hi again
the post op report also says the distal end of the small bowel was then brought through the transverse mesocolon to lie anterior to the distal stomach and adjacent to the promixal pouch.

So, this would be the far end of the CUT PIECE?

unfortunately distal can also mean "the further one".

The distal end of my house is much warmer than the proximal end where I am sitting and freezing my booty off.

Here is a copy & paste of this link:
http://www.lapsf.com/weight-loss-surgeries.html


Pictures always help me!!!
Hope that helps!!!!
-Jamie

Surgery Comparison Chart

Modality of Weight Loss	Restrictive and Malabsorptive (stomach and intestines)		Restrictive(stomach only)
Type of Operation	Roux-en-Y Gastric Bypass (RNY, RGB)	Vertical Gastrectomy with Duodenal Switch(DS)	Vertical Gastrectomy (VG)	Lap-Band®(LAGB)
Anatomy	Small 1 ounce pouch (20-30cc) connected to the small intestine.Food and digestive juices are separated for 3-5 feet.	Long vertical pouch measuring about 4-5 oz (120-150cc). The duodenum (first portion of the small intestine) is connected to the last 6 feet of small intestine.Food and digestive juices are separated for more than 12 feet.	Long narrow vertical pouch measuring 2-3 oz (60-100cc). Identical to the duodenal switch pouch but smaller. No intestinal bypass performed.	An adjustable silicone ring (band) is placed around the top part of the stomach creating a small 1-2 ounce (15-30cc) pouch.
Mechanism	Significantly restricts the volume of food that can be consumed. Mild malabsorption "Dumping Syndrome" when sugar or fats are eaten	Moderately Restricts the volume of food that can be consumed. Moderate malabsorption of fat causing diarrhea and bloating	Significantly restricts the volume of food that can be consumed. NO malabsorption NO dumping	Moderately restricts the volume and type of foods able to be eaten. Only procedure that is adjustable Delays emptying of pouch Creates sensation of fullness
Weight Loss United States Average statistical loss at 10 years	70% loss of excess weight More failures (loss of <50% excess weight) than the DS	80% loss of excess weight More patients lose too much weight or develop nutritional problems than the RNY	60%-70% excess weight loss at 2 years Long term results not available at this time.	60% excess weight loss. Requires the most effort of all procedures to be successful.
Long Term Dietary Modification (Excessive carbohydrate/high calorie intake will defeat all procedures)	Patients must consume less than 800 calories per day in the first 12-18 months; 1000-1200 thereafter?3 small high protein meals per day Must avoid sugar and fats to prevent "Dumping Syndrome" Vitamin deficiency/protein deficiency usually preventable with supplements	Must consume less than 1000 calories per day in the first 12-24 months, 1200-1500 thereafter Consumption of fatty foods causes diarrhea and malodorous gas/stool Failure to adhere to vitamin supplement regimen and consumption of high protein meals more likely to result in deficiency than RNY	Must consume less than 600-800 calories per day for the first 24 months, 1000-1200 thereafter No dumping, no diarrhea Weight regain may be more likely than in other procedures if dietary modifications not adopted for life	Must consume less than 800 calories per day for 18-36 months, 1000-1200 thereafter. Certain foods can get "stuck" if eaten (rice, bread, dense meats, nuts, popcorn) causing pain and vomiting. No drinking with meals
Nutritional Supplements Needed (Lifetime)	Multivitamin Vitamin B12 Calcium Iron (menstruating women)	Multivitamin ADEK vitamins Calcium Iron (menstruating women)	Multivitamin Calcium	Multivitamin Calcium
Potential Problems	Dumping syndrome Stricture Ulcers Bowel obstruction Anemia Vitamin/mineral deficiencies (Iron, Vitamin B12, folate) Leak	Nausea and vomiting Heartburn Severe diarrhea Kidney stones Stricture Ulcers (less than RNY) Bowel obstruction Nutritional/Vitamin deficiencies (Vitamin A,D,E,K)?Loss of too much weight requiring reoperation Leak	Nausea and vomiting Heartburn Inadequate weight loss Weight regain Additional procedure may be needed to obtain adequate weight loss Leak	Slow weight loss Slippage Erosion Infection Port problems Device malfunction
Hospital Stay	2-3 days	3-4 days	1-2 days	Overnight (<1 day)
Time off Work	2-3 weeks	2-3 weeks	1-2 weeks	1 week
Operating Time	2 hours	3 hours	1.5 hours	1 hour
Our Recommendation	Most effective for patients with a BMI of 35-55 kg/m2 and those with a "sweet-tooth". Virtually all insurance companies will authorize this procedure.	Best for patients with a BMI of > 50 kg/m2. Those with BMI of <45 kg/m2 may lose too much weight. Higher overall incidence of complications than other procedures. Most insurance companies will NOT authorize this procedure.	Utilized for high risk or very heavy (BMI > 60 kg/m2) patients as a "first-stage" procedure. Very low complication rate due to quicker OR time and no intestinal bypass performed. Insurance companies will authorize this procedure in select patients.	Best for patients who enjoy participating in an exercise program and are more disciplined in following dietary restrictions. Many insurance companies will NOT authorize this procedure.

