Re: Lap vs Open a Question

August 19, 2001

Hi Debbie-

I'll answer the questions that I can -

Dr. Keshishian (and others) have said that the lap takes at least

another hour longer than the open. Sometimes the incision for the

open is only about 4 inches but is usually longer. The lap is

usually " lap assisted " which means that you will have one scar that

is quite a bit longer than the small ports for the lap equipment.

More often than not, based upon what is admittedly limited

observation, the total length of the incisions for the lap is pretty

close to the same as it is for the open. It would be interesting to

hear from post ops on this question.

A common complication of the open surgery is a hernia. That is a

blessing in disguise because the surgeon usually throws in the tummy

tuck when they fix the hernia. My wife had hernia surgery in an

outpatient surgery facility. She was fully coherent and able to walk

to the car to go home within an hour. Pretty amazing.

If cosmetics is a big issue, the lap is probably your choice. For a

multitude of other reasons, I am going to have the open version.

Best-

Nick in Sage

Dr. Keshishian - 8/29/01

August 19, 2001

Hi Debbie-

I'll answer the questions that I can -

Dr. Keshishian (and others) have said that the lap takes at least

another hour longer than the open. Sometimes the incision for the

open is only about 4 inches but is usually longer. The lap is

usually " lap assisted " which means that you will have one scar that

is quite a bit longer than the small ports for the lap equipment.

More often than not, based upon what is admittedly limited

observation, the total length of the incisions for the lap is pretty

close to the same as it is for the open. It would be interesting to

hear from post ops on this question.

A common complication of the open surgery is a hernia. That is a

blessing in disguise because the surgeon usually throws in the tummy

tuck when they fix the hernia. My wife had hernia surgery in an

outpatient surgery facility. She was fully coherent and able to walk

to the car to go home within an hour. Pretty amazing.

If cosmetics is a big issue, the lap is probably your choice. For a

multitude of other reasons, I am going to have the open version.

Best-

Nick in Sage

Dr. Keshishian - 8/29/01

August 19, 2001

In a message dated 8/19/01 4:41:29 PM Pacific Daylight Time,

tlarussa@... writes:

> Absolutely. Not only that, but when the skin is stretched during the

> tummy tuck, the scars usually stretch to several times their original

> length. Many lap DS patients who later have tummy tucks wind up with

> six or eight FEET of scars crisscrossing their abdomens.

>

Thats the beauty of going to Dr. Baltasar....he does the incision horizontal

and when we get our TT he said, it goes down to the pulic area and thus can't

be see if you show your tummy...LOL

~~* AJ *~~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 - 415.1

08/06/01 BMI 59 - 390.2 -24.9 lbs!!!!!!!!!!~~~~

08/16/01 BMI 58 - 387.0 -27.9 lbs!!!!!!!!!!~~~~

Check out the Bellingham Support Group

and my personal page at WWW.WLSBellingham.homestead.com

August 19, 2001

In a message dated 8/19/01 4:41:29 PM Pacific Daylight Time,

tlarussa@... writes:

> Absolutely. Not only that, but when the skin is stretched during the

> tummy tuck, the scars usually stretch to several times their original

> length. Many lap DS patients who later have tummy tucks wind up with

> six or eight FEET of scars crisscrossing their abdomens.

>

Thats the beauty of going to Dr. Baltasar....he does the incision horizontal

and when we get our TT he said, it goes down to the pulic area and thus can't

be see if you show your tummy...LOL

~~* AJ *~~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 - 415.1

08/06/01 BMI 59 - 390.2 -24.9 lbs!!!!!!!!!!~~~~

08/16/01 BMI 58 - 387.0 -27.9 lbs!!!!!!!!!!~~~~

Check out the Bellingham Support Group

and my personal page at WWW.WLSBellingham.homestead.com

August 19, 2001

In a message dated 8/19/01 4:41:29 PM Pacific Daylight Time,

tlarussa@... writes:

> They are highly social, intelligent, generous

Oh yes...this is me....LMAO

~~* AJ *~~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 - 415.1

08/06/01 BMI 59 - 390.2 -24.9 lbs!!!!!!!!!!~~~~

08/16/01 BMI 58 - 387.0 -27.9 lbs!!!!!!!!!!~~~~

Check out the Bellingham Support Group

and my personal page at WWW.WLSBellingham.homestead.com

August 19, 2001

In a message dated 8/19/01 4:41:29 PM Pacific Daylight Time,

tlarussa@... writes:

