Question:
I need to choose between open and laproscopic proceedures. Any Advise?
If I choose an open proceedure, my surgeon will automatically remove my gall bladder. With a laproscopic procedure, the recovery time is less, but I have to wait four weeks longer for the procedure. I am leading toward laproscopic, but I wanted opinions of people who have gone through the proceedures already. — Amy C. (posted on January 2, 2005)
January 1, 2005
Its well worth the wait to avoid the possiblity of future surgery. My
surgeon says about 1/3 of opens get a incisional hernia, LAP is near zero.
Thats because in opens the muscle wall is cut, and they are left
permanetely weak:(
Add faster recovery, fewer hospital days, etc. Do pick a highly experienced
LAP surgeon preferentially one who has done at least a 100 surgeries LAP.
It takes lots of skill and experience to do it safely.
— bob-haller
January 1, 2005
Make a list of the risk vs benefits. If you can get your gallbladder
removed at the same time it would eliminate another surgery and anesthesia.
Abdominal muscles have to be cut with lap also--just not as large a cut.
Many obese people have hernias. Wearing a binder and following lifting
restrictions will greatly decrease your chance of getting an incisional
hernia. I had an open RNY and my gallbladder was removed and I was back to
work in 3 weeks. A fair number of WLS patients have to have their
gallbladder removed within a year post op. Discuss all your options with
your surgeon. Consider time off work and recovery from 2 surgeries vs one
etc. Good luck.
— dianne E.
January 1, 2005
It is well worth the wait for the laproscopic procedure. I have 7 tiny
scars from mine and I was up and functional in days. With the open, the
recovery period is longer and you're more prone to developing blood clots
because of the inactivity. My surgeon did not remove my gall bladder at
the time of my LAP RNY, and I had to have it removed almost one year to the
day of my original surgery, but he did it laproscopically at that time.
You might ask about having it done as well. Many surgeons don't want to
remove a healthy gall bladder if there are no problems, but with my RNY
patients, it's only a matter of time til it goes bad.
— Cathy S.
January 1, 2005
I chose open because at the time it took less time for the surgeon to do
open than laps and I wanted my family spared the 'wait' time. He also took
out the gallbadder, which if you keep your - there is a HIGH risk you'll
have to have a second surgery within this year...putting the 'recovery'
time for both of these surgies, isnt that much different from open.. In
addtion, since my surgeon was in there, he looked around, turned out I had
a large ovarian cyst I didnt even know I had, and he removed that too.. a
bonus. Even if you 'pick' lap just remember there is no guarantee you'll
stay a lap. There are pros/cons to each.
— star .
January 2, 2005
I just had a lap done on 12/29. I had my gallbladder taken out at the same
time plus repair of a hiatal hernia and liver biopsy. Because of all that I
had done the pain was very intense for the first 48 hours, however every
day is better. I think in two or three day the pain will be barely
perceptible. In an open the muscles are cut which is more painful because
they are so vascular and because you use your stomach muscles every time
you sit up, rollover or go from a lying to sitting position. And in the
first 2-3 days when they get you up to walk every 2 hours you will think
you are being tortured by some sadistic guard instead of a nurse who just
wants to make sure you don't get pneumonia or a pulmonary embolism(a blood
clot that moves from another area , usually the thigh or groin and moves to
the lungs. Pulmonary embolisms are usually fatal and easily preventable,
heparin and walking, walking and more walking. The other downside to an
open is that there is more blood loss and increases the chance that you
might have to have a transfusion. They can remove your gallbladder
laprascopically at the same time as your gastric bypass. However sometimes
you don't have a choice, the doctor may decide to do an open once you get
in the operating room if he thinks it will be too difficult to do a lap- 1
reason is when patients gain weight prior to surgery and the fat around the
liver increase making it hard to get around in there. Good luck.
