Proximal vs. Distal ?!??!?!?

Hi All, Well..I know I'm kind of late in my journey (I just got a date! Sept 12th) but I spent hours today reading this website and I wa**** with a few questions. And it figures: I saw my surgeon 4 days ago and had NO idea about this question so before I call...I'd like feedback ASAP! Thanks! 1) Proximal vs. Distal: what are the differences...and 2) Which type did you "Losers" have done?

I didn't have the RNY done, but the difference between the proximal and distal is the amount of intestines bypassed. Proximal means that less intestines are by passed Distal means that more intestines are bypassed. Scott

Thanks Scott! I should have known about that before...I'm ashamed and mad at myself for not doing better research. Thanks again, Karen

Karen: Most surgeons will ONLY perform a proximal RNY, VERY few do distals (due to significant malabsorbtion and risks associated w/ this, some save for the truly SUPER MORBIDLY OBESE a BMI well over 50)! So you most likely will not have a choice, also insurance companies usually will only pay for a proximal RNY! (no more than 150cm bypassed)..so most people here have probably has a proximal surgery (if they had a RNY)... I will attach a link to help w/ pictures but here is anatomy (I hope I have all my measurements/conversion s correct!) ... http://www.aboutmso.com/pp/pp-gastricbypass.cfm 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 and most people have 21 FEET or 640 cm) 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 absorbtion 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). Depends on surgeon but is ~ 50-75 cm long. 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.....In a proxy this is usually 75-150cm long 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 absorbtion/digestion....(IF TOO SHORT excessive malabsorbtion of nutrients/vitamins etc can happen, diarrhea...possibly requiring reoperation to save life. ****This is HOW distals are measured, by the length of their CC, to be a distal your CC is usually 40-60 INCHES or 100-150 CM)http://www.aboutmso.com/pp/pp-distal.cfm Proximal is usually ~75cm-150cm bypassed (BP limb)...Really doesnt tell u how long your common channel is though (but it is usually WAY over 400cm!) *Note research states over 200cm usually little risk of protein malabsorbtion long-term. http://www.aboutmso.com/pp/pp-proximal.cfm Generally speaking, ALL RNY people will have to supplement at least the basic 8 elements*, though in varying doses. We are all missing the stomach and its normal digestive function. Truly distal (with a lot bypassed, and a short common channel) people need to supplement in larger volume, but will achieve and maintain the better weight loss over time. Proximal (less bypassed, longer common channel) people still need to supplement the basics and can reach a reasonable weight, but after 2 years may have to work a little harder to maintain their goal weight. * the basic 8*** protein iron calcium A D E zinc B12 These need to be supplemented in specific ways to help absorption. We also malabsorb SOME fats/oils and complex carbs. We never, ever malabsorb sugar. (Think cake, cookies, mil**** cream etc) Some will have to supplementw/ Vit K, potassium, selenium, copper, B1, B6, Folate or magnesium, but not everyone. ~~~~~~~ With that said it is a GOOD idea to know what surgery you are having, and get a copy of your surgical record for self IN CASE you should ever need it for revisionary issues down the road! SO many kick themselves it is easy to obtain and is yours just to ask for, write medical records after sign a Release of info and get it after surgery! (*we never know what future will bring and how long our surgeon will be around etc!) More ? or did that help/confuse ya? Let me know! KNOWLEDGE is power, gotta know what tool you have to know how to use it for optimum success! Even a distal can regain weight it is just a tool! Take Care, Jamie Ellis RN MS NPP 100cm Proxy Lap RNY 10/9/02 Dr. Singh Albany, NY 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!"

Hi Jamie, THANKS SO MUCH! What a wealth of knowledge you are, and so willing to share it. I think that getting a copy is an excellent idea, one i did not think of. I'm glad I read your explanation before hearing back from my surgeon (I had emailed him) so I better understand his reply. I had no idea there were differnt ways of doing a RNY...and I thought I had researched it well. Oh well...I'm fired! Thanks again...and you are a true inspiration! -Karen, Long Island NY, Pre-op, RYN

Karen: You're very welcome, share in the knowledge I say! Be well! HUGS Jamie