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Post by Deleted on Dec 20, 2011 13:13:48 GMT -5
One thing (among the many!) that bugs the shit out of me is people who think that they should not only be able to get a revision from RNY to DS at the drop of a hat, but that doing it lap is better than doing them open. Two of the BEST - if not THE very best - DS surgeons ONLY do their revisions open, despite the fact that they have "mad lap skillz" - that should tell you something. Both Rabkin and Keshishian do their revisions open. And now here's a story that may give you an idea why: www.obesityhelp.com/forums/ds/4483266/Terrys-Post-Gave-me-the-Courage-to-Post/" In any case, he explained that when he reformed the stomach in the DS revision and removed the right part of the stomach to create the 'sleeve' he was effectively removing the arteries on the right side -- which was not a problem in theory cause there were enough arteries on the left side, but doing the surgery lap -- he had not been able to see the damage on the left side. In any case, the revision ended up removing all sources of oxygen and blood flow to the stomach which is why it 'died.' " |
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Post by baileymouse on Dec 20, 2011 15:48:12 GMT -5
That is so incredibly sad.  I never understood the people who wanted it lap. I had my RNY open and I had my DS revision open. I weighed 328 at one time, I'm not going to be vain about scars on my smaller body. I'd rather the surgeon be able to see everything he or she needs to see! |
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Post by lyndiain on Dec 21, 2011 20:00:03 GMT -5
My revision was done open, and boy am I glad. There was so much scar tissue and the ring from my previous surgery had eroded and was in a billion pieces that she had to pick out one by one. Having an open surgery wasn't that big of a deal to me.
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Post by Deleted on Dec 22, 2011 10:48:59 GMT -5
As far as "lap" vs "open", I don't mind that choice being left to the surgeon's discretion. After all, it is his butt on the line from a malpractice standpoint.
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Post by Deleted on Dec 22, 2011 19:19:41 GMT -5
As far as "lap" vs "open", I don't mind that choice being left to the surgeon's discretion. After all, it is his butt on the line from a malpractice standpoint. While that is true, it is my butt on line for complications because he can't see clearly enough what is going on with my insides. I am sure that the surgeon in Diana's link thought he could. I had surgery for cancer once, left most of it up to the surgeon (he wanted me to have an abortion, I wouldn't) he took out a bunch of my insides but left the cancer. I would like to think that wouldn't happen today, just because I would want to know more and have more of a say. He may be the doctor, but it is MY life. |
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Post by smileyjamie on Dec 25, 2011 13:56:58 GMT -5
I have no problem having my revision open. I think it is of greater benefit to my surgeon & to ME in the end. I already have a scar from my open RNY, and another from my tummy tuck. And another (up & down on the outside) from my 2006 c-section. And the inside was left to right, TALK ABOUT A DOUBLE WHAMMY!!!!!!!!!!!!!
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Post by Seeking Healthy on Dec 25, 2011 16:37:03 GMT -5
Diana, I couldn't agree with you more especially if you had previously undergone open procedures. There were so many issues cleaned up in side of me during my revisions that if they would have been done lap I may have been in trouble. I never questioned Dr. K's judgement or his reason's for having to do it open. After all he is the expert and I trusted him to do what was necessary to bring me through alive and in better health.
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Post by chicarita on Dec 26, 2011 18:31:58 GMT -5
Diana, do you feel it's as important for a band to DS revision to be open? I'm not opposed to it, I have a ton of scars as it is, I'm not sure my surgeon does it that way and I want to be able to explain why it's important to me if it should be.
I would love to hear your thoughts on it. Thanks for being brilliant as usual!
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Post by baileymouse on Dec 27, 2011 20:39:08 GMT -5
I was looking at my DS scar yesterday, and it's barely visible. It's better than my plastic surgery scars, it's cleaner than my old RNY scar. Dr. Greenbaum did an excellent job. So many people worry about scars, but they should worry more about what's going on inside.
Chicarita, I think almost all surgeries are better when open, for sight issues. Bands have a habit of eroding into the stomach, and they can cause a large amount of scar tissue. If you have the option to have it open, you might want to do so. I've heard stories about bands being taken out in little bits because they eroded so badly.
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Post by Band to DS on Jan 14, 2012 22:53:00 GMT -5
I'm a nurse who works in a PACU (recovery room) at a large teaching hospital. Most, but definitely not all, surgeries can be done using a laparoscopic approach these days. Having extensive scar tissue or prior open surgeries are good reasons for an open DS. RNY to DS revisions are so complex that it also makes sense that an open approach would be better. A skilled surgeon knows when to plan for an open procedure and also knows when to convert a laparoscopic procedure to an open one (and will do so without hesitation). I've only had one abdominal surgery, which was my lap band, so I don't have any problems with Dr. Sudan performing a robotic/laparoscopic DS on me. I think you should talk to him about your concerns & see what he says.
Shelli
Disclaimer: The information contained in this post is not intended nor implied to be a substitute for professional medical advice; it is provided for educational purposes only. You should talk to your healthcare provider to determine the appropriateness of the information for your own situation.
