IS IT A BAD IDEA TO HAVE A DISTAL RNY AS YOUR FIRST SURGERY?????

HELLO,

I am having my Rny surgery on 7/8 and i was informed it is distal 150cm what does this mean .. i am confused i have been reading and i am understanding there is less weight loss. My Doctors assistant advised me i would loose more ?? I am confused someone please educate me that knows the correct answer... I want to know if this is the case to let him know not to do a distal he recommended it because of the fact that i told him my bowels are sometimes hard for me?? Please if anyone can answer??

Distal RNY used to mean the surgeon bypassed all but the last 150 to 100cm of intestine. DSrs would call that a 100cm common channel. I'm not sure what the RNY folks would call it. I hope you can ask more questions of the surgeon and staff. You need all the info in a way you can understand.  Keep us posted. 

--gina

With distal RNY you get similar nutritional challenges as DS but with the eating limitations of a pouch...which means that while your body needs extra fat - that you also may encounter dumping syndrome if you consume fat.  Its a crap shoot, but could pose problems

What do you mean by "less weight loss"? Less weight loss than what?

Very few people have distal RNY as their first bariatric operation. Almost all RNY surgeons will only do proximal RNY. Some people who fail with this operation (the failure rate is substantial) will be revised to distal RNY, but studies have not shown that this gives then significantly more weight loss than they already had. In other words, distal RNY isn't much more effective than proximal RNY.

Now, there is also confusion with ERNY, which stands for extended. In this operation, the common channel is even shorter, and that's what Val is talking about in her answer to you. Many of us consider this to be the worst of both worlds, because you have a lot of malabsorption but nothing to regulate what your stomach does because you aren't using your pyloric valve. Nutritional deficiencies are a real risk, along with all the usual risks of RNY, such as dumping, reactive hypoglycemia, not being able to take NSAIDs for the rest of your life, etc.

It sounds to me like you are still confused about what operation is being planned for you and why, and what ALL your options are. My advice to you would be to research, and that doesn't mean just going to a seminar and hearing what one practice chooses to tell you. They are not going to discuss options they don't perform themselves, like for example the DS. The DS has the best statistics of any bariatric surgery for percentage excess weight loss, for MAINTAINING that weight loss, and for resolution of almost all comorbidities. It maintains use of the pyloric valve, dumping is rare, and you can take NSAIDs. It does require a commitment to taking certain vitamins and minerals and eating plenty of protein for life, but these are relatively easy commitments (my opinion) compared to the very limited diet you would need to stick with for life with RNY.

I realize that your date is fast approaching, but would still strongly advise you to know what you are getting into, what will be required of you for lasting success, and what all your options are before proceeding. If that means a delay in surgery, so be it. Revisions of RNY are very difficult, and once you have it, you will most likely be stuck with it for the rest of your life.

Larra

There is a difference. My RNY was "bypassed" 150cm, which means the intestine carrying the food meets with the intestine carrying the digestive enzymes 150cm from the stomach.    I was planning to have a Distal bypass revision, which means that the connection where the intestine with the food and the intestine with the digestive enzymes meet (called the common channel) and are 150 cm from the large intestine. I'm now looking at the DS as a revision.

First time RNY is called a proximal and the bypass lengths vary between 75 cm and 150cm.  (150 cm is more distal than 75 cm)  Most insurance companies will only pay for 150 cm max.  Most Distal RNY are done as a revision. Over 10 years ago, it was done as first time surgery, but not now.  We have anywhere between 300 and 600cm of small intestine. Over time our intestines adapt and grow villi that will absorb food/calories. It starts day 1 after surgery, but it can take 18-24 months to mature. 

I was told by my surgeon when I had my surgery that having 150cm bypass should help my chronic constipation.  It did not, it got worse with the extra protein and vitamin supplementation. I have to rely on Miralax and Colace daily.

You will need to clarify with your surgeon "if he is going to bypass you 150 cm" or "give you a common channel of 150 cm".