RNY, not RNY - Long and technical

[Guest guest]

,

Thanks for your post. This surgeon calls his a variation of the RNY, and has

termed it the RGB, resectional gastric bypass.

He and his colleagues ( K. Curry, MD, Preston L. , MD, Clifford

A. Porter, MD, M. Watts, MD) wrote a paper that appeared in the

American Journal of Surgery, " Resectional Gastric Bypass is a new Alternative

in Morbid Obesity, " Vol. 175, Issue 5, May 1998, pp. 367-370. I'll just

quote a little of it and see if it makes sense to anyone.

" Surgical Technique - A long midline approach was used in most patients.

The gallbladder is removed routinely. The distal stomach is mobilized, and

the duodenum is stapled and transected. The open end of the pylorus is

oversewn to prevent spillage during subsequent manipulation of the stomach,

which is then mobilized proximally. Great care is taken to avoid splenic

injury as the short gastric vessels are mobilized. The blood supply to the

proximal lesser curvature from the upper branches of the left gastric artery

is carefully preserved. The distal esophagus is neither mobilized nor

encircled. Exposure to the upper gastric area is usually significantly

improved by taking down the left triangular ligament and reflecting the liver

medially. Careful division of the high short gastric vessels improves

mobilization of the upper stomach, permist a technically easier gastrojejunal

anastomosis, and allows accurate measurement of hte gastric remnant. Safe

control of the upper short gastric vessels is facilitated by careful use of

surgical clips.

After the stomach has been fully mobilized, a 50-cm roux-Y limb is prepared

at the convenient point in the proximal jejunum near the ligament of Trietz

and pased through an avascular area of transvers mesocolon. The stomach is

resected so as to leave a residual gastric poch of 39 to 50 cc. A widely

patent two-layer, hand-sewn, end-to-side gastrojejunal anastomosis is then

constructed to the Roux-Y limb...

There is extensive experience with long-term nutritional outcome following

subtotal gstrectomy performed for reasons other than obesity, and in

traditional gastric bypass. If the roux-Y limb arises in the proximal

jejunum, studies have documented long-term nutritional competence. We

therefore believe that major future nutritional problems after RGB are

unlikely, since from a funtional alimentary standpoint RBG is similar to

traditional gastric bypass. "

Make sense to anyone? I'd love to hear what Dr. Rutledge has to say about

this technique.

Donna

[Guest guest]

They're making a very small stomach pouch and a short

intestinal bypass (with the 50cm roux limb). Doesn't sound like

you'd lose as much weight, but with the small stomach, you'd be like

Fobi patients, not able to eat more than 1-2 tablespoons full at a

time(or you throw up).

Worse, they don't do it laparoscopically, so you get a big scar

( " long

midline approach " =big hairy incision down the middle) and a long

recovery time.

Yeah, sounds heavenly. (That's sarcasm).

Show your insurance company the shorter in-surgery room time, shorter

hospitalization time (=$$$) with the lap bypass that Dr. Rutledge

does. They're always interested in saving money.

As far as the " experimental " argument goes, what that guy you wrote

about, below, is doing, is experiemental and I bet he doesn't have

experience with 600+ patients, like Dr. Rutledge does, either.

> ,

>

> Thanks for your post. This surgeon calls his a variation of the

RNY, and has

> termed it the RGB, resectional gastric bypass.

>

> He and his colleagues ( K. Curry, MD, Preston L. , MD,

Clifford

> A. Porter, MD, M. Watts, MD) wrote a paper that appeared in

the

> American Journal of Surgery, " Resectional Gastric Bypass is a new

Alternative

> in Morbid Obesity, " Vol. 175, Issue 5, May 1998, pp. 367-370. I'll

just

> quote a little of it and see if it makes sense to anyone.

>

> " Surgical Technique - A long midline approach was used in most

patients.

> The gallbladder is removed routinely. The distal stomach is

mobilized, and

> the duodenum is stapled and transected. The open end of the

pylorus

is

> oversewn to prevent spillage during subsequent manipulation of the

stomach,

> which is then mobilized proximally. Great care is taken to avoid

splenic

> injury as the short gastric vessels are mobilized. The blood

supply

to the

> proximal lesser curvature from the upper branches of the left

gastric artery

> is carefully preserved. The distal esophagus is neither mobilized

nor

> encircled. Exposure to the upper gastric area is usually

significantly

> improved by taking down the left triangular ligament and reflecting

the liver

> medially. Careful division of the high short gastric vessels

improves

> mobilization of the upper stomach, permist a technically easier

gastrojejunal

> anastomosis, and allows accurate measurement of hte gastric

remnant.

Safe

> control of the upper short gastric vessels is facilitated by

careful

use of

> surgical clips.

>

> After the stomach has been fully mobilized, a 50-cm roux-Y limb is

prepared

> at the convenient point in the proximal jejunum near the ligament

of

Trietz

> and pased through an avascular area of transvers mesocolon. The

stomach is

> resected so as to leave a residual gastric poch of 39 to 50 cc. A

widely

> patent two-layer, hand-sewn, end-to-side gastrojejunal anastomosis

is then

> constructed to the Roux-Y limb...

>

> There is extensive experience with long-term nutritional outcome

following

> subtotal gstrectomy performed for reasons other than obesity, and

in

> traditional gastric bypass. If the roux-Y limb arises in the

proximal

> jejunum, studies have documented long-term nutritional competence.

We

> therefore believe that major future nutritional problems after RGB

are

> unlikely, since from a funtional alimentary standpoint RBG is

similar to

> traditional gastric bypass. "

>

> Make sense to anyone? I'd love to hear what Dr. Rutledge has to

say

about

> this technique.

>

> Donna