Re: alimentary limb - please answer

[Guest guest]

In a message dated 7/17/01 6:35:15 PM, duodenalswitch writes:

<< I'm not sure about the rest of them,

but I'm pretty sure that the New York docs led by Dr. Gagner use a

250 cm standard common channel. This is exactly the same length as

your common channel. >>

Tom: Yes, I think that is correct. I was told by Dr. Quinn (who

co-performed the surgery with Dr. Gagner) that my alimentary was 250 cm, 100

of that being the common channel. So, the common channel itself isn't 250 cm

-- that's the total length of the alimentary limb. THe common channel is the

last 100 cm of that.

Just to let people know -- we aren't walking around with 250 cm common

channels! It is also true that Dr. Gagner and others at Mt. Sinai do not

measure the limbs when they perform a lap DS. I know that other surgeons may

and also may adjust the common channel more based on the individual anatomy

of a patient. At Mt. Sinai, the 100 cm common channel is pretty standard (as

is a 250 cm alimentary limb) and the surgeons think this is the safest, best

proportion for the 'majority of people'. They haven't had many who required

a revision either way.

I've known some patients who DID have shorter common channels (by request,

consideration of starting bmi, etc.) but, for the most part, the measurements

you listed are usually employed.

Also, the absorption of nutrients does not take place until the food reaches

the common channel because the bile/pancreatic juices travel along the other

limb. This separation prevents food from being absorbed. Well, this is true

with the exception of simple sugars, I think. Those CAN be absorbed all

along the alimentary limb, I think.

all the best,

lap ds with gallbladder removal

January 25, 2001

five months post-op and still feelin' fabu!

[Guest guest]

In a message dated 7/17/01 6:35:15 PM, duodenalswitch writes:

<< I'm not sure about the rest of them,

but I'm pretty sure that the New York docs led by Dr. Gagner use a

250 cm standard common channel. This is exactly the same length as

your common channel. >>

Tom: Yes, I think that is correct. I was told by Dr. Quinn (who

co-performed the surgery with Dr. Gagner) that my alimentary was 250 cm, 100

of that being the common channel. So, the common channel itself isn't 250 cm

-- that's the total length of the alimentary limb. THe common channel is the

last 100 cm of that.

Just to let people know -- we aren't walking around with 250 cm common

channels! It is also true that Dr. Gagner and others at Mt. Sinai do not

measure the limbs when they perform a lap DS. I know that other surgeons may

and also may adjust the common channel more based on the individual anatomy

of a patient. At Mt. Sinai, the 100 cm common channel is pretty standard (as

is a 250 cm alimentary limb) and the surgeons think this is the safest, best

proportion for the 'majority of people'. They haven't had many who required

a revision either way.

I've known some patients who DID have shorter common channels (by request,

consideration of starting bmi, etc.) but, for the most part, the measurements

you listed are usually employed.

Also, the absorption of nutrients does not take place until the food reaches

the common channel because the bile/pancreatic juices travel along the other

limb. This separation prevents food from being absorbed. Well, this is true

with the exception of simple sugars, I think. Those CAN be absorbed all

along the alimentary limb, I think.

all the best,

lap ds with gallbladder removal

January 25, 2001

five months post-op and still feelin' fabu!

[Guest guest]

,

Just a small correction. Water soluble nutrients, complex

carbohydrates, as protien, and simple carbs are all partialy absorbed

in the full length of the alimentary limb. Only fat soluble vitamans

and fat have their absorption restricted to the common limb. This is

the key to the BPD procedure. Otherwise it would be just like the old

JIB (Intestinal bypass) which lead to terrible malnutrition problems.

Hull

> Also, the absorption of nutrients does not take place until the

food reaches

> the common channel because the bile/pancreatic juices travel along

the other

> limb. This separation prevents food from being absorbed. Well,

this is true

> with the exception of simple sugars, I think. Those CAN be

absorbed all

> along the alimentary limb, I think.

>

> all the best,

>

> lap ds with gallbladder removal

> January 25, 2001

>

[Guest guest]

Just a small correction. Water soluble nutrients, complex

carbohydrates, as protien, and simple carbs are all partialy absorbed

in the full length of the alimentary limb. Only fat soluble vitamans

and fat have their absorption restricted to the common limb. This is

the key to the BPD procedure. Otherwise it would be just like the old

JIB (Intestinal bypass) which lead to terrible malnutrition problems.>>>>>

Thanks, for the clarification. I knew that carbs and protein were

partially absorbed (though at a higher rate than fats), but I thought this

mainly occured in the common channel, not the alimentary limb since

bile/pancreatic juices were required for absorption... and, since they are

not present in the alimentary limb, they would 'mix' in the common channel.

I knew that simple sugars COULD be absorbed regardless of whether there are

enzymes to process them in the alimentary limb.

So, the biliary limb and separation of enzymes to process and absorb really

only hinders the absorption of fats/fat soluable vitamins. The protein,

carbs, sugars, etc. can still be processed/absorbed without the aid of the

enzymes?

All the best,

TEresa

lap ds with gallbladder removal

January 25, 2001

five months post-op and still feelin' fabu!

pre-op: 307 lbs/bmi 45 (5' 9 1/2 " )

now: 235 (goin' down, man! )

[Guest guest]

Hull thanks for all the great explanations.