In this day and age Laparoscopy is the choice. However from time to time we may need to choose an open procedure.

Reasons:

1. Multiple previous open abdominal surgeries with significant adhesions.
2. 3% to 7% of procedures started Laparoscopic end up being Open. This may be because of adhesions, large left side of liver, internal bleeding, internal injuries, unexpected findings, technical difficulty and others.

Results: 

1. Weight loss for open surgery patients is the same as the laparoscopic procedure because the procedure itself is exactly the same. The approach is the only difference.
2. Complications related to the inside healing such as leaks, bleeding etc are the same as laparoscopic approach.
3. Most significant difference is that the incidence of wound infection and hernia in the incision is about 15% - 20% with an open procedure. With laparoscopy both complications are reduced to less than 2%