> They are highly social, intelligent, generous

Oh yes...this is me....LMAO

~~* AJ *~~

Age 37 5'8''

Post op 7/24/01 Open BPD/DS

self pay - Dr Baltasar -Alcoy Spain

07/24/01 BMI 64 - 415.1

08/06/01 BMI 59 - 390.2 -24.9 lbs!!!!!!!!!!~~~~

08/16/01 BMI 58 - 387.0 -27.9 lbs!!!!!!!!!!~~~~

Check out the Bellingham Support Group

and my personal page at WWW.WLSBellingham.homestead.com

August 19, 2001

>based upon what is admittedly limited

> observation, the total length of the incisions for the lap is

pretty close to the same as it is for the open. It would be

interesting to hear from post ops on this question.

Dear Nick,

My surgery was done fully lap, not lap assisted, in under 3 hours. I

have one incision that you can't even see because it's inside my

bellybutton, and three more measuring 1/4 " , 1/2 " and a shade more

than 3/4 " , but less than 1 " . So my total scar length would be about

1 1/2 " plus whatever the length of the one in my bellybutton is. I

also have two tiny " dots " at the location of the postsurgical

drains. I had no incisional pain and no outside stitches (just

steristrips). BTW my hubby had Lap gallbladder surgery in December

and his incisions are bigger than mine!

Jane J.

230/173 (-57 lbs.)

Lap BPD/DS

April 26, 2001

Dr. Ren

NYU Medical Center, NYC

August 19, 2001

> More often than not, based upon what is admittedly limited

> observation, the total length of the incisions for the lap is pretty

> close to the same as it is for the open. It would be interesting to

> hear from post ops on this question.

Dr. Rabkin's website has a few scar pics from their LapDS patients:

http://www.pacificsurgery.com/Newsletter/Other_Views/other_views.html

M.

---

in Valrico, FL, age 39

Starting weight 299, now 156

Starting BMI 49.7, now 26.0

Lap DGB/DS by Dr. Rabkin 10-19-99

http://www.duodenalswitch.com

Direct replies: mailto:melanie@...

_________________________________________________________

August 19, 2001

Hi Debbie:

> Now my question, if it is true that an open

> ds is faster (less anesthesia) than the lap

> ds and if most (?) have a tummy tuck after

> their weight loss then why opt for lap?

Psychology plays a HUGE role in the choice of lap vs open.

Those who adamantly argue for lap seem to have a deepseated fear of

the large incision. They see it as some sort of psycho-sexual

violation. These people rarely laugh, tend to be loners, and are

extremely anal retentive in nature. (Most were potty trained before

the age of one.) Four of the criminals on the FBI's current " Ten

Most Wanted " list are former lap DS patients -- most of them are

wanted for various terrorist activities.

Those who argue for open, on the other hand, have a deepseated fear

of someone trying to sew up their insides using a pair of chopsticks

and with only a flashlight for illumination. They see the open

incision as a chance to expose themselves to the world through new

experiences. They are highly social, intelligent, generous, are much

more attractive than their pro-lap counterparts, and are secure in

their knowledge of their true selves, (thus they have no need to

worry about the effect of the scar on their looks).

> Also if you have lap and get the 4 or

> 5 holes then get tummy tuck are the

> scars left on the stretched portion of

> skin?

Absolutely. Not only that, but when the skin is stretched during the

tummy tuck, the scars usually stretch to several times their original

length. Many lap DS patients who later have tummy tucks wind up with

six or eight FEET of scars crisscrossing their abdomens.

August 19, 2001

Hi Debbie:

> Now my question, if it is true that an open

> ds is faster (less anesthesia) than the lap

> ds and if most (?) have a tummy tuck after

> their weight loss then why opt for lap?

Psychology plays a HUGE role in the choice of lap vs open.

Those who adamantly argue for lap seem to have a deepseated fear of

the large incision. They see it as some sort of psycho-sexual

violation. These people rarely laugh, tend to be loners, and are

extremely anal retentive in nature. (Most were potty trained before

the age of one.) Four of the criminals on the FBI's current " Ten

Most Wanted " list are former lap DS patients -- most of them are

wanted for various terrorist activities.

