Laparoscopic or open surgery?

I had my rectum taken out via lap surgery. My tumor was very low...I think 8 inches in, which was close but I was able to then have a temp. iliostomy. I did have an abscess afterwards, which put me in the hospital for another week and was painful ( an infection from the lap surgery). The iliostomy was wierd at first, but I called her ' Stella the stoma' and there definitely is a learning curve but you will become very used to it over time and it will become second nature to you. I also had my liver operated on with open surgery when they went in to do my iliostomy reversal and recovery was fine. Sore, but managable. No complications. Good luck.

Everything is gray in medicine and there is really no right or wrong answer. You just have to go with your gut instinct. I have had open and robotic.   Recovery is a little faster with robotic but I always wonder if it is better for the surgeon to get in there and feel around and take a closer look is better with open surgery.  I assume a lot of that depends upon the skill of the surgeon. I have had several open surgeries and found the recovery very smooth. My surgeon always sends me home and says to take Tylonal for any pain. I just had open abdominal surgery to remove a recurrence on June 19 and I started back training for an 8k on July 23 with my surgeons approval.  We are all heal differently.  Pick the surgeon who you feel is more skilled.  I credit my surgeon's skills for my quick recoveries but he is always quick to tell me I give him too much credit.  Good luck with your next steps. 

While the surface scar is smaller, they still have to do the same stuff to your innards.  I had a choice of open or lap for my incisional hernia repair, and after hearing the pros and cons regarding that type of surgery, opted for the open.  The surgeon has a better view, and more room to work.  And actually, for the hernia surgery, supposedly the recovery from the laparascopic procedure is more painful!

Note that for hernia repair, there is a significant difference in what they do in each type of surgery; laparascopically they are able to cover the hernia in mesh and sew that into place to protect it.  In open, they can pull the sides of the hernia together, and then cover with mesh, so it is a more complete repair.  Both are safe results, but one is more complete. 

Speak to your drs and understand the pros and cons for your specific surgery.  Then decide what seems right for you.

Alice

lp1964 said:

The way I see it...

...is that laparoscopic surgery is good in small spaces like joints where instead of cutting the whole joint space open you just create a couple little wholes. But a high risk cancer surgery where checking out the entire area and 100% accuracy is essential I would feel safer with the open surgery. Plus in my case they have to do the anal resection from the outside anyway. Also I just don't see how you can take the end of the colon, bring it up to the colostomy site and suture it from the inside. 

I think I'm gonna try to find a surgeon that does open surgeries instead and someone who (if it's low risk) is willing to save my sphincter. I'm ok with the colostomy too, but if there is a possibility I'd like to save my a$$ Lol.

Thank you for your input. You helped me to make up my mind again and I feel good about it now.

Laz

Also I just don't see how you can take the end of the colon, bring it up to the colostomy site and suture it from the inside. 

I had open surgery, but the surgeon told me that he went up through the anus with a staple gun to put me back togeether again. 

No idea how that works. Maybe I should look on YouTube  .

I too would go with open surgery. That way they can feel as well as look (I think I may have posted that alreay).

but my surgeon (very experienced, with good national rep) insists on open.  He literally pulled all of my intestines out of my abdomen and spent hours sorting through them.  Sorry....that's kind of a gruesome image!  He did this on every one of my surgeries, even when there was only one tumor showing on the PET.  I think his feeling was better safe than sorry, and he didn't want to miss anything.

Recovery was kind of slow (afterwards I always feel like a suitcase that hasn't been repacked properly), and I have a gigantic scar, but since I'm NED for now, I feel like he made the right choice.

Open surgery requires 6 to 8 inch incision to open theabdomen for the operation where as in laparoscopy, by using multiple incisions, a camera is used to view the abdomen and small instruments are used to perform the surgery through the incision points. Laparoscopy is not suitable for all patients. The patients who are obese and had previous abdomenal surgeries required to have open surgery.

lp1964 said:

The way I see it...

...is that laparoscopic surgery is good in small spaces like joints where instead of cutting the whole joint space open you just create a couple little wholes. But a high risk cancer surgery where checking out the entire area and 100% accuracy is essential I would feel safer with the open surgery. Plus in my case they have to do the anal resection from the outside anyway. Also I just don't see how you can take the end of the colon, bring it up to the colostomy site and suture it from the inside. 

I think I'm gonna try to find a surgeon that does open surgeries instead and someone who (if it's low risk) is willing to save my sphincter. I'm ok with the colostomy too, but if there is a possibility I'd like to save my a$$ Lol.

Thank you for your input. You helped me to make up my mind again and I feel good about it now.

