distal or proximal

I am comparing my insurance company policy with what my doctor says that he does.. I am trying to make sure it is the same thing. The policy says they will pay for "gastric restrictive procedure, with gastric bypass; with short limb( less than 100 cm) Roux-en-Y gastrojejunostomy (open or lap approach) is this distal or proximal??? thanks Jenny

Proximal. Proximal is where less than 150 cm of intestines are by-passed and Distal is greater than 150 cm of intestines by-passed. From what I was told, many insurers will not cover a distal unless a persons BMI is greater than 50. I hope that helps. Good luck! -Karen

Jenny: MOST surgeries today (roux-en-y's) are Proximal (amount bypassed); reasons that is what most surgeons prefer, perform, & it is what most insurances approve. MOST surgeons will not do a distal RNY due to the risks outweighing the benefits (nutritionally speaking and w/ deficiencies), if done it is USUALLY reserved for the SUPER MORBIDLY Obes w/ BMIS over 50.... (Some call a 200cm bypass a distal but it is not a true distal, rather a long limb proxy or medial bypass and sadly the literature points that the extra 50-100cm bypass in longterm makes no differenece in wt loss!) Most proximals are 75-150cm... read on for more info (distals are measured in common channel what is left not in amount bypassed, and usually have ~ 100cm LEFT of the usual 630cm of small intestines, meaning a 400cm bypass at least!!!)...... ~~~~~~~~~ LIMBS DEFINED In a RNY gastric bypass there are 3 different 'limbs' they discuss. These 3 limbs meet at a central point (hence the Y in RNY) FIRST: The small intestines in a normie are: stomach attached to duodenum, which turns into the jejunum then the ileum. (The duodenum/jejunum/illeum are the small intestines) The first limb they call the ROUX or ALIMENTARY/ENTERIC Limb. This is the part of the small intestine that comes off of the pouch. (it starts from the pouch/stoma and then gets hooked into the small intestines later on forming the Y connection (with the biliopancreatic limb) It was part of the middle small intestines (jejunum) that was cut and brought up to pouch. This limb is for transport & very little absorption of food happens here (no gastric juices/enzymes/pancreatic juices/bile etc to mix with it)***NOTE IT CAN potentially absorb LARGE quantities of basic nutrients such as amino acids and glucose without any digestive juices as Saliva alone can digest some of this. This limb is also meant to prevent reflux of digestive juices into the pouch. (*If too short reflux and complications can happen). Most PROXIMALS are 75-100cm; some do a long limb proxy 150-200cm but per literature there is no statistical differene in wt loss w a longer limb (unless it ids more like 400cm bypass in that casse is a distal gastric bypass) because we have 630cm +/- of small intestines most have roux limb 100cm and BP limb 100cm leaving a common channel of well over 400cm, a distal (radical) bypass form Super Morbid Obese have a common channel of 100cm! BIG DIFFERENCE! The BILIOPANCREATIC (BP) limb is the duodenum and part of jejunum that is attached to the distal stomach (part of the stomach that is bypassed, never to see food again, but stays in person producing gastric juices) The BP limb's function is to transport ~1.5 Liters a day of bile/gastric/pancreatic juices to the "Y" CONNECTION (where the ROUX limb carrying food meets this BP LIMB) it is at this Y connection that digestion/absorption of food/vits/minerals happens in the altered RNY patient..... The third LIMB is called the COMMON CHANNEL, this is the last part of the small intestines after the Y connection until the large intestines...It is the length of small intestines you have for absorption/digestion....(IF TOO SHORT excessive malabsorption of nutrients/vitamins etc can happen, diarrhea...possibly requiring re-operation to save life. Proximal is usually 75cm-150cm bypassed (BP limb)...Really doesn't tell u how long your common channel is though. REFERENCE: Deital in UPDATE: SURGERY FOR THE MORBIDLY OBESE PATIENT JUNE 2000 http://www.obesitysurgery.com/book.html Take Care, Jamie Lap RNY 10/9/02 Dr. Singh 320/163 5'9'' (lost 45# before surgery) Plastics 6/9/04 & 11/11/2005 Dr. King http://www.obesityhelp.com/morbidobesity/members/profile.php?N=c1132518510 "Being happy doesn't mean everything's perfect, it just means you've decided to see beyond the imperfections!"