Question:
Best pouch size and bypass length for RNY?
I had my first surgical consult today -- thanks to this site, I had a bunch of questions! Two of the issues I was most curious about were how large my pouch will be and how much of my small intestine will be bypassed. My surgeon said that he bypasses 90cm for people my weight (BMI 42), 120cm for heavier folks, and 150cm for supers. He said he "wouldn't do 200cm on anybody." I asked him if he would consider 120cm for me, and he said okay. That it would increase my risk for nutritional deficiencies and diarrhea, but only slightly. He also told me that he usually makes his pouches 35 to 40cc. I asked him if mine could be smaller -- 15cc. He said that he believes pouches that small greatly increase a patient's food intolerances without significantly enhancing weight loss or sustainability. He didn't outright say no, but seemed pretty reluctant. Should I push this issue? How important is pouch size? I'm tempted to really lobby for the 15cc pouch and 150cm bypass -- I want to give myself the best chance possible for long-term success. I'd love to hear opinions from people who have read a lot about these issues and/or have opinions based on their personal experiences. Thanks! — Tally (posted on April 4, 2002)
April 4, 2002
Tally, if you really want to ensure long-term success, you should check out
the duodenal switch (BPD/DS) procedure. I had the DS 7 months ago and am
doing very well. If you want more info on this surgery, check out
www.duodenalswitch.com. I am not saying that the DS is the best surgery,
and it definitely is not for everyone. Continue to do your research. You
are very wise to question your doctor, but if he doesn't want to do what
you are asking, then you may need to check out your other options. Best
wishes to you.
— artistmama
April 4, 2002
Hi, I have not had my surgery yet but I wanted to respond to your request.
You already answered you own questions. You stated that he already told you
that having a 15cc pouch would "greatly increase a patient's food
intolerances without significantly enhancing weight loss or
sustainability". You stated that your goal was to "give myself
the best chance for long-term success". I think that you would be
defeating you goal by insisting on a smaller pouch however the choice is
yours.
— Shiwanda H.
April 4, 2002
personal choice I guess, I just find it interesting that someone looking
into the "sapala-wood mircropouch" asks why someone would want a
15cc pouch if there is no benefit, yet the "micropouch" is 1-2cc
.............I have decided that my personal choice is 30cc........to each
their own.....
— Jeff B.
April 4, 2002
Have to agree with the previous poster. If you were super morbidly obese,
which you are NOT, it might make sense to go for a smaller pouch and longer
bypass. How old are you? This could also be a factor. Long term issues
with nutritional deficiencies might not be so bad if you were older, but if
you are still in your 20s or 30s, that could have a bad effect on your
health long term. If you still want to have children, you may not want to
take a chance on the nutrional deficiencies either. Listen to the doctor.
He is the one who does this surgery and has more more experience with it.
If you are going to trust him to cut you open, why wouldn't you trust him
when it comes to determining pouch size and amount bypassed?
— garw
April 4, 2002
I have a similar BMI and have a transected 15cc pouch and was bypassed
200cm. I take my vitamins and have plenty of energy now that I'm 11 weeks
postop. My doctor is specializes in WLS I have faith that he chose the
right surgery for me. I have NO food intolerances and I'm glad my pouch
isn't bigger because I already feel I can eat too much unless I'm careful.
No one can say how your body will react so it's up to you to decide what
you want to do and if your doctor refuses your wishes than consider hiring
a different one.
— Candace F.
April 4, 2002
Just another thing to think about. No matter how much bypassed you are
still having a malabsorption procedure and you will be supplementing the
rest of your life - period. I'm pre-op too so understand the overwhelming
amount of conflicting advise out there. My best advise is to really do
your research, check with LONG TERM post-ops (5+ years) and make the choice
YOU are comfortable with. After lots of researching, I felt that a distal
was the best choice for me. I'm only 29 years old. I want this surgery to
not only get me down to a low goal weight but KEEP me there long term. I
wish you luck in finding the answers you're comfortable with. If you need
help, Email me and I'll help as much as I can.
— Shelly S.
April 4, 2002
— Tally
April 4, 2002
I'm as distal as you can get, as far as I know, in excess of 250cm
bypassed. With a 15cc pouch. SOME food intolerance is not a bad thing,
yanno. The moment there is bypass of digestion, there is
malabsorption--same 8 elements, either way. But how MUCH we need to
supplement depends on the bypass, sure. I am SUPPOSED to have nutrition
& diarrhea issues, but I don't. I fuss over my nutrition, but it
works. It would be scary if no matter what I did, I couldn't stay
nourished, but the supplements do the trick nicely. So, for me, the longer
bypass, small pouch worked great. And have so far, 7.5 yrs. Maybe trouble
looms in the future, but there's no sign NOW.
— vitalady
April 6, 2002
I just wanted to encourage your great attitude about your doctor. You have
evidently done your research and you need to feel comfortable with your
procedure. I made sure my doctor bypassed 150cm and approx. pouch size is
15-20cc. There are many people who lose very well with larger pouches and
less by-passed, BUT I know I needed the peace of mind that I had the most
help avaliable to me. Get what you need and if this doctor won't do, find
another. I know you probably don't want to start over with a new doctor,
but this is the rest of your life a few more months won't matter. Best of
Luck to you!
— dcopehp
April 6, 2002
I am having an open RNY on July 8th with a 15cc pouch. My doctor explained
to me that the 15cc pouch (micro-pouch) is made up of the extreme top of
the stomach which is less likely to stretch a great deal over time. For
this reason it seems likely to me and my doctor that someone with a 15cc
pouch will lose more over time. Good luck to you.
— Earl Z.
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