Lap vs. open? - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

electrichoney · 02-07-2007, 02:54 PM

I know this topic has probably been covered in other threads, but apparently I have not yet mastered the ability to use the search feature here because none of my searches have been successful.

So, I'm posting the question again. My BMI is 65 and I'm scheduled for open RNY on 2/27. My surgeon's staff told me that only people at lower weights than mine (no definition of what "lower weight" actual means) are appropriate for laproscopic surgery, but I've noticed in a number of people's signatures here that they had lap at or near my BMI/weight. Does a patient's "appropriateness" for lap surgery vary from surgeon to surgeon, or is there a medical best practice that determines which patients can go lap? Chime in if you know anything. Thanks!

Gina in NY · 02-07-2007, 03:42 PM

Quote:

Originally Posted by electrichoney

I know this topic has probably been covered in other threads, but apparently I have not yet mastered the ability to use the search feature here because none of my searches have been successful.

So, I'm posting the question again. My BMI is 65 and I'm scheduled for open RNY on 2/27. My surgeon's staff told me that only people at lower weights than mine (no definition of what "lower weight" actual means) are appropriate for laproscopic surgery, but I've noticed in a number of people's signatures here that they had lap at or near my BMI/weight. Does a patient's "appropriateness" for lap surgery vary from surgeon to surgeon, or is there a medical best practice that determines which patients can go lap? Chime in if you know anything. Thanks!

I had open and did fine and I was a lower weight. So don't worry about that. (If that is what you're worring about) I think there is a limit to how much fat and skin the instruments can get through. Dr. Dyann is sure to set us straight though - if she's feeling up to it, poor thing!

mssg13marinewife · 02-07-2007, 03:47 PM

Rhonda,
It completely depends on your surgeon. I had open and Im 5'7, started at 260 with a BMI of 38.5 So if that helps you give you an idea, my sureon only does open, shes not to comfortable with the lap yet. Plus I felt better knowning that she could SEE everything as opposed to looking through a camera, but that was just me. So Im really not that big and overweight , I was actually the smallest person she has done this procedure on. -

LisaBoston · 02-07-2007, 05:12 PM

My doctor has much more experience doing the open procedure. Plus I knew that I would want a panni after and they have to cut for that...so I opted to have open. He can also have a little look around when he is in there. I know my doctor is doing the lap procedure on some...usually light weights and a select group. The surgery time is longer for lap, therefore he can't do as many and with the 3+ year wait time for surgeries, and him doing 3-6 per week, cutting down on surgeries would not be a good thing.

lds98m · 02-07-2007, 05:22 PM

I had the choice 9 years ago. I choose open. I wanted him to hold it, look at it, feel it. Heck I told him to get his elbows in there if he needed to. I was 310 at surgery and I think I was 50% BMI.

Good luck with your journey!

Dyann · 02-07-2007, 05:24 PM

The answer is which ever one your surgeon does with greater expertise. But here are the facts. Lap GBP should be about an hour to hour and a half and that is it. I had previous abdominal surgeries and even with all of the prior adhesions, It took my surgeon 1 hour and 10 minutes. In general, the complication rates with open are higher than with laparoscopic if a surgeon is proficient at both. If that surgeon is your only choice, you go with which ever they are more proficient in as that will be the safer choice. If you have a choice, laparoscopic has much fewer complications if the surgeon is out of his learning curve (more than 200 cases). You can view the entire abdomen better with a laparoscope. In terms of your size and influencing then decision, it depends on where you carry your weight. If it is more in the hips, butt, thighs, it makes laparoscopy a consideration. If you are more "apple" shaped and carry your weight in your midsection, it makes both difficult, but laparoscopic almost impossible. The more experienced surgeon will give you a better chance of staying laparoscopic. My MD did a 900 pound person laparoscopically.
End of story is only you and your surgeon know your medical history and his/her expertise.

PS. I am a surgeon and a GBP patient....and after last weekend a lap choley patient as well.
__________________

electrichoney · 02-07-2007, 06:41 PM

Quote:

Originally Posted by LisaBoston

My doctor has much more experience doing the open procedure. Plus I knew that I would want a panni after and they have to cut for that...so I opted to have open. He can also have a little look around when he is in there. I know my doctor is doing the lap procedure on some...usually light weights and a select group. The surgery time is longer for lap, therefore he can't do as many and with the 3+ year wait time for surgeries, and him doing 3-6 per week, cutting down on surgeries would not be a good thing.

Your surgeon has a three-year wait?? WOW! Why so long?

LisaM · 02-08-2007, 04:27 AM

Dyann's right - totally between you and your doc and his/her experience... my particular doctor's standard was if BMI was 60+, there was no discussion, he did the surgery as an open.