RNY question - why do some have lap and others have open? - Page 2 - ThinnerTimes

Dyann · 03-14-2006, 09:27 AM

Quote:

Originally Posted by cnvh

I am starting the process of pursuing WLS (going to the hospital's info session on Thursday, woohoo), and in reading over the hospital's literature and website, it states that they do the lap procedure for people whose BMI's are between 40-50. This is quite disappointing to me, since I had thought I would be a good candidate for lap-- I have never had any abdominal surgeries before and thus no scar tissue, and I'm still pretty young (30) and aside from my weight, am in pretty good health. BUT my BMI is about 57. The thought crossed my mind to pester for an exception, but upon further consideration, I think I'd be better off letting a surgeon do whichever method he/she thinks is more appropriate!

It also depends on where you carry your weight. My surgeon has done a 511 pound person laparoscopically. If you carry more in your hips and butt (pear shaped) it is easier than if you carry it in your abdomen (apple shaped). These rules are written down so you are not disappointed if it is not possible...doesn't mean it is a hard and fast rule. Your surgeon will make a judgement call.

feliciadragon · 03-14-2006, 10:06 AM

Quote:

Originally Posted by cnvh

I am starting the process of pursuing WLS (going to the hospital's info session on Thursday, woohoo), and in reading over the hospital's literature and website, it states that they do the lap procedure for people whose BMI's are between 40-50. This is quite disappointing to me, since I had thought I would be a good candidate for lap-- I have never had any abdominal surgeries before and thus no scar tissue, and I'm still pretty young (30) and aside from my weight, am in pretty good health. BUT my BMI is about 57. The thought crossed my mind to pester for an exception, but upon further consideration, I think I'd be better off letting a surgeon do whichever method he/she thinks is more appropriate!

I agree that letting your surgeon make the call is the best choice, but it doesn't hurt to ask about it. My BMI was 59 before surgery and I had 2 previous abdominal surgeries and my surgeron still performed the lap process. He said it also has to do with the size of your liver. Your body stores excess carbs in your liver, so people with a high BMI tend to have large livers. Your liver is in front of/on top of the digestive system they are trying to get to during surgery and if it is too enlarged it makes the process more difficult and more likely to have complications. He had me go on a high protein, extremely low carb diet for two and half weeks before surgery. No fruits, no veggies, nothing with sugar, no bread, pasta, or rice products of any kind. Basically, I was allowed to eat meat (which I don't care for), cheese, eggs, and carb smart peanut butter. Not a healthy diet for long term use, but it forces the body to use the carbs stored in the liver in order to maintain blood sugar levels, thus reducing its size. Of course each surgeon has their own peculiar quirks based on personal experiences, so they can decide best what is right for you.

fitbefore40 · 03-14-2006, 10:40 AM

Some doctors prefer one procedure over another. My doc and I had this discussion - he is 47 and has been doing WLS for 15 years with about 2300 surgeries. He has done more open than lap, purely because by the time the lap procedure was perfected, he had dones hundreds of opens by then. Now, he does both open and lap - and you can choose if he does not have a preference - but he had a preference with me . . . apple body with adhesions from a prior surgery that needs gall bladder removal . . . yeah, I'm open.

cnvh · 03-14-2006, 10:48 AM

Well that's good to know, I am definitely a "pear" and not an "apple"!!

I will definitely ask about the liver issue as it gets closer... I had a coworker who had WLS done at this same hospital two years ago, they did her laproscopically and she was way over the 50 BMI. But they also had her do the no-carb, protein-shake thing for 2 weeks before surgery-- perhaps that was due to the liver so that they could hopefully do it laporoscopically.

Mavisavis · 03-14-2006, 02:41 PM

Quote:

Originally Posted by cnvh

Well that's good to know, I am definitely a "pear" and not an "apple"!!

I will definitely ask about the liver issue as it gets closer... I had a coworker who had WLS done at this same hospital two years ago, they did her laproscopically and she was way over the 50 BMI. But they also had her do the no-carb, protein-shake thing for 2 weeks before surgery-- perhaps that was due to the liver so that they could hopefully do it laporoscopically.

Sounds like docs who are looking at each person individually, which is great. I know the other center in my area does still try to go lap on people with higher BMI's if they can. What I liked most is the quicker healing, less pain, and minimal scarring, but if they had a valid reason for it, I'd have went with open.