Thanks so much, Michelle!!!  That is an awesome explanation...    I appreciate your time!!!

Many blessings...

 Hi Davina,

I had a revision to an ERNY from a 2001 proximal RNY.  My doc removed quite a bit of scar tissue, fixed a couple of bowel obstructions and cleaned up some adhesions.  He left me with a Common Channel of 75 cm.   I chose the ERNY over the DS because I was not comfortable with the elevated risk that the take down of the pouch  and convert to the DS stomach had.  I also only had about 60 lbs to loose. 

As far as the surgery went, I have had no complications to speak of.  It was actually one of the easiest recovery times I had from any of the 6 abdominal surgeries I have had.  It was performed open.   I had my revision in Oct. 2008 and am at my personal goal weight of 125.  I reached my goal about ~4 yo 5 months ago.  For me the decision for the ERNY has been a good one.

The points I do struggle with is the elevated amount of vitamins I have to take and keeping my protein levels up.  This is mandatory and not an option so you need to keep this in mind whether you go for a more distal or a DS.  Like the other posters, I would not recommend any common channel length under the 100 cm point.

Good luck to you.  Let us know how your journey progresses!

Hi, mew6495!

I am so glad you wrote...  I was wondering about the scar tissue.  It's good to know they can clean that up!  Isn't that funny that you had the same amount to lose...  and, congratulations to you!!! 

I did a lot of posting yesterday because I started to get scared about the procedure.  A lot of responses that I got swayed me to back off the idea...  but, this morning I woke up and my head was right back where it started... distal revision.

I am happy to know yours went smoothly, and especially since you have had 6 surgeries already!!!  I have had RNY, 2 hernia repairs, Lap Band, and a spinal fusion that they entered through my lower belly, too.  WoW!!!  That's 5 for me!!!  Never really thought about that...  I just knew there is scar tissue to contend with...  but, you are good so that means a lot!!!

I decided against the DS for the very same reason.  Plus, the surgeon in my area requires a BMI over 50, which mine is not. Besides, my surgeon said that this revision would pretty much have the same results without all of the extra risk.

Thanks, again, for your reply!!!  I am very happy that you are doing well...  it's just so funny that we both have such similar cir****tances!!!  I'd love to follow your posts... so, if you'd like please add me as a friend!!! 

Many blessings...

 Hello,
The nutritional requirements for distal RNY, long limb RNY or ERNY are more stringent than those of the DS patients. The length of the bowel for the common channel does play a role on the short end. The shorter the common channel the better the weight loss, the worst the diarrhea and the nutritional deficiencies (vitamin, minerals and protein) The longer the common channel the worst the weight loss, the less diarrhea, and the less incidence and severe the nutritional deficiencies. 
I do not recommend any distal bypass because of its significant nutritional deficiencies that it has. 
I was laso asked about the Distal RNY and DS. from another post. After reading the post I got so confused   that I had to sit down and write about it.  
The link is attached:

http://www.dssurgery.com/newsletters/dec-5-09.pdf

Hope this helps
Ara

Thank You, Thank You, Thank You for this awsome and informative information!!!!!!! 
-Jamie