Laz

My doc tried laparoscopic and ran into too much scar tiissue from previous surgeries. So I ended up with open. And a ileostomy for good measure.  Six weeks later the ileostomy was reversed with open surgery.  Developed a fistula.  Dr expected to require a third surgery to correct the fistula.  Only it (the fistula) healed itself from the inside out. At this point I was NED, and have been ever since!!! YEA! 

Hi Laz, I did laproscopic because that is all my doctor would do.  He's an older guy but he does the "latest" techniques.  He's the head of the department at Sloan in NY.  I don't know if there is really a difference in how you get cut, just who does it.  You have to look at the person's record.  Laparoscopic means 4 cuts.  One on the belly button, one to each side of it and one underneath it.  A robot is used.  I had the exact same surgery in January that you are having. 

Pain meds are your friend.   Be very clear on what meds you want, how you want them administered and how long you will be allowed to stay on them. Make sure you and your doctor are on the same page. I got a doctor who is anti pain meds. At some point I had to say enough. I need help here. So I started to take pills instead of using the push button system the hospital provided.  I should have insisted on the pills after the first day.   The pills were a great relief and worked very well and I could regulate them myself. I also used them at home but was careful about addiction.   

Some other things to think about no matter what you choose. 

When you get your marking for the ostomy bring several pairs of pants and take into account your underwear line.  This is very important.  Having the lines fall exactly on the ostomy can hurt and doesn't allow the output to come out.  Mine was marked incorrectly.  The nurse simply didn't give me enough info and I didn't do enough research. She marked me in less than 5 mins.  That's a red flag.  It is greatly impacting my life and instead of the ostomy working with my wardrobe, I'm having buy clothes that are fitting to the ostomy which really doesn't give me many choices.  I had to completely change how I dressed.  Marking is very important.  I would have prefered mine lower.  The bag sticks out over all of my pants. I can no longer wear low riders or any pants that don't have a high waist line. Tight shirts are out unless I wear a band around the waste and that's also irritating on a hot day as well as for output.  Have her show you where the bag will land.  Look to see how it lands with your pants on, shirt tucked in, shirt untucked.  Does it show? Will it be comfortable near your legs if you mark it low? What are your marking options?  What will this mean for comfort, ease of changing, how you dress?  Even in 100 degree heat I'd have to wear a band over my abs to cover it since mine is so high.

Waking up without an anus is a bit surprising (even though you know it's coming).  It's literally just rolled skin all sewn into place with nothing to cling to because the muscle is gone.  It's swollen at first so it looks so weird but eventually it starts to look normal and you forget all about it.  At first the bag seems uncomfortable and you just want to get rid of it and sleep normally and you can get depressed about the whole situation.  Be ready in case that hits.  Remind yourself that going to the bathroom is such a small part of your day.  Once you can sit again, make sure you do things like go out to dinner, spend time with friends outside of your home  because this let's you forget and realize you are just fine.  This all thankfully goes away and you completely get used to the whole thing.  It's now August and I feel perfectly fine with my ostomy.  No more phantom pains, no more feeling like I need to go the old way, no more wanting to rip the bags off of my body.  Completely adjusted.

Watch the video that the hospital provides you.  I don't know why they don't make people watch this in the hospital, it really makes a huge difference as far as how to start off right (and avoid rash).  Learn about the ostomy supplies like adhesives, bags, powders and pastes, price them with your insurance.  It turns out my insurance had a $2000 deductible and i have great insurance.  This new bill was a great suprise.    I now use a disposable system with tape and throw away bags.  I find them easy.  I use baby wipes for cleaning (I'm not sure if you're supposed to do this but it's been working for me), I keep ostomy powder for rash days and I keep paste in case I have a bad rash and need to protect the surrounding surface. 

Before you buy large quantities, call the companies and have them send you samples, tell them you want several days because you are trying to pick a product.  You need 8 bags for everyone one adhesive for the throw aways.  My at home nurse (who wasn't very helpful because she knew nothing about ostomies) ordered two boxes of adhesives and bags that I couldn't use.  I use them now only in an emergency.   Don't buy in large quantities until after you have healed a lot.  Your ability to tolerate the tape changes.   Often what you use in the hospital is not what you end up liking.  I like Convatec's esteem system but when I first came home, this tape would have hurt me.  It's now easy on the skin, sticks well and the bags are pretty reliable but at first the tape really hurt and I had to use a mild system from coloplast which doesn't stick as well and so I had to use powder and special wipes that make the powder stick, expensive!

Good luck.  Feel free to ask me anything, it's all still fresh in my mind.