Open RNY verses Lap RNY - ThinnerTimes - Gastric Bypass Forum, Lap Band Forum, and Vertical Sleeve Gastrectomy Forum

BeccaTyme · 09-07-2007, 09:52 PM

My surgeon only does Open RNY surgery. He is the chief surgeon at the #1 rated hospital in the US (John's Hopkins) so I am very confidant with him. But....I just got off the phone with my sister in law who had the Lap RNY surgery four years ago. Which one is best? I have a surgery date and am really excited but now I'm worried that I mad the wrong decision and should find a doc that does Lap RNY.
Any advice?

Andie · 09-07-2007, 10:12 PM

Well Lapriscopic RNY is less invasive and the healing time is way less. I know that is the big thing. But the down side is sometimes depending on size and equipment it isn't doable and the dr's have to switch to open anyways. I had open mainly because I had two hernias repaired at the same time. If your doctor is that good and willing to do the surgery...I think I would stay with him, he obviously knows what he is doing. Perhaps you can also talk to him about why he only does Open RNY. He can go over the benefits etc. If you switch drs you may have to start the whole process over but a second opinon may be what you need if you are not confident, you have to do what is right for you! Wish you well on your journey!

Squishy · 09-08-2007, 06:40 AM

Mrs Squishy and I had planned on having Lap, but our surgeon talked us into open. His reasoning was that at 46 years old, he wanted the opportunity to look and feel around while he was in there to make sure there were no other problems so that we would never have to be opened up again. Also, he dis some additional stitching to hold everything in place properly so that the chances of things twisting later are minimal. He said that this was not possible during a Lap procedure. He showed us pictures of many of the things he encountered unexpectedly and repaired when he opened people up.

As it turned out, we were both grateful that we had open because he found problems in both of us that he took care of while he was in there. With Jane, aks "Mrs Squishy", I received a call from the surgeon in the operating room requesting permission to do a hysterectomy. Turned out, she had a large benign tumor (the size of a football). He also found her gall bladder was full of stones and her appendix had some scarring that indicated that she had had some appendicitus, so he took them both out. It is unlikely he would have seen any of those problems if he had done it Lap. This would have probably resulted in two additional surgeries had he not done it while he was in there doing the bypass.

In my case, I had a previous laparoscopic gall bladder removal, and the scar tissue was causing problems. Apparently it had kind of spider webbed out and grabbed everything around it and pulled it up under my rib cage. There is some kind of curtain of tissue between your abdominal muscles and your internal organs. It had grabbed that and pulled it up under my ribs along with some organs. He spent an extra hour and a half cutting everything back down so it was hanging where it was supposed to be before he could do the bypass. If he had started out Lap, he would have certainly had to open me anyway because there was no way he could have done all that Lap.

Oh yeah...He also repaired umbilical herinias in both of us that we didn't know we had.

The recovery is probably a little more uncomfortable with open, but I did not personally think it was any worse than my previous Lap gall bladder recovery once I got home. The only difference was with the gall bladder, I went home the same day and with the open bypass, I was in the hospital for a couple days after. If you add up the length of the Lap scars, they are probably equal to the length of the one open scar. My Lap scars are almost invisible now, and it has been about 4 years. I'd say they were pretty invisible after a couple years. Can't say about the open scar because it is too new.

The chances of getting a hernia are also a little higher with open because they cut all those muscles and put them back together. For the most part, as long as you follow the lifting restrictions in the first 6 to 8 weeks, that should not be a problem, though.

I have a brother who had a Lap procedure in November and has had no problems with it at all (Lost 140 pounds so far). He had it on a Monday and was back to work on Friday. He never even told anyone that he had it done. I had mine on a Wednesday, came home on Friday and took the next week off at home. I would not advise going back to work as fast as he did. He didn't have any problems with it, but c'mon...take a little break to heal.

I don't think there is a right or wrong answer, so you can't go wrong either way. If you found a surgeon that is that good, I would not hesitate to have open.

