Question:
I had my consult and was told because my BMI is over 50 I will have to have open rny
I want to know why some surgeons are doing lap on people with high BMI's like me ( I've read quite a few profiles where I have seen this!!) instead of the open rny? My surgeon explained that the reason she does it like that is because the less time a person's "on the table" the less chance for death. So, on a high BMI person she's not going to want them out for the longer time it takes to Lap vs RNY. Anyone have any thoughts on this? I'm just curious why some people can get the LAP and some can't. Is it the surgeon's decision? — kathleen-Joan piper (posted on March 29, 2003)
March 29, 2003
I think this issue truly is dependant on your surgeon and the hospital he
operates at. My BMI was 81 at the time of surgery and at my first consult
with my surgeon, he told me most likely I'd be able to have LAP, no
problem, and it wasn't any problem, I had NO complications at all. The
hospital I was at is well-equipped with extra-long LAP instruments, which
allows for LAP surgery on SMO individuals.
<p>
Plus, I had Lap-RNY on 1/13/03 and have lost 83lbs to date!!
— thumpiez
March 29, 2003
Jen my widfes BMI was 60 at the time of srgery. Her table time LAP was 1.5
hours. Its the surgeons choice and depends on their skills and tools. Extra
long LAP tools cost a fortune. You might have to shop around for a LAP
surgeon that does high BMIs
— bob-haller
March 29, 2003
This decision totally depends on the skills and experience of your surgeon.
My BMI was 64 and I had lap with no problem, though he reserved the right
to switch to open during surgery if he needed to. Of course, I am
convinced that my surgeon is the best in the nation... *smile*!
— jen41766
March 29, 2003
My BMI was 50 and I had my open. My doctor told me because I had other
surgerys in that area he felt better doing it open. I sounds more painful.
It wasn't has bad has I thought. I was out of the hospital in 4 days. I was
able to drive in a week. I do aerobic exercise and play with my kids. I
can't lift and thats why I haven't gone back to work. It will be two weeks
on April 1st. I fell I am back to a somewhat normal life. Don't be
worried. Think of the great out come . GOOD LUCK!!!!!!!!!
— Lori L.
March 29, 2003
My BMI is over 50 and my surgeon prefers to perform the surgery open. He
said that he feels more comfortable doing it this way b/c he can see better
and he is able to do everything by hand. He also told me you are under less
time than with a Lap.
— Lisa N.
March 29, 2003
There are a number of reasons for limiting lap surgery to those with a
lower BMI. One is the length of time you are under anesthesia. Another is
the ability to get to the parts they need to get to under the fat and often
fatty liver. Lastly, not all facilities have the longer tools necessary to
perform lap on larger patients. There are a few surgeons who actually
specialize in lap rny on larger patients.
— JoAnn B.
March 29, 2003
I wanted LAP really bad at first and even looked for other surgeons that
would do a 64 BMI, 432 lb person. While they were out there they were
either a long wait or a lot further away. The more I thought about it I
knew that I wanted the surgeon would only do the open. His reputation and
track record were way to great to pass up. So I made the decision to go
with the open. It has worked out fine. I actually still have a very deep
hole in my incision at 8 weeks PO but we are working on trying to get it
resolved. The problem is that it's very deep but very skinny, so it wasn't
getting enough air. The surface wants to heal up no problem but not down
deep. My surgeon has opened it up more now and hopefully that will solve
it. Even with this minor inconvenience, I don't regret having the open.
This will eventually take care of itself and it's really not affecting my
life at all. I just have topack it twice a day and that's it.
<p>The last thing you want to do "force" a surgeon to do
LAP when they don't feel comfortable doing it on you for whatever reason.
The surgeon was way more important to me that the open versus LAP.
