Question:
What do you know about this?

Had my gastric bypass surgery in July of 2000. It is not working. I have had a horrible and frustrating time of it. I went to see my surgeon today and he talked to me about going thru another surgery where they bypass more intestine. The surgery I had two years ago bypassed six ft of intestine, but I can eat alot and I mean alot. This is incredible to me. I have had a upper GI which shows the staple line to be intact. Has anyone had surgery with more than six ft of intestines bypassed? If so, what is the correct name of this procedure? Is the surgery to do this as difficult as the original surgery of the gastric bypass which included the stapleling of the stomach pouch and the bypass of intestines? Does this surgery or revision to more intestines bypassed take as long or is as difficult? Also how have you done with it? I know there is more absorption and takeing your vitamin supplements are a absolute necessity or you could suffer malnutrition. I need some help with this to figure out what to do. Thanks!    — Sarah B. (posted on August 16, 2002)

August 16, 2002
Hi Sarah. I'm not going to pretend I have all your answers but I might offer some help in figuring it out. It sounds as though your original surgery may have been a proximal RNY which means a relatively short section of intestine is bypassed. A distal RNY bypasses more of the intestine and it sounds as though this is what your surgeon wants to revise you to. I would think (don't know -- just my opinion) that the revision surgery would NOT be as difficult as the original due to the fact that the stomach should not have to be divided again. It should just be a matter of moving your connection to your intestine further down the line (so to speak). If you were an open RNY this sounds like something that could easily be done with a lap procedure. I am curious about one thing -- you said the procedure is not working. Has it ever worked? When you were first operated on, did you lose weight? Have you always been able to eat around it? If that's the case, I'd have my doubts that bypassing more intestine would solve the problem. Sorry to bring that up but I felt obligated to mention it. You may want to consider a second opinion if that's feasible. Best of Luck.
   — Pam S.

August 17, 2002
6 ft. would NOT be proximal. Most surgeons average between 50-100cm which is just over 3 ft. and includes the part of the intestine that generally absorbs fats and sugars. Beyond 100cm, insurance companies start calling it "experimental" and the dangers of malnutrition are high. My surgeon who specializes only in gastric bypass and does about 1/day goes to about 80cm, which is just over 2 1/2 ft. Not an answer to your question, but all info can be helpful, I hope!
   — jen41766

August 17, 2002
Distal. Meaning that the reconnection of the two hunks of "Y" is made at a far distance from the stomach. Yes, I'm more bypassed than that. A true distal is usually measured, not by what is NOT used, but by what is left IN use. Mine is on the far radical end of the scale. I had an old fashioned one, staple line only whicih bit the dust at 5 yrs post-op. I was revised in 2000, which was just cutting the stomach in two, no touching of the intestinal portion. Still, a hole in the tummy is a hole in the tummy. I was in good shape nutritonally (even with my radical distal), and my recovery was uneventful. I watch my labs like a hawk (but I'm like that), and so while there ARE nutritional issues (& specific ways to supplement them) to be aware of, it's possible to do very well with something more distal than what you have. Please feel free to email me privately if you have more questions.
   — vitalady

August 17, 2002
My surgeon told me that VERY proximal is preferred - the length of intestines not the important issue- but what IS important is the pouch. I think he meant proper size opening into small intestine and eating properly - 3 "regular meals" and I don't know about snacks yet. I know I can eat a lot if I use food easy to slide thru fast. I hear water logging - lots of protein and exercise is popular. Plz discuss the anatomy and workings of pouch with your dr. - and a second opinion would not be a bad idea before more intestine change - in my humble opinion. Charlene Mai
   — charlene M.