I hope this helps.
-Mike-

cnvh · 09-08-2007, 06:45 AM

I'm going to have to disagree with Andrea a bit... Unless a person NEEDS to have open RNY for whatever reason (extremely high BMI, prior abdominal surgeries, etc., etc.), I think having RNY done laparscopically is a much better option-- faster healing time, less post-operative pain, lower risk of infection, less chance of hernias later on, plus more benefits I can't think of at the moment.

The procedure is the same whether it's done lap or open-- the only difference with lap is that you're not left with a great big incision afterwards, and regardless of how skilled the surgeon is, large incision = increased risk of infection. With open, you have all the additional wound care requirements, having to wear a binder, being extra-super-careful not to strain the incision site to keep it closed, and so on. With lap, you're left with 5 tiny incisions (mine were so small, none of them even required any stitches) that heal much more quickly and easily.

The way I look at it, one should probably go with the least invasive option available to them... if you're an appropriate candidate for lap RNY, I really can't think of a single good reason to go with open instead. It's not like this surgeon at Johns Hopkins is the only good WLS surgeon out there, you know? There are tons of highly-skilled surgeons who do LAP RNY's every day, and at a place as big as Johns Hopkins, I can't imagine that they don't have competent lap RNY surgeons on staff as well.

lward76 · 09-08-2007, 09:39 AM

My doc told me that it depends ones size!! And he too is chief of surgerons At BARNES JEWISH HOSPITAL.....DR.CHISTOPHER EAGON!! And thats all i really asked him about it!! Oh i think he also said something about the liver? not for sure on that but my appt is coming up and i will ask him again!!

lward76 · 09-08-2007, 09:41 AM

Quote:

Originally Posted by cnvh

I'm going to have to disagree with Andrea a bit... Unless a person NEEDS to have open RNY for whatever reason (extremely high BMI, prior abdominal surgeries, etc., etc.), I think having RNY done laparscopically is a much better option-- faster healing time, less post-operative pain, lower risk of infection, less chance of hernias later on, plus more benefits I can't think of at the moment.

The procedure is the same whether it's done lap or open-- the only difference with lap is that you're not left with a great big incision afterwards, and regardless of how skilled the surgeon is, large incision = increased risk of infection. With open, you have all the additional wound care requirements, having to wear a binder, being extra-super-careful not to strain the incision site to keep it closed, and so on. With lap, you're left with 5 tiny incisions (mine were so small, none of them even required any stitches) that heal much more quickly and easily.

The way I look at it, one should probably go with the least invasive option available to them... if you're an appropriate candidate for lap RNY, I really can't think of a single good reason to go with open instead. It's not like this surgeon at Johns Hopkins is the only good WLS surgeon out there, you know? There are tons of highly-skilled surgeons who do LAP RNY's every day, and at a place as big as Johns Hopkins, I can't imagine that they don't have competent lap RNY surgeons on staff as well.

you know i agree with that after rereading this!!

Zenomia · 09-08-2007, 10:12 AM

The difference between the two proceedures has already been stated, I won't re-cover that. The difference in Surgeon preferance is a little easier to explain.

Odds are your Cheif Surgeon - (title doesn't a good surgeon make...) has had no training in the use of laproscopic tools. That is why he only does open. The use of laproscopic equipment is a specialized skill that requires additional training hours and specialized training. If a Surgeon won't do it, it's most likely because he can't. Most of the older Surgeons opt. to continue doing surgery the way they now how best. The questions you should be asking are not why he doesn't do LAP, but what his results/complication rates are with the proceedures he does open. If he has relatively low complications and little or no deaths with the open, then odds are he's a good choice. If his answers are = to the National average, or higher, you may want to consider someone with a better track record. Being a Cheif Surgeon only means you were there the longest and got the job, it doesn't automatically equate skill or being a good Dr. at bariatric surgery. It doesn't matter what hospital your at...John Hopkins, or Mercy Medical here in Iowa....Drs. are only as good as thier personal skill and training. Each has a line of specialization, you need to find someone who has had clear training with bariatrics, and whom you feel confident will give you the best possible outcome with your surgery. This isn't like shoping for a new pair of jeans....it's more like shopping for your LIFE. Don't be swayed by titles, prestigous names or locatons....be swayed by skill, ability, track record, and your belief in that persons ability to bring you through it with the best possible results!

