Re: Texas Janice / Common Channel Length (Long)

[Guest guest]

Thank you Terry for your " take " on common channel length. It was very

helpful.

Now I just hope I get an opportunity to have one.

Janice in Texas

Texas Janice / Common Channel Length (Long)

> Hi Janice,

>

> Here is my take on the channel length subject. I posted most of this

> a few weeks ago; it seemed to become clearer in my own mind as I

> wrote it. Forgive the duplication if you have already read it.

>

> The way I understand it, the overall success of this surgery is a

> matter of trying to achieve balance. From what I have heard, there

> is around an 18 month window where patients will achieve the greatest

> degree of weight loss and then it will taper off. I think this is

> the period of time it takes what is left of the stomach to stretch to

> " normal " size. Once the stomach stretches and a slightly larger

> quantity of food is eaten regularly, weight is maintained by the

> malabsorption component of the intestinal bypass.

>

> So, it seems, here is the tightrope walk; and everyone is different.

> How much weight is lost and how quickly (and how COMFORTABLY) it is

> lost depends upon BOTH the size of the stomach and the length of the

> common channel. The longer a patient eats smaller quantities, the

> more rigorous one adheres to smart food choices, the more weight will

> be lost even with a longer (100 cm or more) common channel. The

> shorter the channel length, the less nutrients and calories that will

> be absorbed before and after the 18 month window, and the GREATER the

> chance of serious malnutrition issues lifelong. I think shorter

> channel lengths also contribute to possible bowel/gas difficulties -

> on account of foods passing through that are less broken down and

> less absorbed.

>

> I see it as everything being inter-related. Channel length, stomach

> size, food choices/quantities, inherent metabolism, pre-disposition

> to bowel/gas problems, exercise and vitamin & mineral supplementation.

>

> Good surgeons work with their patients to find this balance. They

> determine channel length based on the doctors' experience and perhaps

> the patient's metabolic history. They structure their aftercare

> programs to maximize the peak post-surgery weightloss window for each

> patient while minimizing long-term malnutrition risks. The patient

> needs to be observant of what food/drink combinations work well with

> their bodies and which do not; all WITHIN the parameters of their

> doctor's aftercare program.

>

> Common channel length is one component we (or, actually, our

> SURGEONs) control. But, because of the balance of everything,

> deficiencies in one can be compensated (to some extent) by some of

> the other components. For example, a patient who, pre-op, may

> already have sensitive bowels, may be better served with a longer

> channel length and/or more conscientious food choices. While someone

> who has never had bowel issues may experience uncomfortable symptoms

> due to their shorter channel length but may be able to control it

> with smart food choices. This might be why some surgeons say they do

> not see major variations in outcome with slight to moderate

> differences in common channel length (25-50 cm).

>

> Hopefully, this helps somewhat. For me and my metabolism, I

> personally would lean towards a *slightly* shorter channel length (75-

> 80 cm) because I haven't had bowel issues regularly as a pre-op. I

> also know I will be vigilant about taking my supplements and getting

> in my protein. But if, for whatever reason, my surgeon said he could

> only give me a 100cm length, I don't believe I would be doomed; not

> in the least.

>

> Terri Hassiak

> BMI 60

> http://www.obesityhelp.com/morbidobesity/profile.phtml?N=H980366398

> email(no spaces): bunsofluff @ hotmail.com

>

>

[Guest guest]

Thank you too , You guys are the greatest. Thank you and all of you for your posts to help me, and I hope others, grasp a bit more understanding about some of the differences with the various common channel lengths.

Janice in Texas

Re: Texas Janice / Common Channel Length (Long)

Here is an interesting statement about the common channel length. This is comparing the BPD and its 50 cm common channel and the DS with a 100 cm common channel. I found this on the ASBS site in the footnotes of the "Story of obesity surgery" section.Marceau, P., S. Biron, et al. (1993). "BILIOPANCREATIC DIVERSION WITH A NEW TYPE OF GASTRECTOMY." Obes Surg 3: 29-35.The biliopancreatic diverting intestinal limb was anastomosed to the nutrient ileal limb 100 cm proximal to the ileocecal valve instead of 50 cm proximal to it, thus doubling the length of the common ileal absorptive segment. Weight loss after either operation was greater than 70% of the inital excess weight. Following the new operation, there was a lesser prevalence of side effects, especially loose stools and malodorous gas, a lesser degree of hypocalcemia* and no hypoalbuminemia*. *Definitions:----------------hypocalcemia - Low blood calcium can be seen in cases of hypoparathyroidism, low vitamin D intake, pregnancy, osteomalacia and certain kidney diseases. Normal blood calcium should be in the range of 8.5 to 10.5 mg/dl. hypoalbuminemia - Decreased concentration of albumin in blood (normal 3.5-5.0 gm/dl) typically found in chronic liver disease because of decreased production. Oncotic edema is the most prominent consequence of hypoalbuminemia.