Proximal RNY to Distal RNY (Xpost)
Hi... I have an appointment with my doc next Friday to discuss (again) the revision of my original RNY to a distal RNY. I got the Lap Band a few years ago, but it didn't do anything but spring a leak. So, now I need to at least replace the port. Not such a big deal. But, I still have 60+ pounds to get off and I don't necessarily feel that fixing the band will solve the problem. I think I need to fix the RNY. But, the reason for my post is that I am getting nervous about the idea of having another surgery.
Has anyone here revised their proximal RNY to a distal? And if so, how did it go? What did your doc say about scar tissue, complications, and common side effects? I am just wondering if I am getting similar info from my doc. I really do trust and like my surgeon. I guess I just want to back it up. I have done a lot of reading on a lot of different sites and believe I have a pretty good idea what to expect. But, a little more first-hand knowledge and experience could never hurt!!!
Thanks in advance for your time!
Many blessings...
Has anyone here revised their proximal RNY to a distal? And if so, how did it go? What did your doc say about scar tissue, complications, and common side effects? I am just wondering if I am getting similar info from my doc. I really do trust and like my surgeon. I guess I just want to back it up. I have done a lot of reading on a lot of different sites and believe I have a pretty good idea what to expect. But, a little more first-hand knowledge and experience could never hurt!!!
Thanks in advance for your time!
Many blessings...
God bless all of our efforts... Davina 
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
I think the surgery is not very complicated unless you have pouch work done.
Do you have an enlarged stoma? Any trouble with ulcers or eating Dense protiens? If the answer is yes I would not revise to distal, I would shoot straight for a reputable ds revision surgeon( not that many) Rabkin, Kershinian, are 2 that I am sure do the full on ds revision.
I had the rny to distal( also called erny) I am loosing very slowly. I didnt do the full revison because I was scared to death. I ended up having wound complications anyways! Just be sure of what you are getting into, keep reading all you can and get the best revision! (ds)
shele
LiFeLoNg hEaLtH iS mY GoAl
RNY 5-11-04 280
Lowest weight 174
Highest re-gain 238
erny 3-23-09 (120 common channel
low post revision 190
Current Weight 204
Height 5'6"
GOAL 154 Normal BMI
Thanks, Shele!
I, too, am getting to be scared to death! That's why I am having second thoughts about the revision part, and think maybe I should just do the repair part (band). I mean, the "E" for effort is a given in both situations... maybe I could make the band over my existing rny work...
I did consider the ds, but my bmi is not high enough for the surgeon here to do it. I still have an appointment scheduled for Jan 20, but if I can get things resolved with Dr. Joyce, I will. Plus, from what I understand for revisions they make you do either 6 or 9 months of psych and nut counseling before they will touch you. It seems like a lot to go through for 60 pounds. Hopefully by then I will have lost it already!
To answer your questions, I believe I do have an enlarged stoma (need to confirm that with the doc), no ulcers, and I can handle dense protein just fine. Problem is, I can handle just about everything just fine! My husband asked if they have a band for my brain yet!!! A lot of it has to do with the basics... I know. But, as far as revise or repair? I don't know!!!
Thanks for your input!!! I really appreciate it...
I, too, am getting to be scared to death! That's why I am having second thoughts about the revision part, and think maybe I should just do the repair part (band). I mean, the "E" for effort is a given in both situations... maybe I could make the band over my existing rny work...
I did consider the ds, but my bmi is not high enough for the surgeon here to do it. I still have an appointment scheduled for Jan 20, but if I can get things resolved with Dr. Joyce, I will. Plus, from what I understand for revisions they make you do either 6 or 9 months of psych and nut counseling before they will touch you. It seems like a lot to go through for 60 pounds. Hopefully by then I will have lost it already!
To answer your questions, I believe I do have an enlarged stoma (need to confirm that with the doc), no ulcers, and I can handle dense protein just fine. Problem is, I can handle just about everything just fine! My husband asked if they have a band for my brain yet!!! A lot of it has to do with the basics... I know. But, as far as revise or repair? I don't know!!!
Thanks for your input!!! I really appreciate it...
God bless all of our efforts... Davina
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
Define "distal". Your doc's name didn't ring a bell with me for doing a true distal.
If he's really planning to do a long limb proximal, it's probably not worth the risk for surgery #3.
How to find out? Ask him how much common channel. If he says he will "bypass xxx........", it's a long limb proximal.
If he's really planning to do a long limb proximal, it's probably not worth the risk for surgery #3.
How to find out? Ask him how much common channel. If he says he will "bypass xxx........", it's a long limb proximal.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
Okay... now my stupidity is really going to show!!! What exactly is the difference between a true distal and a long limb proximal?
I have really backed off of the idea of another revision... I have even revised my question sheet, etc, to bring to my appointment. I have been a posting bandit today! I have read and gotten a lot of feedback, and it all seems to point to the same direction... not worth the risk.
Still curious as to the difference, though...