— pammatria
January 2, 2005
I had mine done LAP and recovery time was great I hardly used the morphine
pump was in surgery for 2 hours 2mins surgery was at 10 AM had some scar
tissue from a previous surgery that had to be delt with that took the extra
time was back in my room by 2 PM and was up walking the halls that evening
had the surgery on Wed home on Fri afternoon. I took a pain pill when I
left the hospital for the ride home because I live 1 1/2 hours away and
never took another one went shopping the next day and really everyday
because the weather was bad so went to the stores for long walks and did
short walks in the house. I didn't drive though for the 2 weeks the Dr
recommeded even though I felt well enough too. But do your research and
choose a Dr who is well trained in Laproscopic procedures if that is your
choice my surgeon I chose was doing Advanced Laproscopic procedures before
he ever started doing WLS so I felt very confident that he knew his stuff.
And if your Dr does OPEN and that is who you like then I would say go with
an OPEN but do whatever you are comfortable with and don't let anyone tell
you what to do make up your own mind. Good luck on your journey...Nancy
— nefish
January 2, 2005
I had my rny lap, almost 2 years ago. My recovery has been text book for
the most part. I have had other surgeries open in the past and have done
well with them, but if I had my preference I think I'd wait for the lap. I
don't see why the surgeon can't take the gall bladder along with doing the
rny, as many surgeons do. My gall bladder was removed 16 months after my
WLS, also lap, by my WLS surgeon. Although it was a real
"nothing" surgery, I would have ideally preferred to have it all
done at once, but my surgeon also does not like to remove healthy organs.
I think that if I could convince my surgeon to take the gall bladder with
the WLS, I'd definitely wait. Best of luck !!!!
— Fixnmyself
January 2, 2005
Hi Amy,
I am 3 1/2 years post-op. I had a lap. I, unfortunately, have been
blessed with the "Queen of Scar Tissue" title. LOL. Seriously, I
have had many complications, none life-threatening, just annoying. I have a
tendency towards developing alot of scar tissue. I have gone through 8
endoscopies so far because my stoma keeps closing up. I am actually calling
my surgeon today to schedule another. I always know when it is time, but I
also have an ulcer at the anastimosis (forgive me if I have used the wrong
term here) which does not help at this point. Now, I have been told, that
with an open, patients seem to have less complications with strictures. I
cannot tell you if it was another patient or a physician that told me this,
but I have since heard it from others as well. You should ask your surgeon
about this if there is any tenedencies toward scar tissue build-up in your
family. It would not hurt to ask. Now, if your surgeon laughs when you ask,
I will die a thousand deaths and bury my head in shame! LOL. Seriously, I
am not trying to scare you or change your mind, but I guess I am trying to
say that when you do make your decision, just remember to take into
consideration how others in your family have reacted to surgery,
physically, and emotionally. Something to mull over. Best wishes and God
Bless!
— Sheila K.
January 2, 2005
Amy-
The laparascopic procedure is a better procedure-- from reduced risks of
incisional hernias and wound infections to faster recovery time, there a
multitude of sound reasons why the National Institute of Health termed the
laparascopic RNY the "gold standard" for weight loss surgery.
There is no increased risk of any complication of any kind (including
adhesions, internal hernias or blockages) from the laparoscopic procedure
vis-a-vis the open procedure.
Secondly, less than 20% of people who rapidly lose weight develop gall
bladder disease and less than half of them will need to have their gall
bladders taken out; therefore, basing a surgical decision on avoiding an
operation that you are likely not going to need doesn't seem to make
sense.
Lastly, as some of the other posters have already commented, there is a
world of difference between having surgery as someone who is morbidly obese
and having surgery as someone who is in a healthier weight category.
Therefore, even if you are in the minority of people who will need to have
your gallbladder removed, it would not become a problem for at least 6-8
months (provided it is healthy today) and the surgery then would be routine
day-surgery.
— SteveColarossi
January 2, 2005
I'm glad I did the LAP procedure. Very small scars - the largest was the
size of a half dollar next to my belly button. When I had my plastic
surgery, they cut off almost all of those scars so you lose them anyway.
Even if you have to have your gallbladder taken out later (I had mine done
a year after my tt), since it was done LAP also, the scars are again, very
minimal. Much better then if done open.
— Patty H.
