when is 100 cm not 100 cm? [was Re: DS vs RNY ]

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At 6:27 PM +0000 9/13/01, chull1@... wrote:

>Dawn,

>

>This is quite true. In fact the common channel length for a distal

>RNY is required to be 150cm to avoid nutritonal problems. So the

>distal RNY is not quite as malabsorptive as the DS. They tried 50cm

>common channel with the distal RNY, and had terrible results!

>

>Hull

At a recent support group meeting, Dr. Elariny said something of

considerable interest re limb and channel lengths in the way he (and

unnamed others, apparently) do lap surgeries. He measures the common

channel at 100 cm without stretching out the intestine the way that

it could be done with open surgery. This is because the small

grippers that would be needed to stretch out segments of intestine in

lap surgery would probably also injure the intestine. So, the 100 cm

of in situ intestine with lap is longer than the 100 cm of stretched

out intestine for open surgery. This helps me understand, in part,

why my weight loss may not be happening as fast as with some others

(I had a lap DS), although some folks with the sleeve (vertical

gastrectomy alone) are losing faster than I. It also makes me feel

more confident that my malabsorption may not be as severe over the

long haul, though perhaps at the expense of weight maintenance.

That's a tradeoff that I am willing to make for myself, personally

(others will undoubtedly have their own personal choices).

Another interesting sidelight: when he measures the alimentary limb,

nominally at 250 cm, he might lengthen it a bit so that,

anatomically, it will mate up at the duodenal stub without placing

strain on the intestine or the mesentery (blood vessels feeding the

intestines).

--Steve

--

Steve Goldstein, age 61

Lap BPD/DS on May 2, 2001

Dr. Elariny, INOVA Fairfax Hospital, Virginia

Starting (05/02/01) BMI = 51

BMI on 09/12 = 41 (-63 lb.)