for open I'm told I'd be under for approx 1 1/2 hours. WIth LAP I'm told I'd be under about 5 hours. Anyone know if the extra 4 hours will hold that much more risk for complications??? Thanks agian for everyones help.    — Karen A. (posted on January 5, 2001)

January 5, 2001
Hi, I just had an Lap RNY on 12/21/00. I was only in the operating room for 1 hour and 10 minutes. If it will take your doctor 5 hours, he doesn't have enough experience. Find a different doctor who has had a lot more practice. Hope my answer helps you. Good luck with your decision.
   — Judy G.

January 5, 2001
Just curious if you are having RNY or DS, if you are having DS this would be a normal amount of time, but not for RNY??
   — [Anonymous]

January 5, 2001
A lap DS does not have to be five hours long --- unless it is a revision or the surgeon experiences complications. I'm sure some surgeons (who do not have as extensive experience) do have longer lap surgery times. My surgeon (Dr. Gagner/Mt. sinai) usually does a lap BPD/DS in under 3 hours -- around the same time as an open. I would be concerned if the lap RNY would be five hours long... it is a less complicated surgery and usually takes a much shorter time than a DS. I don't want to sound really negative, but I would get all the info on your surgeon's statistics (ie. how many lap procedures he/she has done) because it sounds like this person *may not* have extensive experience with a laparoscopic procedure. IMHO, it is really advantageous only to the extent that one has an extremely experienced laparoscopic specialist. There is nothing wrong with an open surgery -- and, if the surgeon is accustomed to open surgeries, I would much rather go with an open rather than a five hour lap if the surgeon is not extremely experienced with the laparoscopic method. :) You didn't mention whether the surgeon expects certain complications - this may also extend the time frame. I mean, the benefits of lap surgery is increased recovery time and mobility, less risk of blood clots and other such complications (although risk is still present)... but an extended time in the OR can lessen these advantages.. I would certainly discuss the surgeon's past experience and then make a more informed decision! :) all the best,
   — Teresa N.

January 5, 2001
I agree with Judy...if your surgeon takes 5 hours to do a lap RNY, find another surgeon! My surgeon's average time for lap RNY is 1 hour...my surgery took 1 hr. 10 min due to significant adhesions from a previous gall bladder surgery. This is your life...experience is everything.
   — Diana T.

January 5, 2001
My LAP proceedure took 7 hours with GB removal, and I would not have had another surgeon under any circumstances. My surgeon has done thousands of LAP procedures and is extremely qualified. The length of the surgery is not an indication of the competency of the doctor.
   — Angela J.

January 5, 2001
Angela: There is a learning curve for a laparoscopic surgery. When a doctor is in the early stages, the surgery will take much longer. As he/she masters this craft (and it is radically different from open surgeries --- a surgeon can be *excellent* at open surgeries but still be 'learning the ropes' so to speak with laparoscopic), the operation time WILL decrease. While I agree that there is no 'absolute' link between operating time and a surgeon's overall ability, and, as I mentioned in my response -- complications (whether predicted or not) can lengthen time in the OR, such an extended time under anethesia for a laparoscopic WLS ***may*** be an indication that that particular surgeon is in the earlier stages of performing laparoscopic surgery (and I did use the word *may* in my previous post). This patient should be aware that a five hour operation, especially for an RNY, is on the long side, since there are surgeons who perform an RNY in two hours or less. :) The DS does take longer (even via lap), but it is not always a five hour procedure (unless, once again, the surgeon is not as experienced performing the DS laparoscopically and/or there are complications involved). A surgeon's 'newness' to laparoscopic surgery does not mean that they are unqualified nor does it mean the surgeon isn't good -- It can simply mean he/she has not performed the laparoscopic surgery for an extended period of time, even though he/she has extensive experience with open procedures. One must weigh the pros and cons of their personal case to see whether the benefits of laparoscopic surgery outweigh the negatives. In some cases, I do believe that open may be the way to go. All the best,
   — Teresa N.

January 19, 2002
I know this is more than a year after this question was asked, but I thought my answer might help someone reading this now. I had a LAP RNY on 12/4/01 and my surgeon also told me to expect 6 hours, and I was concerned about the length of time. The morning of surgery, the hospital staff told me the surgeon had the operating room reserved for 5 and a half hours. Prep time was at least 30 minutes...I was surprised to see how much they still had to get ready when I was wheeled into the OR. I found out my actual operating time was under 3 hours. I imagine my surgeon tells people 6 hours to prepare them for complications. I do know that after he's done doing the RNY, he takes a look see to make sure everything else inside you is normal. I know of one patient who had an ovarian cyst removed (she didn't even know she had one) and another who had an unknown hernia repaired. These extra procedures will add time to your RNY surgery.
   — Cyndie K.

January 2, 2003
I actually just read an article today that was written by a very experienced surgeon, and he stated that length of surgery differs when it comes to LAP, because it takes longer to do on more severely obese patients. He stated the length of time varies from 2 to 7 hours. Also, it would seem to me that the most experienced surgeons had to start somewhere. What I looked for in my surgeon was his credentials, his licensing and training, and his experience with lap surgery in general, not just WLS. I feel confident in my choice. While he doesn't have hundreds of WLS's under his belt, he does have 12 years experience with laparoscopic surgery, a clean record, and an ASBS preceptorship and more than adequate training.
   — Jennifer C.

May 21, 2003
I have heard many stories such as the question regarding longer operating times needed for laproscopic surgery and wanted to respond. First, whether the bypass is performed open or laproscopically, the same internal work is performed on the organs; therefore, the amount of time it should take to create the pouch and reconnect your intestines is the same under both procedures. Secondly, there is considerable time involved in the open procedure due to the need to close the lengthy incision (as you know internal stitches are needed to repair the muscles that were cut and then the skins' layers need to be closed). Consequently, with a skilled and experienced surgeon, the laproscopic procedure is a much shorter operation than an open Rous-en-Y would be. For my own experience, I was 500 pounds at the time of my procedure, and I was off the time in 1 hour and 40 minutes with a laproscopic rous-en-y.
   — SteveColarossi

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