As always when I start to get stressed, I've started hyper-researching and wanting as much information as humanly possible before my surgery in a couple weeks. As a result, I called my surgeon's office last week to ask 1) if he completely severs the pouch or leaves it attached (I don't want the possibility of a gastro-gastric fistula), and 2) if he performs a proximal or distal RNY. His fellow called me back today and said he does separate the pouch, but she wasn't sure what I meant by proximal vs. distal. She said she assumes it's distal because the point of the RNY is in part the malabsorption, but she also said they bypass about 150cm of intestine, so I'm not sure if she knew what I was asking (which I guess could be possible if distals are rarely performed these days). I looked up some academic articles my surgeon has published, and regarding the RNY in general, he states:

By dividing the proximal stomach, a 30 cm ³ stomach pouch is created. A Roux limb is then created 40 cm (variable) beyond the ligament of Treitz and anastomosed to the gastric pouch. The proximal jejunal limb (biliopancreatic limb) is then anastomosed to the Roux limb 100 to 150 cm distal to the gastrojejunostomy.

To those with knowledge about these things, does that seem more characteristic of a proximal or distal bypass? I won't change my mind at this point, but I'd like to know ahead of time how my vitamin and mineral absorption may be affected down the line. Thanks for any insight!

First...reading the an academic article by the surgeon isnt going to tell you what he has selected for you.

Proximal means that they will connect up higher in the GI tract (i.e. you will absorb more). Distal means they reconnect further down (i.e you will absorb less)..this would be similar to DS.

Tell the fellow you want the surgeon to message you or tell the fellow which it is.  The fellow is going to be IN the surgery (and maybe even getting to do the stitches or cutting under the tutlege/observation of the surgeon (this is HOW they learn)) but the fellow at this point isnt "the brains" behind the operation. The fellow doesnt have the experience to know one way or the other.

Skinny

Who once ended up in the ER with a disclocated shoulder and got a fellow that could not read and understand an X-ray.  I screamed/yelled a lot that "that guy DOESNT GET TO TOUCH ME!!!"

Thanks, unfortunately my surgeon is on vacation and I'm his first surgery when he gets back, but I will be sure to ask that morning on my way to the OR, lol.

When a distal rny is measured, it starts from end of small intestine towards the pouch.  The term common channel is used, which is how much sm bowel there is that has the mixture of food and digestive enzymes before emptying into the large intestine. This will leave you with some permanent malabsorption. Most common channels are 100-200cm.

When a proximal rny is measured, it starts at the pouch going down the small intestine. Most proximal bypasses are 75-150cm. You will lose most of your malabsorption between 18-24 months.

I'm in the process of getting a distal revision. My original bypass was 150 cm. My weight loss failure was attributed to slow resting metabolic rate. I need 1400-1500 calories to maintain 230 lbs! To have a normal BMI, I would need to eat 1000 calories.

Thanks for the info; that makes a lot of sense. I have a fairly fast metabolic rate (which means I've really never had an excuse for my weight besides bad eating habits), so I hope it doesn't get severely altered by surgery! Was yours always slow, or did it slow down after RNY?

About 5-7 years before surgery,I noticed that my resting heart rate was in the 60's, and I was not in shape. After I had surgery, it lowered to the upper/mid 40's.  I was seen by a cardiologist and endocrinologist.  All the labs and procedures came back normal. It was assumed that it was my slow metabolism from many years of yo-yo dieting. My weight loss was slower than average and I stopped losing weight at 18 months. At 24 months, I began to gain weight. I was hungry all the time and I was eating 1600-1700 calories.  

Are you revising to a duodenal switch?

Distals are not done much anymore because studies simply didn't show that there was enough difference in weight loss to make it worth the additional loss of vitamin absorption.

Remember, even with a distal bypass, you are going to lose the majority of the caloric malabsorption in 18-24 months, but the lack of vitamin absorption is permanent.

Lora

ETA: the 150cm bypass would make it a proximal.

Thanks Lora, that's sort of what I thought, that perhaps they're so infrequent that she didn't really even understand my question. I hope that's the case, but just for my own knowledge, I'll ask my surgeon on my way to the OR in a couple weeks.    But I think you're right, it definitely sounds like a proximal the way she described it.

Keep in mind that length of small intestines can vary greatly from one person to another as well -- from about 15 feet to 30 feet. Women's small intestines average slightly longer than men's. 150 cm bypass is 5 feet. So your small intestine can end up longer still than mine was before bypass. After about two years, what that all means is absolutely, positively nothing, except for vitamins and minerals, as Lora said.

It's a little like the sleeve size debate among VSGers. My sleeve may be larger than yours, but I can still lose more weight. Size is not the sole, or even major determinant.

It is possible to bypass soooo much that food will go right through you. Back in the 1950s they had experimenral surgeries that essentially hooked people's mouths directly to their anuses. That was REALLY distal. But those poor *******s had every deficiency you could imagine.

The metabolic part of any of these surgeries is still the most important part.