Common Channel length for the DS?
As I explained to my urologist regarding kidney stones, there's a big difference between people who live it, and doctors *****ad and write about it in a book. The study you referenced does not appear to take into account the size of the associated vsg, or any longer term effects from the different cc length sample groups. It looks very simplistic with a preplanned result.
I'm not giving advice as a doctor, but as someone who lives what I'm talking about, the shorter length would likely have offered a worse outcome for me.
I believe mine was 75 and what is referred to as a proximal RNY .
Eight years and some depression and Covid confinement and two miscarriages later I'm still healthy.... and I didn't always take my vitamins or stop drinking ... or even eat sometimes.
weight wise I wasn't perfectly happy with the results in the beginning ( although I looked really good ) .... but I was scared I'd regain.
As the years have gone by excess weight is less of a concern vs health . I'm not fat in any way mind you nor emaciated .... just skinny/ normal figured . I have noticed a tendency to not regain more recently... I can tolerate a snack food occasionally without blowing up .
Proximal RNY? What does that mean? I don't really know much about the RNY, I was asking about the DS. For me, being that I am 24, keeping as much weight off after the surgery as possible is a priority for me. So I don't want a longer common channel then I'm struggling with regain down the line. I'm glad you were able to find some success though, and yeah, health is important.
The proximal RNY is the standard gastric bypass that most people here (at least in the US) have, where everything is performed on the upper, or proximal, part of the intestine. The 75 cm referenced may be either the biliopancreatic limb, from the remnant stomach to the anastomosis, or the roux limb from the stomach pouch to the anastomosis, with the remainder of the 20-30 feet of small intestine being the "common channel" in DS vernacular. These upper limbs can be varied by surgeons' preference, usually between 50 and 150cm. The distal RNY is more comparable to the BPD/DS in that the surgeon will measure from the lower end of the small intestine (the "distal" end) where it joins the large intestine, typically leaving a DS like 100-150cm of common channel, with the remaining 20-30 feet of intestine above being split between the two upper limbs. The distal is rarely done in the US (from what I have seen, most insurance doesn't approve it as a primary WLS) and is mostly used as a revision from an earlier proximal RNY, or another WLS where the BPD/DS isn't appropriate or the surgeon doesn't know how to perform it.
In short, (so to speak..) comparing limb lengths of the DS and proximal RNY is an exercise in futility as they are quite different procedures that work in different ways. Likewise, the SIPS/SADI/"Loop DS" is a very different procedure from the BPD/DS, so limb and common channel lengths don't directly compare. You say that you have seen some with long CC who have done poorly - do they have the BPD/DS or the SIPS/Loop DS which typically has a longer CC. As the SIPS is a newer procedure that is not as standardized as much as the BPD/DS or RNY is, there is going to be more variation in patients' results with that, as surgeons are doing them with greater variations as they figure out what really works with that configuration. I certainly wouldn't let someone's poor results with a long CC SIPS influence my view of CC length in a BPD/DS. Make sure that you are comparing apples to apples.
Reiterating what I indicated above, I would talk to several BPD/DS surgeons and get their take on the issue. I understand your concern about long term weight maintenance and regain resistance, which is the strong suit of the BPD/DS. There are several here on this board who are around 20 years out and maintaining well, likewise, my wife and I have dinner with a largely DS support group, most of whom are in the 20 year range as well, and maintaining as relatively normal people - sometimes one gains a little and has to cut back for a while to bring it back in line - like a "normal" person. Which is basically what we are looking for in our WLS.
I can see and argument that because you are on the young side, that you may not need a particularly short CC to maintain effectively, as your metabolism may not be as damaged as a similar person who started this process when older. This is something to discuss with the surgeons and draw from their experience, as they are the ones who have done hundreds or thousands of DSs and have a lot of insight into what works best for what kind of patient. As the DS is still a fairly niche procedure, most DS surgeons are quite used to dealing with patients who travel to see them, and are used to doing remote consults, at least the initial ones, so it can be well worth it to consult with several of them and get some consensus on this.
Good luck, there's lots to absorb here,
1st support group/seminar - 8/03 (has it been that long?)
Wife's DS - 5/05 w Dr. Robert Rabkin VSG on 5/9/11 by Dr. John Rabkin
The article referenced was highly inaccurate. In a nutshell, the DS is about 13 years old and there are studies that prove comparable weight loss to the Hess DS.
I had the Sadi DS done 7 years ago and lost more than 100% of the excess weight (152lbs). It stays off no matter what I eat, and I have far fewer needs than a Hess DS would require.
It's also not true that an extremely short common channel is better. It substantially increases malnutrition issues and usually doesn't result in more weight loss.
