xpost- surgical report..help me understand please

Candy V.
on 11/1/12 2:03 am - MI
RNY on 09/12/12

This is the part I believe tells how long the bypass was...but I don't understand the phrases they use...

The jejunum was measured for 100 cm distal to the ligament of Treitz and was divided using a GIA 60 bowel length stapler with seamgard. The Roux limb was then measured an additional 100 cm.  A side to side anastomosis was then completed between the Roux limb and biliopancreatic limb. 

Is this a standard length for RNY.  I was wondering how bad the vitamin malabsorption is and will be?   I personally would rather lose a little slower and keep some of my vitamin absorption.  I thought I had read other posts that theirs was 150cm, maybe just wishful thinking.

Thanks for all you VETS do for me and all the newbies!!

added on to xpost:  I had a few replies on the RNY board... but still unclear.  One person said the two measurements were added together, if so why do they say divided and stapled after the first 100 cm.  I will ask the Dr at my next consult to be sure, it is just bothering me not to understand.

 

 RNY 9/12    TT 9/13    HT 5' 4"   HW 250    SW 242   CW 125

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(deactivated member)
on 11/1/12 4:06 am
RNY on 08/31/12

Because your jejunum is "webbed" together with the rest of the intestinal system with hundreds of little blood vessels and tissue. It is not a single tube just stuffed inside an area of your abdomen that can be snipped and moved around. They have to divide it from the rest of the small intestine group so they can move it and your stomach over to the side of your pouch. Here is a good image of the webbing (look at the second image from the top).

http://bio.bd.psu.edu/cat/Circulatory_System/arteries_and_veins_of_digestive_.htm

Once they divided it from the webbed connecting tissue, they had to staple it to control bleeding and they had, voila, a Roux limb! That was the first moment that section became separated from its "mother-ship" intestinal system. Then they measured another 100 cm's to complete the full length of the Roux limb but it looks like they don't divide that part off from the "mother-ship" as blood flow is important there. They hook the end of it (about 4 feet) further down into your "regular" intestinal system. That procedure is called the "anastomosis." They also stapled your regular intestine to your pouch. 

It's been years since I worked in autopsy, so I'm dusting off the old cap. 

 

 

Candy V.
on 11/1/12 12:01 pm - MI
RNY on 09/12/12

Thank you soooo much!!   A picture is worth a thousand words!

 RNY 9/12    TT 9/13    HT 5' 4"   HW 250    SW 242   CW 125

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(deactivated member)
on 11/2/12 2:35 pm
RNY on 08/31/12

I did some more reviewing and I realized I advised something incorrectly because when I read your original post with the doctor's transcript, I assumed it was written with perfect accuracy. I think the doctor's summary was dictated and a medical transcriptionist wrote it. So here is what I want to correct...

1. The webbing part of the small intestine was not likely "divided" as it sounded by the sentence structure or otherwise that part of the intestine would have tissue death from lack of blood vessels (I wasn't thinking clearing).

2. I think the reference to the "divided" part is actually jumping to another subject without being clear about it and is referring to the division of the stomach itself as that is what really gets stapled to high heavens!

Ask your doctor about that. I really think now that it is referring to the stomach portion. The rest of what I wrote is accurate I believe. The measuring, etc. I'm so darn curious I'm going to ask my doctor next time how the webbing of blood vessels is handled, too. Are they stretched and made to fit or can they fit into a different position just fine?

 

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