Guest guest Posted July 7, 2001 Report Share Posted July 7, 2001 Dear Cindy, I really don't know how the RnY changes the functioning of the pylorus valve. Sorry, but I'm sure there are folks out there who would know. Peace, Robyn revision of RnY to DS > In a message dated 07/07/2001 1:21:57 PM Central Daylight Time, > rreso@... writes: > > << ch this surgery who have had a RNY that failed and who want a revision > to DS. I could be wrong, but it is my understanding that revision from rny > to DS is quite difficult. >> > > > I was wondering-- is it possible for your pyloric valve to work properly > again after not having been used, as in the RnY? > > Cindy W in MS > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 7, 2001 Report Share Posted July 7, 2001 In the RNY the pylorus valve is either removed or set aside and is non functional as they create a pouch for your stomach so your own stomach is no longer churning food as it once was. With the RNY your pouch is like an open drain...forever open, if you can visualize that! Judie revision of RnY to DS > > > > In a message dated 07/07/2001 1:21:57 PM Central Daylight Time, > > rreso@... writes: > > > > << ch this surgery who have had a RNY that failed and who want a revision > > to DS. I could be wrong, but it is my understanding that revision from > rny > > to DS is quite difficult. >> > > > > > > I was wondering-- is it possible for your pyloric valve to work properly > > again after not having been used, as in the RnY? > > > > Cindy W in MS > > > > ---------------------------------------------------------------------- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 In a message dated 7/8/01 3:53:07 AM, duodenalswitch writes: << In the RNY the pylorus valve is either removed or set aside and is non functional as they create a pouch for your stomach so your own stomach is no longer churning food as it once was. With the RNY your pouch is like an open drain...forever open, if you can visualize that! >> I don't think the pyloric valve is ever removed with an RNY (perhaps you're thinking of the BPD surgery?). Usually the lower stomach (along with the pylorus) remains in the body, but is completely 'shut off' from the process of digesting food (either it is stapled off or the stomach is cut into two and stapled shut). It can still produce stomach acid, but that acid plays no role in digestion. This is why the 'bypass' begins after the duodenum: They want to leave the duodenum intact so the stomach acid has somewhere to go. The intestines (beyond the duodenum) are then attached to the upper pouch. Yes, the 'stoma' that is created is never able to 'shut', so food is processed relatively quickly and must be chewed thoroughly. People can also experience 'dumping' when sugars enter the intestines so quickly. This is a really good question and I don't know if many studies have been done on it. I'm sure there are patients for whom this would be an issue (either revisions from RNY to DS or RNY reversals). I think that I've read that there is no guarantee that the pyloric valve will work properly and that it can 'atrophy' due to non-use. I guess this depends on how long it has been in this situation, etc. To be totally honest, I would never consider this as a viable future option. First of all, the stomach has been traumatized by being cut (or stapled) into two horizontally. With the DS, you'd have to 'piece it back together' and cut some of it away. There would already be extensive scar tissue to the stomach.... I'm not saying it can't be done but I wouldn't go into an RNY surgery saying 'oh, if this doesn't work out, I can always get a DS later'. I think there would be serious issues about whether the stomach would be able to function normally or as optimally as if the patient had gotten a DS the first time around. all the best, lap ds with gallbladder removal January 25, 2001 five months post-op and and still feelin' fab! Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 Thanks ...I didn't realize that about the RNY. Funny how once you hit on the surgery that you think is the one...you tend to focus on it. I started out looking at the RNy but the size of the pouch and the stoma thing really bugged me and I was relieved when I found the DS! i just never looked back...LOL ~~* AJ *~~ BMI 59 Surgery date 7/24/01 going self pay - Dr Baltasar Spain Check out the Bellingham Support for WLS WWW.lookin2bthin.