January 2, 2005
I would wait for the lap. What Steve told you is exactly right. No surgeon
should be removing healthy organs, so I would not base your decision on
that. What usually determines if you go Lap is the size of your liver (part
of the liver is over the top portion of the stomach, and if the liver is
very fatty, it can be difficult to do the surgery via Lap.) Of course, all
of this assumes that your chosen surgeon is experienced with Lap surgeries
and that you are actually an appropriate candidate for a Lap procedure. If
you do choose the Lap procedure, the four week wait could be quite an
advantage to you-- you have time to start doing a higher-protein, lower
carb eating plan, and maybe starting a walking regimen, which is something
you will ned to do after the surgery.
— lizinPA
January 3, 2005
If your surgeon is experienced with lap, I would wait and go that route. I
have no noticable scars. As long as you take your actigall, there's a
great chance that your gallbladder will be fine. I still have mine 3.5
years later.
— mom2jtx3
January 3, 2005
A lap is almost always the best way to go. This decision should be made by
your surgeon as an open procedure should only be done when there is too
much abdominal fat for a lap to be done safely or in the event of a fatty,
enlarged liver that could possibly be damaged during a more confined lap
procedure. Keep in mind that the larger the incision, the more muscle that
is being cut, the more adhesions etc etc
GOOD LUCK!!!
— Barbara F.
January 3, 2005
If it was me the only way I would wait is because he or she has almost a
100% success rate of doing LAP on people your size or larger. You are only
a 47+ BMI so LAP should be fairly easy as long as the surgeon has tons of
experience at it. As for statistics. Talk to people in his support group
to see what the complication rate has been from LAP. There is a greater
risk of things not getting closed up as tight, but it is rare for someone
who does LAP regularly.
<p>I was a 65.3 BMI and my surgeon would not even consider it at that
time - almost 2 years ago. However, there was a surgeon about 75 minutes
away that would try it but there was no guarantee and it was an 8 months
wait just to get into see him. I went with the guy who I felt most
comfortable with and got me in within a very short time. I had open and do
not regret it at all. My open incision is now gone since extensive PS and
the vertical incision is barely noticeable.
<p>I did not find my recovery from open to be unbearable. LAP would
have been great but I also wanted to make sure my surgeon could see what he
was doing and get in and out fast. The larger you are the greater the risk
of anesthesia, so shorter is better.
— zoedogcbr
January 3, 2005
I had an open rny at the Bariatric Treatment Center (now known as Barix)in
Ypsilanti MI. I am very pleased with my recovery from surgery, I was back
to work in 2 1/2 weeks. Barix has an excellent post op eating plan so I
adapted well and I have no problems 2 years later. (My experience with
their support groups and leaders was terrible though!) I have several
friends who had the Lap procedure and they still have problems eating meat
and different types of things. I still do not eat any refined sugar, but
can tolerate everything else and I have done well at maintaining my loss.
I dont really know or understand if the procedure makes any difference in
what you can tolerate. I did have an incisional hernia repaired last June,
but prior to my surgery I had had gall bladder surgery and (2) hernia
repairs without mesh. I had gall bladder surgery in 1994 and I was about
80lb lighter than when I had WLS in 2002, they removed the gall bladder by
Lap procedure and noted how difficult the procedure was due to the excess
weight I carried in my gut area. Because of this past experience there was
no way I would even consider a Lap for WLS , I had a 55 BMI. I feel the
WLS is very risky and I was very lucky coming through it with flying
colors. I would do it again in a heart beat--- and I would have it done
open.
— debmi
January 3, 2005
Find out what your surgeon is most comfortable with. How many of each has
he/she performed? Personally, I went with an open RNY. I wanted the surgeon
to actually lift the organs and inspect them for leaks. When doing a lap on
morbedly obese patients, very often they are working at the end of the
instruments capacity and with the mortality rate associated with WLS, I
perferred not to take any chances. That was just my rational. My recovery
was quick and I am very proud of the scar I have. It is a visiable reminder
that my life has changed for the better -- besides with all the stretch
marks I have, what was another scar? :-D
— coffenut
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