Question:
Length of Long Limb RNY

Can someone tell me where I can find a medical industry accepted definition of mini, standard and long limb RNY. I got my aurgery approval letter and it says they will not cover a mini or long limb RNY because they are experimental My doctor plans to do a 150cm bypass, which I always assumed was distal. I searched the library and it is clear there are a lot of opinions but I need cold hard facts. I'm trying to figure out if I have a problem with the 150cm bypassed or not. If 150 is the starting point for long limb then he can bypass a few cm less. I just don't want some sort of a problem should insurance ask for a copy of the surgery report. I also don't want only 100cm bypassed as it is not enough for someone my size. If I'm going through with this I want the best possible chance for maximum results. I did find one bit of info doing a search and it said that a long limb has a procedure code that is one number different than the one my doctor will perform. Just trying to figure out how much sleep I should lose tonight. LOL    — zoedogcbr (posted on January 7, 2003)

January 7, 2003
There are several schools of thought on this, not sure there is a country wide standard. I believe proximal is 100cm or less, 150cm is a Long Roux limb, NOT a distal. I believe distal is 200 cm or more. I had 150 cm and have had no problems, 16 weeks postop, down 90#.
   — Dana S.

January 7, 2003
Distal just means "distant", as proximal means "in close proximity". In our case, this refers to where the junction of the Y is made. *I* am truly distal, being WAY out more than 300cm. I consider 150cm proximal. Some docs call it distal because it's more distal than THEIR proximal. Some call it medial. Helpful, huh? Long limb usually refers to something as distal as mine, which is not experiemental, but in the wrong hands can certainly be dangerous. The 150cm is rapidly becoming the gold standard, so I think you're safe with it. When we see that limitation here, they do a 150.
   — vitalady

January 8, 2003
I had 150cm bypassed and my surgeon considers it a "Long Limb RNY". I know this is all so confusing, but, for insurance purposes they will probably consider 150cm bypassed "Long Limb". I say this because the surgeons all have their own school of thought on what is a Proximal, Medial or Distal. Your insurance company probably has it spelled out in black-and-white what IT considers "Long Limb" or Distal. I suggest you call your insurance carrier and find out specifically they consider "Long Limb" and "Distal" Hope this helps.
   — Sandra C.

January 8, 2003
I had 150cm bypassed and my Dr. considered that a long-limbed RNY. I haven't had any problems at all with it. (lost 109lb in 9months) Maybe your Dr. can shorten it by just a few cm so that your ins. will still cover it. Good luck to you!
   — Leah H.