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Post by omeaga7 on Jan 22, 2012 18:43:06 GMT -5
One thing (among the many!) that bugs the shit out of me is people who think that they should not only be able to get a revision from RNY to DS at the drop of a hat, but that doing it lap is better than doing them open. Two of the BEST - if not THE very best - DS surgeons ONLY do their revisions open, despite the fact that they have "mad lap skillz" - that should tell you something. Both Rabkin and Keshishian do their revisions open. And now here's a story that may give you an idea why: www.obesityhelp.com/forums/ds/4483266/Terrys-Post-Gave-me-the-Courage-to-Post/" In any case, he explained that when he reformed the stomach in the DS revision and removed the right part of the stomach to create the 'sleeve' he was effectively removing the arteries on the right side -- which was not a problem in theory cause there were enough arteries on the left side, but doing the surgery lap -- he had not been able to see the damage on the left side. In any case, the revision ended up removing all sources of oxygen and blood flow to the stomach which is why it 'died.' " Good topic Diana...thanks. The question has been on my hmmmm list and I had been leaning heavily toward an open surgery and now it is definite. Great info everyone, thanks. |
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Post by sherylr on Jan 23, 2012 11:19:15 GMT -5
Thank you for this post, I am in the beginning of the revision process and would have asked this question later... I've had 3 abdominal surgeries, 2 lap and 1 open... I'd think open would be better for me so he can see all the scar tissue and what else happens to be going on inside. It's a longer recovery, but worth it to me... Thanks again and good luck!
Sheryl
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Post by nannette on Jan 30, 2012 16:08:56 GMT -5
I am the original poster of the linked post on OH -- and while I now don't disagree with what Diana says, obviously I thought the surgen had the expertise to do it lap. As a result of what happened with me, he is now doing further pre-op 'testing' before consenting to doing lap revisions from RNY to DS.
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Post by Carolyn H. on Feb 2, 2012 21:03:22 GMT -5
Are you referring to RNY and Lapband revisions or all? Do they do the VSG to DS revisions open or lap? If you can do a full DS lap, why would just the 'switch' portion need to be done open if the stomach is already sleeved?
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Post by reinventingangela on Feb 5, 2012 2:04:49 GMT -5
Nannette, we're just glad you made it through....and you look fabulous, I hope you feel fabulous as well!
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Post by Deleted on Feb 12, 2012 12:50:12 GMT -5
I am not a medical doctor, but this is what I understand:
Generally: there can be adhesions ANYWHERE when there has been a previous surgery (and even, in some people, with NO previous surgery). This can make future operations more difficult.
Band or VBG to DS: there can be so much damage from erosion of the band into the stomach that it requires picking pieces of the band out of where it is embedded into the stomach wall - a procedure best done under conditions where the surgeon has a good view of what is going on.
RNY to DS: undoing the RNY intestinal configuration, putting the intestines back together so they can be re-partitioned in the proper proportions, putting the stomach back together where it was transected, and then recutting ACROSS the previous suture line in the scar-ridden stomach tissue to form the vertical sleeve is a HUGE amount of surgery, requiring careful and secure view of the condition of the stomach. Previous scar tissue can obscure the field as well, I would assume.
Sleeve to DS: If ONLY the switch is being added, I would assume that could be done laparoscopically. But if a resleeving is being done, all the caveats above regarding re-operating on a scarred stomach apply, PLUS the need to completely excise the previous suture line to minimize the risk of leaks.
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Post by SuzeW.A. on Feb 25, 2012 11:06:37 GMT -5
This post seriously made me think, I am very pale, I scar easily, and they don't fade. Ever. So to be honest I was worried about more scars all over my stomach. I have my lap ones from my Band, a few more from removing my ovary, and a few more. But after reading this it really makes sense to ME anyway, to have an open surgery if at all possible. I certainly don't want my band pulled out "in pieces" if it can be helped and I want the surgeon to have as much "sight" as he needs. Thanks for posting this.
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Post by michelehei on Feb 25, 2012 12:07:59 GMT -5
Well....Dr. Gagner did my VBG to DS revision lap. Maybe that's why I have little restriction and this horrid 250 cm cc. There is a thread called research right now. I'm ashamed to say that maybe I should have spent a lot longer doing my research before jumping into surgery with Dr. G. Who knows.
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Post by anniemck13 on Jul 4, 2012 23:48:55 GMT -5
Thank you for this Diana, this is something that I had not really thought about since my prior surgeries (band, gall bladder and hysterectomy) were all done via lap. I don't particularly care open or lap as long as it is done correctly and safely.
This certainly gives me something to question the surgeon on however, as I know that Dr. Smith prefers Lap.
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Post by alaja957 on Jul 5, 2012 8:25:11 GMT -5
Dr.Roslin prefers to do his surgery lap because he can visualize the top portion of the old pouch better in an abdomen filled with gas as opposed to one that collapses on itself during an open procedure. He expressed that his surgeries go better lap. I would seriously suggest talking this over with your surgeon.
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Post by ginany on Jul 5, 2012 8:37:55 GMT -5
My RNY was open. My DS revision was done LAP.
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