Those who argue for open, on the other hand, have a deepseated fear

of someone trying to sew up their insides using a pair of chopsticks

and with only a flashlight for illumination. They see the open

incision as a chance to expose themselves to the world through new

experiences. They are highly social, intelligent, generous, are much

more attractive than their pro-lap counterparts, and are secure in

their knowledge of their true selves, (thus they have no need to

worry about the effect of the scar on their looks).

> Also if you have lap and get the 4 or

> 5 holes then get tummy tuck are the

> scars left on the stretched portion of

> skin?

Absolutely. Not only that, but when the skin is stretched during the

tummy tuck, the scars usually stretch to several times their original

length. Many lap DS patients who later have tummy tucks wind up with

six or eight FEET of scars crisscrossing their abdomens.

August 19, 2001

Tom,

While I found your post funny and amusing, I do think that

labeling people who desire lap as somehow psychologically

inferior to those who don't kind of ignores the history of

laparoscopic development in general and creates unnecessary

stereotypes. I don't know how long it took my parents to

potty-train me and I'm sure they don't either. I would like to think

I'm not anal-retentive...no one has ever said that...but it could just

be an occupational hazard. I laugh a LOT, sometimes to a fault

and I have never broken the law (Honest, ossifer!), unless you

count that illegal u-turn and some weak moments in high school

(I didn't inhale!!).

Delphine recently presented results from the first 100 lap

patients in Dr. Rabkin's practice. One of the things she asked

the patients was WHY they wanted lap over open. The

overwhelming, although not 100%, response had to do with the

size of the scars and Delphine said that that wasn't what she

originally expected (although I don't think she was necessarily

surprised). While I am more worried about things like

complications, nutrition, being able to get to a bathroom, etc., I

have had surgery before so my skin isn't " virgin " . It is easy, by

comparison, to " worry " about the scar in light of the other

possible complications or changes in lifestyle, so I think some

people focus on that on the surface at first.

Lap procedures have advantages over open procedures that go

beyond the vanity of scars. There is less of a chance (less of,

not no chance) of incisional hernias simply because the

incisions are smaller. Recovery time, in general, is reduced

(yes, I know everybody is different, and so is every procedure). If

recovery time is faster, the patient feels better faster and is able

to get on with the business of living and healing.

In the case of my lap gallbladder removal, I already have scars

all over my trunk for various reasons. I've already resigned

myself to not wearing that green dress that wore

at the Grammy Awards (darn), without someone pointing and

saying " Damn, where'd you get that scar? " (and laughing their

a$$ off). I didn't choose lap for vanity reasons, but having had

previous surgeries, I chose it for the potential of quicker recovery.

My surgeon explained several times that agreeing to lap DID

NOT MEAN I wouldn't have open. If he got in there and decided

he coudn't do it lap, he'd open me up, so if I woke up with an

8 " -10 " scar, don't be surprised. However, I talked to several

people who had had open gallbladder surgeries who told me

about 2-5 days of hospital stays and 2-3 weeks of rest and pain

medication or longer. I went home the next day (my surgery was

late afternoon) and hosted an impromtu " farewell gallbladder "

dinner party for five two days after my surgery.

I agree that the scars from tummy tucks, lifts of all sorts,

brachioplasty (sp?), etc are all over, although the surgeons do

their best to hide them under normal clothing lines. However,

maybe people don't think that far ahead? I notice a lot of people

who hope that they won't need TTs or other plastic surgery after

WLS. It is a " wait and see and I'll deal with it later " kind of a thing

and in the meantime they would like to do without the larger scar.

Fair enough, as long as they have done their research and have

confidence in their surgeon.

Having had lap and non-lap surgeries in the past, I have to say I

greatly prefer lap. I am completely comfortable with the lap

concept. I have confidence in my research and my chosen

surgeon. I have available to me a surgeon who does lap

procedures and I know that that doesn't guarantee I won't end up

with an open procedure. Having said that, if the only DS surgery

available to me was open, I'd be the first to say, " Gimme that

scar, baby! Bring it on! "

Ciao,

> Psychology plays a HUGE role in the choice of lap vs open.

<snip>

August 19, 2001