What is Closed Bypass and Open Bypass? What are the Differences?
Closed bypass and open bypass are two different surgical methods performed to treat coronary artery disease.
What is Closed Bypass?
The method known as closed bypass among the public is medically referred to as minimally invasive. Closed heart surgery is performed without splitting the sternum (breastbone) and with small incisions. The necessary procedures are performed by reaching the heart through the ribs via small incisions. In closed bypass surgery, there is no cutting of bones or ribs. The surgery is carried out through the spaces between the ribs. Incisions can be made in different locations such as under the left breast or above the left breast, depending on the surgeon’s decision.
What is Open Bypass?
The coronary bypass surgery performed by cutting the breastbone, known as the sternum, is called open bypass among the public. This surgery has been the standard procedure that heart surgeons have been performing for many years, and surgical training is based on this technique. In recent years, due to public demand and the long recovery process involved in cutting the bone, as well as complications like delayed bone healing or difficult and prolonged treatment in case of infections, the shift has been towards minimally invasive methods (closed bypass) that involve smaller incisions and no bone cutting or breaking. However, for some coronary bypass surgeries, this method remains indispensable.
What are the Differences Between Open and Closed Bypass?
First of all, it is worth noting that the choice of technique in heart surgeries can vary depending on the tests and analyses conducted by your doctor. It is important to choose the method that is healthiest for the patient and to follow your doctor’s recommendation.
Since the incisions in closed bypass surgery are smaller compared to open bypass, the risk of infection is lower. Additionally, the small incisions in closed bypass surgery provide an advantage in terms of a faster recovery process. The rapid healing of wounds in closed bypass surgery is also advantageous for diabetic patients.
In open bypass surgery, since the incisions are large and the breastbone is opened, movements must be controlled and limited. Movements should be controlled when lying down, walking, picking up objects, and getting up. Additionally, long-lasting coughs and sneezing bouts in open bypass surgery can disrupt the stability of the breastbone and lead to healing problems.
Since the incisions in closed bypass are small, it offers an advantage in terms of aesthetics compared to open bypass surgery.
Closed bypass surgery takes a little longer than open bypass surgery because it is performed through small incisions. However, in the hands of experienced surgeons, the duration of both methods is almost the same.
In open bypass surgery, since the chest cavity is opened, it is recommended to sleep on your back for at least six weeks. Sleeping on the side can hinder bone healing. The patient should always have assistance when getting in and out of bed, and should not use their arms when sitting down or getting up. Going to the bathroom independently is not possible. Additionally, if the patient drives, they are allowed to drive their vehicle only after 6-8 weeks.
After closed bypass surgery, the patient is allowed to move independently as soon as they are moved to the ward. They can get in and out of bed and sit down on their own, and they can go to the bathroom without assistance. They can use their arms freely. There is no need to sleep on the back, and they are allowed to sleep in any position they prefer. They are allowed to drive their car 15 days after the surgery.
Although there are risks in both open and closed bypass surgeries, these risks may vary depending on factors such as the patient’s age, health condition, and previous surgeries.
The procedures performed in closed bypass surgery are identical to those performed in open bypass surgery. In closed bypass surgery, a bypass can be performed on every artery that can be bypassed in open surgery. There is no issue of being unable to reach the arteries at the back. Bypassing all arteries is possible with the closed method.
