Question:
want to know honestly what the difference is between distal or proximal

ok, i have been a participant on this site for three months or more. i am scheduled for lap rny on 5/31/00. i want the distal rny but none of the surgeons in my state(that are bariatric certified surgeons) will do the distal rny. I want to know if someone with a medical backround, or anyone with information that is valid, what the real difference is in the average amount of weight lost, and the average percent of people who keep the weight off. I have about 180 lbs to lose, I do not by any possible means want to gain this weight back. I need some assurance for myself that if I have the proximal rny I will not gain the weight back. Any help from anyone is greatly appreciated!!!    — twenc (posted on April 17, 2000)

April 17, 2000
Melanie makes a very good point. The proximal RNY has less malabsorbtion, and so you may need to be a little more careful over the long run with what you eat. Off the top of my head, the average weight loss for a proximal RNY is about 70% at one year post-op and 55-60% after a few years. Remember - this is the AVERAGE, and yours may be more (or less). These figures also take into account some of the older methods of restriction, which were more prone to failure. The newer techniques (transecting the stomach, double rows of staples, suturing staple lines) hold a lot of promise for eliminating the later weight gain that early RNYs experienced. There are a lot of informative papers that have been posted at AMOS, and you may want to read those for exact figures and percentages. Best of luck to you!
   — Kim H.

April 17, 2000
Toni, I am a Registered Nurse but I certainly don't know it all!!! But the difference between a proximal and distal operation lies in the amount of common intestinal length (don't get confused by how much is bypassed or sectioned off- it's the common limb that is the marker) Now, please remember that the RNY and the DS both involve disconnecting parts of the small intestine and creating new pathways for food and digestive juices and enzymes. The DS is designed to be distal while the RNY is not. Most RNY operations are done proximally which creates a very mild malabsorption factor but are mainly classified as restrictive operations. The farther down the length of the small intestine the connection is made the greater the malabsorption will be. That is why there are the variations people talk about regarding proximal, medial, or distal RNY. Where ever the intestine is connected, from that point on and over to the large bowel this created section is now known as the common channel or common limb. That is because that is the only area anymore where the food and all the digestive fluids will actually mix and come in contact with each other. So if the connection is made 100 cm (approx. 40 inches) from the end there is only about 3 1/2 feet out of the normal 20 feet of intestines for the mixing to take place. This sets up the malabsorptive component of the DS and the Distal RNY. Should the surgeon make the anastamosis 300 cm from the end, naturally then there is a greater length for the mixing to occur and thus absorption to happen. Then in the proximal RNY, the length of the common channel may be as long as 15 ft. with so much length intact and that is why the proximal RNY is not really considered a malabsorptive operation. Does this sound as clear as mud? You can picture in your mind the division of the small intestines creating 2 separate pathways and sometimes the 2 substances traveling along their separate ways meet up early in the journey and mosey along together; sometimes these 2 different travelers remain solitary and only join forces for the homestretch. There are other differences in the actual DS and RNY operations (besides the obvious major difference in the stomach/pouch /upper GI modification.) But the intestinal or lower modifications are not as different as one might think. (Although the duodenum is partially left in with the DS which is why the DS is a DS!!!!) IMHO, all of the medical hullabaloo regarding fears and panic about malabsorption is greatly overexaggerated and so blown out of proportion. Good compliance to post operative nutrition is a must for the RNY and the DS patient. Also, keep in mind that the weight loss can be phenomenal with a proximal RNY or lackluster with a DS.. As has been stated by others, we all know many people who have lost tremendous amounts of weight with a proximal RNY and I know some with the DS or Distal RNY who are very discouraged with their results. Nothing is guarenteed with this surgery but we all are willing to try in order to have a better life. Good luck and I'll be praying for you!!
   — Fran B.