Debz · 09-08-2007, 10:13 AM

Just gonna throw my 2 cents in...I had my lap RNY on August 6th and am still dealing with the repercussions. I wound up with a hematoma on my diaphragm that is still causing me pain and havoc. I am unable to exercise or to even perform the activities of my daily life. I get breathless at the slightest effort and find it extremely difficult to sleep at night because of the pain.

All of this is due to the laparoscopic approach. The trocars they placed to do my surgery caused damage to the tissue in my abdomen, which formed the hematoma. I did have contraindications to laparoscopy; I am obese, (obviously), and I'd had previous WLS.

Had I known of the possible complications of laparoscopic surgery, I may have made the decision to have open instead. At least the incisional pain is straight forward and predictable. As it stands, I could have this pain for weeks to come.

Dyann · 09-08-2007, 01:08 PM

Becca,

I am going to take off my patient hat and put on my surgeons hat. I may offend some who have had the open procedure but here are the real issues.

1. Your surgeon only does open as that is all he knows how to do...end of story. All of the stories about being able to feel things and "to get a good look" is BS. A laparoscope give much better visualization of the pelvis and the corners of the abdomen then the open incision.

2. There are reasons to do open that are patient directed and already mentioned (tool limitations, numerous previous surgeries etc.) If you fall into that category, then you want the one who has more experience with the open procedure.

Now a days, the only reason to do the open is if you don't have a surgeon with high success with the lap RNY at your access. Being near Maryland/DC area, you must have a ton to choose from.

Lap has a lower complication rate (*****if the surgeon is out of their learning Curve*******), faster recovery, and is the exact same surgery inside.

Debz....I am sorry you are going through the hematoma pain near the diaphragm, but that can happen with either approach. Bleeding and collections are part of surgery, lap or open. Yours may have originated from a trochar site, but it can equally as easily happen from the open incision site.

Zen is right about beware of titles. Busy surgeons don't have time to be the chief. I am not saying this as a blanket statement, but my chief of surgery when I was a junior resident was the worst at the university. Have you ever heard the statement, "those who can't do, teach". I am not saying that applies to him, but just don't be seduced by a title.

Bottom line is, if you are electing to have an open procedure, your surgeon needs to be proficient in his craft with a complication rate that is as low as or better than the accomplished laparoscopist. You also need to be comfortable with your decisions. Sometimes bad things happen for no reason with either procedure. We have all seen that here.

Gina in NY · 09-08-2007, 02:35 PM

Quote:

Originally Posted by BeccaTyme

My surgeon only does Open RNY surgery. He is the chief surgeon at the #1 rated hospital in the US (John's Hopkins) so I am very confidant with him. But....I just got off the phone with my sister in law who had the Lap RNY surgery four years ago. Which one is best? I have a surgery date and am really excited but now I'm worried that I mad the wrong decision and should find a doc that does Lap RNY.
Any advice?

I had open with my surgeon because he has the lowest complication rates around. He was taught open, does open and gets good results. He also does lapriscopic surgery all the time, but not with the gastric bypass. (Took out my good friend's gall bladder the other day - she also had a very quick recovery)

My recovery was nothing. I could have danced out of the hospital. Now I was in great shape before hand, but the point is, I was comfortable with him. If he had told me he was going to use a crowbar and hack saw, I'd have most likely stayed with him. You have to feel good about the person cutting into you.

Everything everyone said is true - but for me - the surgeon was most important. A couple of other things that made me happy with my decision are that he does the endoscopy first - so you're under general anesthesia during that. That made me happy. Then afterwards he does a leak test while you're still out. That made me happy. The lap folks around here do those things while you're awake and I get a bit squirrelly about those things.

ANYWAY! There are no guaruntees. You have to decide what you think. Talk to his patients. Ask to see scars. I went to a few support groups and sat down with people he'd done this surgery on. Every one of them did really well - healing as fast as, if not faster than the lap people. You have to do some research and find out. Ask your surgeon's other patients about "hell week". I didn't have one, frankly, but maybe that says as much about me as my surgeon. We were a good match and that is what it comes down to. I'd do it again in a heart beat.