Quote:
Originally Posted by CanuckDiva
My surgeon and the whole team at Beth Isreal Medical Centre in NYC only does Open too. The reasons he gave were 1) he's had to re-do many laps gone wrong (so he said - and there were many testimonials to this effect from his patients), 2) he did not think it was as effective a route for me, 3) he stated it was not an approved surgery by the American Society of Bariatric Surgeons.
Good luck with your decision.
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As a surgeon, I have to strongly disagree with the statements above except for the open route being more effective for you personally as I don't know your medical/surgical history. I feel there are many ways to do something and I don't usually speak out as there is a certain art to medicine, but I don't want anyone to believe open=safer or Lap is not approved. For your statement saying it was not an approved surgery.....I can't even respond as that is just false. I believe your MD. was the former pres of the ASBS (now known as the american society for metabolic and bariatric surgery). The following are quotes from their consensus statement which are the guidelines that are recommended by the society members/board
1.Current techniques: Gastric bypass can be performed by
both open and laparoscopic techniques. In the United States,
the laparoscopic technique has become the more popular
approach.
2. Operative mortality and morbidity: Operative (30-day)
mortality for gastric bypass when performed by skilled
surgeons is about 0.5%. Operative morbidity (eg, pulmonary
emboli, anastomotic leak, bleeding, wound infection)
is about 5%. Compared with open procedures, laparoscopic
gastric bypass has a higher rate of intraabdominal complications;
whereas duration of hospitalization is shorter,
wound complications are lower, and postoperative patient pain control is better. Ventral hernia formation is more prevalent after open
gastric bypass than after the laparoscopic approach.
By 2003, nearly two-thirds of bariatric procedures
worldwide were performed laparoscopically. Laparoscopic
bariatric surgery is not experimental or investigational.
Open bariatric operation has certain advantages over
laparoscopic procedures. These include tactile control of
dissection and the ability to palpate tissues, greater ease and
speed for lysis of adhesions, freedom to use fine suture
technique and materials, greater facility to perform ancillary
procedures, possibly a lower incidence of certain perioperative complications (eg, leaks, hemorrhage), and decreased
risk of specific longterm complications (eg, anastomotic
strictures, internal hernias, bowel obstructions). Laparoscopic
bariatric surgery has certain advantages over open
procedures, such as minimal incisional scars, less postoperative
pain, increased mobility, shortened hospital stay,
shorter convalescent time, and fewer late ventral hernias.
Operative times vary between open and laparoscopic procedures
from surgeon to surgeon. Costs are similar; the cost
of additional operative equipment disposables needed for
laparoscopic surgery equals the cost of longer hospital stay
for open procedures. Longterm weight loss and amelioration
of comorbid conditions are essentially the same for
open and laparoscopic bariatric operations.
When the laparoscopic approach proves to be difficult
(eg, adhesions, size of liver, size of patient), the surgeon
should convert to an open operation. For certain conditions,
the surgeon may initially select the open approach, eg, super
(BMI > 50 kg/m2) and central obesity, hepatomegaly, inability
to tolerate pneumoperitoneum, presence of congenital
anomalies, anticipated severe adhesions, certain abdominal
wall hernias, management of complications, and some
planned revision procedures. Open and laparoscopic bariatric
operations are not competitive; they are complementary.
This was put out by the society in 2004-5. Since then surgeons have become even more proficient in the laparoscopic approach where the leak rates are even lower and the incidence of intra-abdominal infections are lower.
Finding an accomplished surgeon is the key, not which procedure you have. Given access surgeons who can do either, laparoscopic is the safer procedure and becoming the gold standard. Being able to "feel" everything in the open procedure is something that older surgeon rely on as they are not comfortable with the laparoscopic technique. Those surgeons who grew up in the era of laparoscopy have a different perspective.
Bad things happen with either procedure. Go to an accomplished surgeon and don't be seduced by titles, ask for their statistics.
- 3 year surgery anniversary (Jan 09)
CanuckDiva 
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