I have really backed off of the idea of another revision... I have even revised my question sheet, etc, to bring to my appointment. I have been a posting bandit today! I have read and gotten a lot of feedback, and it all seems to point to the same direction... not worth the risk.
Still curious as to the difference, though...
God bless all of our efforts... Davina
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
You can give without loving, but you cannot love without giving.
~ Amy Carmichael ~
Just a sec. I wrote something a million years ago that is a very primitive explanation of the difference. BRB.
***
I'd also revise the vitamins we need today and I don't see much difference in labs between less or malabsorption, over the long haul. I know! Heresy!
***
Let's assume that we all start with 300" of (small) intestine. We don't, but we need to have a figure, so that's it. From the pix you've seen of RNY/gastric bypass, you know there is a left side, right side and tail of the Y. The "junction" of the sides is the determiner if a procedure is proximal or distal.
The original intestine comes out of the old stomach and carries the digestive juices that are manufactured in the old stomach. This piece is called the bileo-pancreatic limb because it carries bile from the gallbladder and pancreatic juice from the pancreas. There is no food here.
This is the LEFT side of the Y. This is the portion that is bypassed.
The alimentary limb connects to the pouch and only carries food, but cannot digest or absorb. This is the RIGHT side of the Y.
The tail of the Y is where both elements mix together and where digestion (if any) and whatever absorption will occur. This is the part that is still in use and is also referred to as the common channel.
If the junction of the Y occurs in near proximity to the stomach, it is said to be proximal. If the junction occurs as a far distance from the stomach, it is said to be distal. That said, neither word describes any actual measurements of anything, so the meaning is in the mind of the person speaking of the procedure. What is proximal to my doctor is considered distal by another.
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.
My doctor measures what is in use, not what is not. So, in my case, I have a 40" common channel, then 60" was used to reach the pouch. The bypassed portion is then ABOUT 200".
Most procedures performed are measured backwards from that. The doctor will bypass 12 to 72", use 60-80" for the right side of the Y, and the common channel will be 100-200".
* 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.
Some will have to supplement potassium or magnesium, but not everyone.
***
I'd also revise the vitamins we need today and I don't see much difference in labs between less or malabsorption, over the long haul. I know! Heresy!
***
Let's assume that we all start with 300" of (small) intestine. We don't, but we need to have a figure, so that's it. From the pix you've seen of RNY/gastric bypass, you know there is a left side, right side and tail of the Y. The "junction" of the sides is the determiner if a procedure is proximal or distal.
The original intestine comes out of the old stomach and carries the digestive juices that are manufactured in the old stomach. This piece is called the bileo-pancreatic limb because it carries bile from the gallbladder and pancreatic juice from the pancreas. There is no food here.
This is the LEFT side of the Y. This is the portion that is bypassed.
The alimentary limb connects to the pouch and only carries food, but cannot digest or absorb. This is the RIGHT side of the Y.
The tail of the Y is where both elements mix together and where digestion (if any) and whatever absorption will occur. This is the part that is still in use and is also referred to as the common channel.
If the junction of the Y occurs in near proximity to the stomach, it is said to be proximal. If the junction occurs as a far distance from the stomach, it is said to be distal. That said, neither word describes any actual measurements of anything, so the meaning is in the mind of the person speaking of the procedure. What is proximal to my doctor is considered distal by another.
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.
My doctor measures what is in use, not what is not. So, in my case, I have a 40" common channel, then 60" was used to reach the pouch. The bypassed portion is then ABOUT 200".
Most procedures performed are measured backwards from that. The doctor will bypass 12 to 72", use 60-80" for the right side of the Y, and the common channel will be 100-200".
* 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.
Some will have to supplement potassium or magnesium, but not everyone.
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
If you kinda squinty up your eyes and look at your basic RNY, as in the letter Y, picture this.
The food goes from the pouch into one "arm" of the Y. The digestive juices/enzymes from the stomach go down the other "arm" of the Y. Where they mingle together is called the common channel, the tail of the Y.
The JUNCTION of that Y is either made in "close proximity" to the stomach (proximal) OR "at a far distance" from the stomach (distal).
The far end of the Y connects to the colon. A true distal measures from the colon BACKward to the junction, thence to the food supply. When you read my op report, you get the common channel and the food supply measures.
A proximal, long limb or otherwise, is measured from the stomach out. When you read this op report, you get the measures of the 2 top limbs, no common channel
The food goes from the pouch into one "arm" of the Y. The digestive juices/enzymes from the stomach go down the other "arm" of the Y. Where they mingle together is called the common channel, the tail of the Y.
The JUNCTION of that Y is either made in "close proximity" to the stomach (proximal) OR "at a far distance" from the stomach (distal).
The far end of the Y connects to the colon. A true distal measures from the colon BACKward to the junction, thence to the food supply. When you read my op report, you get the common channel and the food supply measures.
A proximal, long limb or otherwise, is measured from the stomach out. When you read this op report, you get the measures of the 2 top limbs, no common channel
Michelle
RNY, distal, 10/5/94
P.S. My year + long absence has NOTHING to do with my WLS, or my type of WLS. See my profile.
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