Distal RNY for BMI >50 - do you have this type of RNY?

Hello All,

I am scheduled to have the RNY on 1/20/2009.  I heard that it is up to the surgeon to decide if you get the Proximal (most common) or the Distal RNY.  Has anyone ever woken up from surgery to find they had the Distal RNY? 

Proximal – A proximal RNY patient has less than 150 cm of intestine bypassed.  Most RNY's are proximal.  The Proximal patient still has a mal-absorption of food and sugar, though to a lesser extent than a Distal patient.  The result is still weight loss, though it may be considered that the patient has less of a worry about mal-absorption of nutrition.  

Distal - This refers to the amount of stomach bypassed.  A distal RNY means that over 150 cm of intestine is bypassed - the section that processes sugar.  Thus the distal RNY patient does not process sugar and has a greater mal-absorption of food and nutrients.  The result is a more rapid weight loss, but a need for closer watch of nutritional intake.  An RNY patient may refer to their surgery as a "Distal RNY Fobi" procedure, or a "Distal RNY".  Distal RNY is usually reserved for patients with BMI >50

Wow, Thanks for posting that! I really didn't know what the difference was. I had proximal. Which one are you hoping for?

Distal RNYs are uncommon now. Ask your doctor how much he plans to bypass and after surgery confirm that it was bypassed that far. I was bypassed 150cm, which is what my doctor does for most people. He adjusts pouch size a little based on BMI but he bypasses 120-150cm generally. Personally, I would avoid a distal as malnutrition issues are more prevalent.

Just some correction in terminology from your distal definition -  its referring to the amount of intestine bypassed, not stomach, and sugar is processed higher up in the gut so it absolutely does not affect sugar absorption. If you eat sugar you will absorb the calories from sugar.  What it affects is fat absorption, and thus also the absorption of vitamins that are fat-associated like A,E, and D. Parts of the stomach and intestinal track are  "bypassed" in an RNY. The stomach is made into two parts, the large bottom half and a small pouch made from the top half. The small pouch is connected directly to your intestines. The rest of the stomach is no longer used but is still present. It makes some chemicals that are important for digestion, like intrinsic factor, which allows you to absorb B-12 from your diet.  Where your pouch is attached to the intestine (i.e 150cm farther down your intestine than where it connected to your original stomach) is the bypass - thus you are bypassing 150cm of intestine (and the larger stomach).

The true "distal" is rarely performed anymore, and with good reason.

The length of an RNY roux limb is measured down "from the top" where they connect your roux limb after passing several feet of intestine-- for most people on OH, the standard length is generally not over 150cm. Studies have shown that greater length in anyone under a BMI of 50 has absolutely no positive effect, and it's inconclusive whether a minorly longer bypass is advantageous either.

(I have a longer one-- at over 200 cm, but it is NOT distal, it's a "long-limbed proximal RNY.")

The definition of distal that you have above is commonly referenced but incorrect (especially regarding sugar, which is absolutely false.) A true distal bypass measures up from the other end of the tract, at your common channel, and bypasses several times as much intestine as a standard proximal, thus exponentially increasing the malabsorption. When you couple this with the very small pouch the RNY creates, and the issues with the stoma and pyloric valve, it can be very very difficult for distal RNYers to maintain adequate nutrition.

An increasingly popular approach for the SMO (and the procedure that seems to have mostly replaced the distal RNY) is the Duodenal Switch, which gives you the greater malabsorption, but gives you a more normally functional and larger stomach remnant to work with.
 

A Distal RNY would have been the only way I could possibly lost enough weight. When I was considering a revision from my band, I first thought the distal rny was the best option considering my high bmi of 73.2.  After that, I was guided to find out about the DS. Hands down, it has been the most successful WLS for those with high bmis. Be sure you have done enough research, if you have a high bmi, a distal rny would be much better to even consider getting towards goal.