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 another thought : not only about keeping the pyloric valve, but if they made the pouch at the lesser curve where the pylorous is located, the tissue there is much less stretchy then at the greater curve or the fundus, and the pouch would be less likely to stretch out over time and enable you to eat too much again. > In a message dated 7/8/01 10:50:10 AM Pacific Daylight Time, > jhensel@c... writes: > > > > Their reasoning baffles me as I really think keeping our own stomach and the > > valve is what makes our surgery the best there is..... > > > > > > I dont understand the reasoning on that either. Why do they feel it better > to bypass that section? Wouldn't it be possible to make the pouch and use > the valve? That is one of the main reasons I choose the DS...that and the > low low chances of late regain...I am ONLY doing this once! > > ~~* AJ *~~ > BMI 59 > Surgery date 7/24/01 > going self pay - Dr Baltasar Spain > Check out the > Bellingham Support for WLS > WWW.lookin2bthin.homestead.com Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 In a message dated 7/8/01 2:23:40 PM, duodenalswitch writes: << I know personally, 2 RNY patients from another group who had their stomachs removed like in the DS only they had the pouch created for them. Another one said her surgeon told her that the pyloric valve is still there but will not function even if she has a revision.....it seems that the longer it sits there unfunctioning, the less chance it will ever work again (or properly as ours does now) >> Wow - I would think that would be extremely risky.. I think I remember someone mentioning this in my reading along the line, too. I think that the lower stomach remains mainly as a 'safety default' (ie. - it can be 'reversed', etc) and, for many who choose this surgery, that seems to be a MAJOR selling point (even if it isn not quite accurate -- I mean, sure -- mechanically you can 'reverse' an RNY but I don't think it's any walk in the park and there's no guarantee that things will work the same again). I could not imagine only having that little pouch and absolutely nothing else! Yikes! Yeah, I think that over time the pyloric valve would get 'sluggish' or become non-functional because of non-use... all the best, lap ds with gallbladder removal January 25, 2001 five months post-op and still feelin' fab! pre-op: 307 lbs/bmi 45 now: back to 240, man --- lost 2 and then gained it back.. now in a holding pattern (again)... I'll keep you posted... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 >> Their reasoning baffles me as I really think keeping our own stomach and the >> valve is what makes our surgery the best there is..... > I dont understand the reasoning on that either. Why do they feel it better > to bypass that section? Wouldn't it be possible to make the pouch and use > the valve? That is one of the main reasons I choose the DS...that and the > low low chances of late regain...I am ONLY doing this once! Over the years, the studies have shown that order for proximal RNY patients to achieve and maintain a satisfactory percentage of excess weight loss, the stomach pouch must be made very tiny, and it must be created out of the stomach tissue that is least stretchable. That tissue happens to be located in the upper portion of the stomach, near the esophagus. The tiny non-stretchable pouch helps ensure a permanently high level of food restriction, which is the only way to keep the weight off with a proximal bypass. So, the reason that a standard RNY could not include the pyloric valve is that in order to retain the esophagus-stomach-pylorus-intestine pathway, it would be impossible to keep the pouch as small as it needs to be. The anatomy of a stomach is simply too long between the esophagus and the pylorus to allow the surgeon to make a small, nonstretchable pouch. That is also why the DS procedure always comes with a distal bypass. Our stomach restriction is not extreme, and our capacity (since we keep the stretchy tissue) does increase with time (to a point!). With the more-normal stomach size, DS patients would have a hard time keeping weight off with only a proximal bypass. Hope that made sense! The real question is why any surgeon does a distal RNY, I think! The distal bypass in itself will keep the weight off, so the extreme restriction of the pouch, not to mention the issues of having a bypassed duodenum, make this procedure somewhat senseless to me. But then I am partial, so you are free to take that statement with as big a grain of salt as you like. M.--- in Valrico, FL, age 38Starting weight 299, now 156Starting BMI 49.7, now 26.0Lap DGB/DS by Dr. Rabkin 10-19-99http://www.duodenalswitch.comDirect replies: mailto:melanie@... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 , I have a friend who had the RNY with stomach removal and pouch created without pyloric valve and she also has a distal.....my thinking is she could have had a better quality of life if she had kept the 25% of her own stomach with the valve....... Judie RE: Re: revision of RnY to DS >> Their reasoning baffles me as I really think keeping our own stomach and the >> valve is what makes our surgery the best there is..... > I dont understand the reasoning on that either. Why do they feel it better > to bypass that section? Wouldn't it be possible to make the pouch and use > the valve? That is one of the main reasons I choose the DS...that and the > low low chances of late regain...I am ONLY doing this once! Over the years, the studies have shown that order for proximal RNY patients to achieve and maintain a satisfactory percentage of excess weight loss, the stomach pouch must be made very tiny, and it must be created out of the stomach tissue that is least stretchable. That tissue happens to be located in the upper portion of the stomach, near the esophagus. The tiny non-stretchable pouch helps ensure a permanently high level of food restriction, which is the only way to keep the weight off with a proximal bypass. So, the reason that a standard RNY could not include the pyloric valve is that in order to retain the esophagus-stomach-pylorus-intestine pathway, it would be impossible to keep the pouch as small as it needs to be. The anatomy of a stomach is simply too long between the esophagus and the pylorus to allow the surgeon to make a small, nonstretchable pouch. That is also why the DS procedure always comes with a distal bypass. Our stomach restriction is not extreme, and our capacity (since we keep the stretchy tissue) does increase with time (to a point!). With the more-normal stomach size, DS patients would have a hard time keeping weight off with only a proximal bypass. Hope that made sense! The real question is why any surgeon does a distal RNY, I think! The distal bypass in itself will keep the weight off, so the extreme restriction of the pouch, not to mention the issues of having a bypassed duodenum, make this procedure somewhat senseless to me. But then I am partial, so you are free to take that statement with as big a grain of salt as you like. M.--- in Valrico, FL, age 38Starting weight 299, now 156Starting BMI 49.7, now 26.0Lap DGB/DS by Dr. Rabkin 10-19-99http://www.duodenalswitch.comDirect replies: mailto:melanie@... ---------------------------------------------------------------------- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 Dear M., The distal RNY is almost never done as an " original " procedure. However, patients who fail to loose weight with proximal RNY can be converted to distal RNY quite easily. My father-in-law is a case and point. Of course the distal RNY patients get all the disadvantages of the RNY restrictions AND the DS malabsorption. I am wondering if it is even possible to revise the RnY to DS. I have seen an abstract on modifiying the RnY to BPD (without DS), sot this is certainly possible. I would think that preferable to distal RNY, but the dumping syndrome is still there. Hull > >> Their reasoning baffles me as I really think keeping our own > stomach and the > >> valve is what makes our surgery the best there is..... > > > I dont understand the reasoning on that either. Why do they feel it > better > > to bypass that section? Wouldn't it be possible to make the pouch > and use > > the valve? That is one of the main reasons I choose the DS...that > and the > > low low chances of late regain...I am ONLY doing this once! > > Over the years, the studies have shown that order for proximal RNY > patients to achieve and maintain a satisfactory percentage of excess > weight loss, the stomach pouch must be made very tiny, and it must be > created out of the stomach tissue that is least stretchable. That tissue > happens to be located in the upper portion of the stomach, near the > esophagus. The tiny non-stretchable pouch helps ensure a permanently > high level of food restriction, which is the only way to keep the weight > off with a proximal bypass. > > So, the reason that a standard RNY could not include the pyloric valve > is that in order to retain the esophagus-stomach-pylorus-intestine > pathway, it would be impossible to keep the pouch as small as it needs > to be. The anatomy of a stomach is simply too long between the esophagus > and the pylorus to allow the surgeon to make a small, nonstretchable > pouch. > > That is also why the DS procedure always comes with a distal bypass. Our > stomach restriction is not extreme, and our capacity (since we keep the > stretchy tissue) does increase with time (to a point!). With the > more-normal stomach size, DS patients would have a hard time keeping > weight off with only a proximal bypass. > > Hope that made sense! > > The real question is why any surgeon does a distal RNY, I think! The > distal bypass in itself will keep the weight off, so the extreme > restriction of the pouch, not to mention the issues of having a bypassed > duodenum, make this procedure somewhat senseless to me. But then I am > partial, so you are free to take that statement with as big a grain of > salt as you like. > > M. > > --- > in Valrico, FL, age 38 > Starting weight 299, now 156 > Starting BMI 49.7, now 26.0 > Lap DGB/DS by Dr. Rabkin 10-19-99 > http://www.duodenalswitch.com http://www.duodenalswitch.com/> > > Direct replies: mailto:melanie@t... Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 Dr Fox of Tacoma WA has done the distal RNY as an " original " procedure for years. Surely he isn't the only one. The RNY cannot be, AFAIK be modified to a DS. in Seattle Open DS Dr Welker Portland OR 1/5/2001 295/210 Re: revision of RnY to DS > Dear M., > > The distal RNY is almost never done as an " original " procedure. > However, patients who fail to loose weight with proximal RNY can be > converted to distal RNY quite easily. My father-in-law is a case and > point. Of course the distal RNY patients get all the disadvantages > of the RNY restrictions AND the DS malabsorption. > > I am wondering if it is even possible to revise the RnY to DS. I > have seen an abstract on modifiying the RnY to BPD (without DS), sot > this is certainly possible. I would think that preferable to distal > RNY, but the dumping syndrome is still there. > > Hull > > > > >> Their reasoning baffles me as I really think keeping our own > > stomach and the > > >> valve is what makes our surgery the best there is..... > > > > > I dont understand the reasoning on that either. Why do they > feel it > > better > > > to bypass that section? Wouldn't it be possible to make the > pouch > > and use > > > the valve? That is one of the main reasons I choose the > DS...that > > and the > > > low low chances of late regain...I am ONLY doing this once! > > > > Over the years, the studies have shown that order for proximal RNY > > patients to achieve and maintain a satisfactory percentage of excess > > weight loss, the stomach pouch must be made very tiny, and it must > be > > created out of the stomach tissue that is least stretchable. That > tissue > > happens to be located in the upper portion of the stomach, near the > > esophagus. The tiny non-stretchable pouch helps ensure a permanently > > high level of food restriction, which is the only way to keep the > weight > > off with a proximal bypass. > > > > So, the reason that a standard RNY could not include the pyloric > valve > > is that in order to retain the esophagus-stomach-pylorus-intestine > > pathway, it would be impossible to keep the pouch as small as it > needs > > to be. The anatomy of a stomach is simply too long between the > esophagus > > and the pylorus to allow the surgeon to make a small, nonstretchable > > pouch. > > > > That is also why the DS procedure always comes with a distal > bypass. Our > > stomach restriction is not extreme, and our capacity (since we keep > the > > stretchy tissue) does increase with time (to a point!). With the > > more-normal stomach size, DS patients would have a hard time keeping > > weight off with only a proximal bypass. > > > > Hope that made sense! > > > > The real question is why any surgeon does a distal RNY, I think! The > > distal bypass in itself will keep the weight off, so the extreme > > restriction of the pouch, not to mention the issues of having a > bypassed > > duodenum, make this procedure somewhat senseless to me. But then I > am > > partial, so you are free to take that statement with as big a grain > of > > salt as you like. > > > > M. > > > > --- > > in Valrico, FL, age 38 > > Starting weight 299, now 156 > > Starting BMI 49.7, now 26.0 > > Lap DGB/DS by Dr. Rabkin 10-19-99 > > http://www.duodenalswitch.com http://www.duodenalswitch.com/> > > > > Direct replies: mailto:melanie@t... > > > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 8, 2001 Report Share Posted July 8, 2001 Dr Stanley Klein in Torrance, Calif does the distal too but only does the RNY....he removes the excess stomach rather than staple it off..... The only thing they can do with the RNY revision to DS is the bowel part....... Judie Re: revision of RnY to DS > > > > Dear M., > > > > The distal RNY is almost never done as an " original " procedure. > > However, patients who fail to loose weight with proximal RNY can be > > converted to distal RNY quite easily. My father-in-law is a case and > > point. Of course the distal RNY patients get all the disadvantages > > of the RNY restrictions AND the DS malabsorption. > > > > I