Question:
HELP!!! I want a distal RNY and my in network Dr. only does proximal!

I have a BMI of 66 and everything I have read states that with a BMI over 50 a distal/long limb RNY is the procedure of choice for the greatest initial & long term weight loss. Most of what I have read is from individual surgeons reports. Is there organization or study (NIH, Annals of Surgery, etc.) that is well known and respected by most surgeons that I can show to my surgeon their documented info regarding proximal vs distal for BMI greater than 50? My insurance only covers this in network surgeon, so I feel I am "stuck" with a proximal RNY, which I believe for me is not starting out with the best tool possible! Thanks!    — victoriandove (posted on February 28, 2003)

February 28, 2003
I had only 75 cm bypassed according to my surgeon and I have lost 152 pounds since my surgery last July. I started out with a BMI of 74 - it's now 47...JR
   — John Rushton

February 28, 2003
Lisa, I've been told that those of us who have WLS, whether its proximal or distal, lose equal amounts of weight. The bypassing of more intestine, to make it distal, means that you have less absorbtion of nutrients/vitamins and other essential things. Yes, it means less absorbtion of the fat, but the more your bypassed, the less absorbtion of the good stuff in food that is critical to our health. This could lead to major problems down the road. To this day, there are no studies out there that definitely can say how much is being absorbed, to include the protein in the food we eat, so the way I look at it, let the surgeons leave in as much intestine as they can while still assuring that you will lose significant amounts of weight. Remember, the weight loss occurs with in the first 2 years, but then you will have to live with the results and malabsorbtion issues the rest of your life.
   — Cindy R.

February 28, 2003
Lisa, You have several options if you are set on getting the long-limb bypass. <p>1. You can go to a doctor out of your area, but still in network, which means you'll have to travel and stay in a hotel for a few days after release.<p>2. You can try to find a surgeon in your area who does the duodenal switch (DS) surgery and see if your insurance will approve. The DS offers the long bypass with 100 cm common channel, your stomach would still be functional and your pyloric valve intact, but the stomach would be greatly reduced in size to hold about 4 oz. at first. For more info. check out www.duodenalswitch.com <p>3. You can go to an "out-of-network" surgeon and pay the higher co-pay; or--<p>4. You can settle for the proximal with your current surgeon. <p>Personally, I would not settle for less than whatever you have your heart set on. You've come this far. Don't let some stupid insurance company dictate what surgery you're going to have. You are the one who did the research. You know your body and your needs better than anyone else. It's ultimately up to you what happens from here. If you want it--fight for it. God bless you in your WLS journey.
   — artistmama

March 1, 2003
Lisa, the following journal article might be helpful to you: "A bariatric surgery algorithm." Obes Surg 2002 Dec;12(6):733-46; discussion 747-50 Buchwald H.<br><br> Dr. Buchwald is a very big, well-respected name in bariatric surgery circles, and he argues that the DS or a distal RNY is needed for super MO (BMI > 50) patients. I've only read the abstract for this recent article, but it seems that Dr. Buchwald's algorithm is a proposed formula for matching patients to the most appropriate bariatric procedure (AGB, VBG, prox. RNY, BPD-DS, or distal RNY) depending on BMI, comorbidities, age, gender, race, and body habitus. You can get a copy of the article online for $26, or you might be able to access the journal at a large university library. Good luck!
   — Tally