Common channel length and DS success

There's a new report in the May 05 issue of the American Journal of Surgery from McConnell et al in Oregon. They point out that the optimal common channel length is still unknown. They looked at 119 patients with DS and 5 with BPD who were followed for at least a year. They had three groups of patients. Those with 150 cm CC had an average weight loss of 45 kg (about 87 lbs) Those with 100 cm CC had an average loss of 55.8 kg. (about 123 lb) Those with 80-90 cm CC had an average loss of 61.5 kg. (about 135 lb) Only 40% of those with the longest CCs lost at least 50% of their excess body weight, compared to 63% of those with CCs between 80-100 cm. The authors conclude: "In general, the length of the CC should not exceed 100 cm." The study didn't look at the other variable in optimal CC length: nutritional status over time. My question: did the patients who were in the study have a say about which CC length they got? Are other surgeons doing studies like this without telling patients they are part of a study?

Thanks, Nancy. As someone planning on DS soon, that is very good information to have. And as someone who has both run research studies and participated in them, I know that patients/participants in an experimental type study must give explicit consent or the study would never even make it past the review board. Manipulating someone's surgery for research purposes without consent would be so far outside of ethical boundaries I hate to even imagine it! Much more likely, the authors used data that was already available and just did a simple data analysis to come to these conclusions. It's probably even stated somewhere in the methodology portion of the paper. As you mentioned, this only took one variable into account and others could be involved that have yet to be studied. Annie

Does anyone have this full article I would love to read it I am having my surgery next month by Dr. Deveney and at my next appt I would love to talk to him about my CC length as I want to lose 150 lbs.

Hi There Anne, I just wanted to say that you have a really terriffic name! Sounds really familiar to me!! LOL Anne

When talking about common channel length, one also has to consider total small bowel length. For optimal success, the common channel should be measured according to the total small bowel legnth. The average small bowel is 600cm long. That is why the majority of Hess's patients have 75cm common channels. However, there are patients, like me, with small bowels as short as 375cm. My common channel is also 75cm and I stopped loosing weight after 2 months. The common channel is not the only factor. How it is calculated is a big part of the equation. Another part of the equation is limb lengths. My limbs are 50/50%. Hess uses 40/60%. With the Alimentary (food) limb 40% of the small bowel length and the Bileopancreatic limb 60% of the small bowel length. The shorter Alimentary limb means less carbohydrate absorption. The only study I've found that takes all of these factors into consideration is Hess's. Dr. Crystal Schlosser here in MN is usind a modified "Hess" method. She is making the common channel 10% of the small bowel length (minnimum of 50cm) and the limbs 40/60%. So far all of her DS patients are doing great! Tammy

Tammy, You said you stopped losing after 2 months, did you stop completely or slow down drastically? I'm curious how you are doing now and did they do anything to change your rate of loss? Terri

I made a mistake in my previous post. It was at 3 months that my weight loss pretty much stopped. At 3 months I was loosing .5 pounds per month. At 2 months I lost 7 pounds. My first month I lost 15.5 pounds. After 3 months post-op, I wasn't loosing weight but I didn't gain either. At 8 months post-op I decided to start dieting. Since then I have stayed with an extremely low carb diet (less than 10 grams per day) and I'm loosing about 10-12 pounds per month. I'm currently down 124 pounds and only 21 pounds from my goal weight. I have fears about regain but my new DS surgeon has already agreed to shorten my common chanel if I start to regain weight after I reach my goal weight. I have switched my follow-up care to another DS surgeon and that surgeon has reviewed my surgical report and believes that my surgery should have been done differently. If my DS would have been done differently my weight loss wouldn't have stopped when it did. It was not a matter of compliance. It was a matter of anatomy and physiology. This surgery must be individualized to have optimal success. My advice to pre-ops is: beware of DS surgeons who use a "cookie cutter" approach. Tammy

Wow Tammy, you are the first person I have come across who had a shorter small bowel length than me. Mine was 400cm, so my surgeon (using the Hess method) gave me a 40cm common channel, which was 10% of the total length and divided the remaining bowel to form the alimentary limb (40% of total) and the biliopancreatic limb (50% of the total). If I had been given a cc of 100 or 150 cm, I think that I would have had very limited weight loss. Even with my exceptionally short common channel, I am not losing weight at an extraordinary rate, I would say my loss is rather average -77pounds in 4 months. Anne

Thanks, Nancy for the info. I just emailed by surgeon's NP and program coordinator to ask how long he will make my common channel. Robindaringtobelieveadifferentkindoflifeispossible

Hi Nancy, Thanks for the info....but here's a question: What were these patients beginning BMI?? Mine is just at 40 and my surgeon will make mine 125cm's he said because I'll lose TOO much if it's any shorter, due to my bmi being *just* 40?? Did the study matter what the BMI? Just interested. Thanks again for the GREAT info!! Hugs, Marcie