Question:
My insurance approved me for a 100 cm limb, but my surgeon usually does 200...

I'm not sure I need the 200 - I have a BMI of 41. My insurance is changing on 2/1/03 to BC/BS and they may approve the 200. I'm not sure whether to go ahead with the 100 cm surgery now or wait 2-3 mos. for the 200. Anyone have any experience with this? I would greatly appreciate any recommendations/advise/comments. And if anyone has any suggestions of places to research this, I'd be very grateful.    — barbdeane (posted on January 4, 2003)

January 4, 2003
Barbara, with a BMI of only 41, I would opt for the 100 and not the 200. A 100 cm bypass is considered a proximal while the 200 is a distal. A 100 will bypass less of the intestine and give you a greater chance of absorbing nutrients and vitamins from food. We want some malabsorbtion but not too much. Distal is usually done on those who start out at a higher weight to give them a better chance to lose well over 100 pounds. They must take more vitamins/supplements for the rest of their lives than the proximals do. I started with a BMI of 42 and had 110 cm bypassed. My recommendation would be to go with the 100. Have you asked your surgeon why he is recommending 200 cm for you? Is that his norm for everyone?
   — Cindy R.

January 4, 2003
I agree with the previous poster. Your BMI is relatively low (don't you love being a so-called "lightweight"? lol!). Just my 2c, but I wouldn't be looking for more malabsorption than you need to live with in the long run. And I have the vague impression BC/BS is relatively conservative (I think I've seen posters who were disappointed when turned down for approval for DS, but who were approved for RNY), so it's possible they won't go for the 200 cm. removal either with your BMI. Either way, good luck!
   — Suzy C.

January 4, 2003
I had a BMI of 41, and had 100cm bypassed. My surgeon bases the amount to bypass, on your BMI. Since I was at a low BMI, he went for the least amount. Otherwise, he said I might become underweight, and that's a "whole nother" problem. I'd go for the 100. You want to lose the weight, but not cause problems for yourself later on.
   — Diana L.

January 4, 2003
Naturally I have to "weigh" in on the side of the more distal procedure. It's certainly not as distal as I am. But the length of bypass isn't about GETTING it off (that's pouch size & maintenance), it's about KEEPING it off over the long haul. The moment you bypass the normal digestive function, you incur nutritional issues, though easily maintained via supplementation. That extra 100cm that you would not longer have for processing food may mean 1 more iron pill, 2 more protein shakes. BUT it may also mean that many years down the road, you are able to maintain your wt with just "sensible" eating (following our specific conditions, of course). I'd vote the 200.
   — vitalady

January 6, 2003
Thanks everyone for your input. I'm having my follow-up appointment tomorrow morning and am planning to go ahead with the 100 cm surgery unless the surgeon convinces me otherwise. Wish me luck...:) Barb
   — barbdeane