common channel length

[Guest guest]

Hi All!

I'm still confused about common channel length. Do most surgeons ask what

length you want? Is 100 the " norm " ? I'm now reading about some people who had

revisions and had the common channel cut down to 50. Is my understanding

correct that the shorter the common channel the faster you lose weight because

of greater malabsorption? What is the minimum and maximum length of the common

channel after WLS?

Thanks for clarifying!

Pre-op in MD

[Guest guest]

For the DS 100 seems to be the most common, but mine is 65. My surgeon usually

does 75cm. I think most of the surgeons have their own way of doing things so

you really need to talk to him to see what his norm is and discuss why and what

you're looking for.

AJ

JVaszil@... wrote:

>

>Hi All!

> I'm still confused about common channel length. Do most surgeons ask what

>length you want? Is 100 the " norm " ? I'm now reading about some people who had

>revisions and had the common channel cut down to 50. Is my understanding

>correct that the shorter the common channel the faster you lose weight because

>of greater malabsorption? What is the minimum and maximum length of the common

>channel after WLS?

>

>Thanks for clarifying!

>

>Pre-op in MD

>

>

>----------------------------------------------------------------------

>

[Guest guest]

Hi :

> Do most surgeons ask what length you want?

No.

> Is 100 the " norm " ?

That depends.

I can tell you how my doc, ( Anthone at USC), decides:

First he measures the entire length of your small intestine.

If the total length of your small intestine is less than 500 cm, then

he uses a 75 cm common channel.

If the total length of your small intestine is greater than 600 cm,

then he uses a 100 cm common channel.

If the total length of your small intestine is between 500 cm and 600

cm, he makes his decision based upon how much weight the patient

needs to lose.

Most docs who do the lap DS, on the other hand, don't measure the

length of the small intestine, so they just use the same common

channel length for everybody. Note: Dr. Rabkin in San Francisco is

the exception to this " one size fits all " lap philosophy -- he makes

an extra incision, (about 4 " I think), so that he can measure the

small intestine and tailor the surgery to the patient.

> Is my understanding correct that the shorter

> the common channel the faster you lose weight

> because of greater malabsorption?

Yep.

> What is the minimum and maximum length

> of the common channel after WLS?

I assume you mean after the DS, and not just after WLS in general,

right? (RNY surgeons do all kinds of wacky things that I neither

know nor care much about.)

My understanding is that DS surgeons in the US use a common channel

of 75 to 100 cm, except in extraordinary circumstances.

HTH

Tom

Panniculectomy, Dr. Anthone, 11/10/2000

Open DS, Dr. Anthone, 03/30/2001

Goal: Lose 80% of Excess Weight

*******************************

* Starting Weight = 386 *

* " Ideal " Weight = 142 *

* =========================== *

* Total Excess Weight = 244 *

* 80% x Excess Weight = 201 *

* Goal Weight = 386-201 = 185 *

* =========================== *

* Total Needed to Lose = 201 *

* Loss To Date = 118 *

* =========================== *

* Remainder to Goal = 83 *

*******************************

Weight By Date:

(most recent first)

08/20/2001 . . 268

08/13/2001 . . 270

08/06/2001 . . 272

07/30/2001 . . 275

07/23/2001 . . 276

07/16/2001 . . 278

07/03/2001 . . 286

06/25/2001 . . 293

06/15/2001 . . 299

06/03/2001 . . 301

05/18/2001 . . 316

05/03/2001 . . 328

04/19/2001 . . 338

03/30/2001 . . 360

11/10/2000 . . 386

[Guest guest]

<snip> Most docs who do the lap DS, on the other hand, don't measure

the

> length of the small intestine, so they just use the same common

> channel length for everybody. Note: Dr. Rabkin in San Francisco

is

> the exception to this " one size fits all " lap philosophy -- he

makes

> an extra incision, (about 4 " I think), so that he can measure the

> small intestine and tailor the surgery to the patient. <snip> Tom

Dear Tom,

I had a full Lap BPD/DS (not lap assisted), my lap incisions are

approx. 1/4 " , 1/2 " , 3/4 " plus one totally hidden inside my

bellybutton (plus two drain punctures (two tiny dots). My surgical

report specifically states that my surgeon measured the intestines

using umbilical tape. I have a common channel length of 100 cm and

another patient who had her surgery done two days before me by the

same surgeon has a 80 cm common channel. It is really not fair to

any DS surgeon to make such generalized statements unless you

actually know these facts for sure. It kinda gives folks the

impression that a fully lap surgery is cheating them out in someway.

BTW, I am very happy with my 100 cm. common channel. I am losing an

average of 3.4 lbs. a week, I eat anything and everything and I have

no diarhea or gas. I only have one BM a day after the first several

days. I was working part-time from home 6 days after surgery, full-

time in my office on the 11th day after surgery. My three month labs

were perfect so I must be absorbing enough of the supplements and

protein from food sources that I am taking in.

Jane J.

230/172 (-58 lbs.)

Lap BPD/DS

April 26, 2001

Dr. Ren

NYU Medical Center, NYC

[Guest guest]

>

> I had a full Lap BPD/DS (not lap assisted),

...

> My surgical report specifically states that

> my surgeon measured the intestines using

> umbilical tape.

According to the paper published by Dr. Ren, Dr. , and Dr.

Gagner, you're partly correct. That is, they do measure the first

250 cm of the ileum before dividing it, and they do vary the length

of the common channel between 75 and 100 cm. (I guess, although they

do not say so, that they decide on the length of the common channel

based on how much weight the patient has to lose?) So, I was wrong

in regard to the common channel lengths.

But, according to their article, they do NOT measure the entire

length of the small intestine, and they set the length of each and

every alimentary limb at the same 250 cm, regardless of how long or

short the individual patient's total small intestine may be.

> It is really not fair to any DS surgeon to

> make such generalized statements unless you

> actually know these facts for sure. It kinda

> gives folks the impression that a fully lap

> surgery is cheating them out in someway.

With the exception of my one factual error regarding the length of

the common channel, " the impression that a fully lap surgery is

cheating " patients in some way, (as you call it), is created, if at

all, by Dr. Ren, Dr. , and Dr. Gagner.

Personally, I wouldn't call it " cheating. " Like most decisions in

life, we make tradeoffs between what we want most and what we don't

care as much about. In the case of patients who place high priority

on having the procedure done by full lap, the tradeoff comes in the

form of a one-size-fits-all alimentary limb, and a common channel

that is not tailored to the length of the patient's small intestine.

I hope this clears things up.

Tom

[Guest guest]

At the last monthly pre/post-op meeting, Delphine was

presenting data on the first 100 Lap DS patients. I guess you

were in there, !

Anyhow, one of the measurements she presented was the

duration of the surgery. Originally, Rabkin was doing

lap-assisted and then switched to hand-assisted, where the

intestines were pulled out and measured by hand through the

small incision above the belly-button. I don't remember the

actual details, but the earlier surgeries were around 5+ hours!

Now, with hand-assist and more experience, their average is

around 3 hrs. Delphine pointed out that the hand-assist allowed

for a quicker measurement, which makes sense. I'm sure that

was the not ONLY reason for the hand-assist, but it was one of

the ones she pointed out.

FYI...it looks like they've updated some info on Rabkin's site:

http://www.pacificsurgery.com/Obesity_Surgery/Our_Results/our

_results.html