am wondering if it is even possible to revise the RnY to DS. I > > have seen an abstract on modifiying the RnY to BPD (without DS), sot > > this is certainly possible. I would think that preferable to distal > > RNY, but the dumping syndrome is still there. > > > > Hull > > > > > > > >> Their reasoning baffles me as I really think keeping our own > > > stomach and the > > > >> valve is what makes our surgery the best there is..... > > > > > > > I dont understand the reasoning on that either. Why do they > > feel it > > > better > > > > to bypass that section? Wouldn't it be possible to make the > > pouch > > > and use > > > > the valve? That is one of the main reasons I choose the > > DS...that > > > and the > > > > low low chances of late regain...I am ONLY doing this once! > > > > > > Over the years, the studies have shown that order for proximal RNY > > > patients to achieve and maintain a satisfactory percentage of excess > > > weight loss, the stomach pouch must be made very tiny, and it must > > be > > > created out of the stomach tissue that is least stretchable. That > > tissue > > > happens to be located in the upper portion of the stomach, near the > > > esophagus. The tiny non-stretchable pouch helps ensure a permanently > > > high level of food restriction, which is the only way to keep the > > weight > > > off with a proximal bypass. > > > > > > So, the reason that a standard RNY could not include the pyloric > > valve > > > is that in order to retain the esophagus-stomach-pylorus-intestine > > > pathway, it would be impossible to keep the pouch as small as it > > needs > > > to be. The anatomy of a stomach is simply too long between the > > esophagus > > > and the pylorus to allow the surgeon to make a small, nonstretchable > > > pouch. > > > > > > That is also why the DS procedure always comes with a distal > > bypass. Our > > > stomach restriction is not extreme, and our capacity (since we keep > > the > > > stretchy tissue) does increase with time (to a point!). With the > > > more-normal stomach size, DS patients would have a hard time keeping > > > weight off with only a proximal bypass. > > > > > > Hope that made sense! > > > > > > The real question is why any surgeon does a distal RNY, I think! The > > > distal bypass in itself will keep the weight off, so the extreme > > > restriction of the pouch, not to mention the issues of having a > > bypassed > > > duodenum, make this procedure somewhat senseless to me. But then I > > am > > > partial, so you are free to take that statement with as big a grain > > of > > > salt as you like. > > > > > > M. > > > > > > --- > > > in Valrico, FL, age 38 > > > Starting weight 299, now 156 > > > Starting BMI 49.7, now 26.0 > > > Lap DGB/DS by Dr. Rabkin 10-19-99 > > > http://www.duodenalswitch.com http://www.duodenalswitch.com/> > > > > > > Direct replies: mailto:melanie@t... > > > > > > ---------------------------------------------------------------------- > > Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2001 Report Share Posted July 9, 2001 In a message dated 7/8/01 11:16:03 PM Central Daylight Time, jhensel@... writes: << he only thing they can do with the RNY revision to DS is the bowel part....... >> I thought, basically, the bowel part was about the same. Cindy W in MS Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2001 Report Share Posted July 9, 2001 At 8:51 PM -0700 7/8/01, Montgomery wrote: >... > >The RNY cannot be, AFAIK be modified to a DS. , I am not so sure of that. I know of one person in Dr. Elariny's group ( " Fairfax Sharon " ) who was recently revised from an RnY to a DS. But, there could be subtleties that I am missing here. --Steve -- Quote Link to comment Share on other sites More sharing options...
Guest guest Posted July 9, 2001 Report Share Posted July 9, 2001 Re: Re: revision of RnY to DS > In a message dated 7/8/01 11:16:03 PM Central Daylight Time, > jhensel@... writes: > > << he only thing they can do with the RNY revision to DS is the bowel > part....... >> > > > I thought, basically, the bowel part was about the same. > > Cindy W in MS > Not completely......I know there is a diagram out there that shows both of them...but I dont know where to find them right now. I do know that the distal is like the proximal except it extends further down.....or something like that. With the DS we are literally " switched " but not so with the distal of RNY patients. At least that is how it was explained to me by an RNY patient. It may be " close " though. > ---------------------------------------------------------------------- > Quote Link to comment Share on other sites More sharing options...
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