— zoedogcbr
March 29, 2003
Hey! I am 10 weeks post from Lap. My BMI was almost 57. I was on the
table out for 1 hour and 20 min. and no complications. I had my surgery
in Birmingham, AL. I do not know where you are from, but like you I wanted
Lap. I am very pleased with all the decisions my surgeon made. He did
reserve the right to do open if it looked like Lap would not go so well
once I was under. Thank God, he was able. I would look around at other
surgeons if you are uncomfortable with your dr.'s decision. You need to
feel comfortable and confident. Good Luck to you I hope everything works
out the way you want, after all this is for you.
— christy B.
March 29, 2003
I have a BMI of 57 and my surgeon will be doing an open RNY on me. I was
told this about lap vs open: Lie on your back and look at your stomach.
If it kind of falls to the sides, chances are that a lap would be okay. If
your stomach is firm and stays up, an open would be better. People who are
pear shaped do well with lap while people who are apple shaped (like me)
would do better with an open. My surgeon said that he does both lap and
open and he prefers doing the open on me. I want him to be VERY
comfortable with doing my surgery, so I will go open. This is one of the
most important things to me; I want the best chance at success as possible.
Good luck. :)
— Judy K.
March 29, 2003
I too wanted to have the Lap RNY. I started out at BTC, but heard of this
Dr. That did it Lap. When I went to see him, he told me that he would only
do it Open because of the shape of my body cavity. Chances were I would
have alot of fatty tissue around my liver so he did not want to start lap,
but finish open.
— E. C.
March 29, 2003
It requires a great deal of extra training and experience to perform
laparascopic surgery and perform it well. Many general surgeons only offer
"open" surgeries because they either have not had the training
for laparascopy, or their practices are already established and they do not
wish to take the extra time away from those practices to obtain the
necessary training. Laparascopic WLS is a sub-specialty best left in the
hands of those surgeons with experience and expertise. When you read about
long operating times, or surgeons who tell their patients that
"open" is preferable because the surgeon can "see
better", or that lap cannot be done on patients weighing more than 300
lbs, those surgeons are likely very inexperienced in the techniques and/or
do not have the extra-long (and very expensive) laparascopy instruments
required to perform lap WLS on very obese patients. It would be a much
safer move for patients to have an open surgery than to have a lap surgery
with an inexperienced and unqualified surgeon. If you are fortunate enough
to locate an experienced board-certified bariatric surgeon who specializes
in laparascopy, you will find that they frequently perform lap WLS on
patients with BMIs in the 80's, and have average operating times of 1-2
hours. These surgeons will also tell you that the "see better"
theory is not accurate. An experienced lap surgeon has a much better and
more highly magnified view of the surgical field with his cameras than any
other surgeon can see with the naked eye. Five of us in our family have
had completely uncomplicated lap RNY surgery with one of the founders of
the current lap WLS procedures. Our BMIs ranged from 43-70, and our
operating times ranged from 50 minutes to 1 hour/10 minutes. We had
two-day hospitalizations, and were back to work in 8-14 days. Experience
is everything in this situation. Best wishes!
— Diana T.
March 29, 2003
I had an open RNY and consider my scar a trade-off! I'm 4 months out, and
thrilled with life!
— jengrz
March 30, 2003
Jennifer - I figure the scar will be less noticeable than all the damaged
skin I have from the darn tape they used. I have major skin discoloration.
Oh well! Doesn't really bother me as I don't plan to become a model and
showing my tummy to the world.
— zoedogcbr
March 30, 2003
Kathleen: Could you travel to Western PA? My son's surgeon has performed
many Lap RNY's on patients over 500 pounds. He is one of the foremost
surgeons in our area, if not in the country, and has performed over 600 Lap
surgeries, with only one death of a very high-risk patient. In fact, I
think he only performs Lap surgeries as a general rule, of course, with the
knowledge going in that there may be a reason to have to finish it
"open." He is a wonderful doctor, and very highly sought-after,
with a long waiting list, of course. He works with a surgical team of
doctors, and he basically handles the high-risk (over 400 lbs) patients.
If you really want Lap, try looking for another surgeon. If the doc is
highly skilled, your table time should not be much longer than for an open
surgery. Good luck!
— Carlita
Click Here to Return