Approaches to Surgery: Open Versus Minimally Invasive Surgery

Bariatric surgery has been performed actively in the United States since the 1960’s. For many of those years, the surgery was performed as an open procedure. An open procedure means a surgeon creates a long incision, or cut, through the abdominal wall, opening up the patient to reveal and rearrange the digestive tract. As medical technology evolved, laparoscopic or minimally invasive surgery became at first a possibility and then the norm for this procedure. With laparoscopic surgery, the surgeon creates small incisions for the insertion of a camera and working instruments. Both approaches have similar success rates in reducing excess weight and improving or resolving co-morbidities.^24,25

Most surgeons will perform bariatric surgery using the laparoscopic method. However, this is a decision that the doctor and patient must make together.  Important questions for patients to ask are:  What is the surgeon’s training and experience with minimally invasive surgery?  How many minimally invasive versus open procedures has the surgeon performed?  How often are minimally invasive procedures converted to open procedures? Read below to learn more about both procedures.

Open Surgery
Open surgery involves the surgeon creating a long incision line to open the abdomen and operating with "traditional” medical instruments. Because of the incision, the patient’s stay in the hospital will be several days longer than with minimally invasive surgery. The recovery time is also longer. Patients generally will need to heal for several weeks before returning to work and regular physical activities. With a longer wound, there is more of a chance of wound complications such as infections and hernias. A long incision leads to a long scar. In some cases, the open method is necessary due to some patient-specific risks.

Laparoscopic or Minimally Invasive Surgery
A laparoscopic operation involves making several small incisions for different medical devices to be used. There are, on average, four to six ports created. The devices, including a small video camera, are inserted through the ports. The surgeon uses a monitor to perform the procedure. Most laparoscopic surgeons believe this gives them a good view and access to key body parts. Many patients are able to recover from the surgery in a shorter time than open procedures require. In fact, some return to work in little more than a week, and many are able to quickly return to physical activity. Patients generally have very small scars. There is also a lower chance of wound complications such as infection and hernia.

Your Next Step
Laparoscopic and open procedures for bariatric surgery both produce similar weight loss. However, not all patients are candidates for the laparoscopic approach, just as all bariatric surgeons are not trained to perform this less-invasive method. The American Society for Bariatric Surgery recommends that laparoscopic bariatric surgery should be performed only by surgeons who are experienced in both laparoscopic and open bariatric procedures.

________
References

24 Nguyen NT, Ho HS, Palmer LS, et al. A Comparison Study of Laparoscopic Versus Open Gastric Bypass for Morbid Obesity. J Am Coll Surg 2000 Aug;191(2):140-155.

25 Schauer PR, Ikramuddin S, Gourash W, et al. Outcomes After Laparoscopic Roux-en-Y Gastric Bypass for Morbid Obesity. Ann Surg 2000 Oct;232(4):515-529.