Question:
Success greater with more/less bypassed??

Hello Everyone! I have recently had my consultation with my surgeon and am waiting to hear from BCBS of GA. for insurance approval(hopefully!) and was wondering if anyone could explain the difference between distal and proximal? My surgeon explained that he will be doing a lap RNY of 85cm bypassed. This seemed like a small amount bypassed?? Is there a difference in the outcome of the surgery and weight loss results based on the amount bypassed? I am 340# and need to lose 174 excess weight according to their charts. I do realize how much I lose is mostly up to me and the surgery is just a tool, however, it seems to me that greater weightloss amounts are achieved when more of the intestines are bypassed? Anyone with information on this? Thanks so much and HAPPY HOLIDAYS!! Kristy...waiting patiently :0 Dr. Smith 340/340/??    — ktnjp (posted on December 25, 2003)

December 25, 2003
With the more distal procedures, you have an increased incidence of malabsorption issues. I have a 2 oz pouch and 75cm bypassed and have lost over 200 pounds and am 10 pounds away from goal - so it *is* how you work the tool. How much you lose *is* up to you as you say...JR (open RNY 07/17/02 -204# since surgery, -217# total, 10# til goal!!!)
   — John Rushton

December 25, 2003
I used Dr Duncan in Atlanta. He says he bypasses between 75 and 150cm. He told me I would be 100cm. Typically the more you weigh the more they bypass, however, remember there are people weighing 500, 600 or more pounds so keep that in mind. I am a light weight and only need to loose about 120 to be at ideal weight so 85 sounds conservative but you have to have faith in your Dr. If you are still concerned about it talk to him again and see what he says. On the positive side the less they bypass the less problems you will have with dumping. As far as the difference between proximal and distal, this seems to be subjective by my Dr. considers 100cm to be the dividing point.
   — chadwick

December 25, 2003
As John said it's how you use the tool that matters. But for me personally I prefer the slightly longer bypass I have as it give me a little extra assurance - at least mentally. I was 442 shooting for 200 lbs, I am currently 35 lbs from goal weight in 10-1/2 months. If you go by height/weight charts I should be shooting for somewhere around 156-165, but it is not a size or weight that I want to achieve. I figure after all is said and done and PS is done I will settle out between 180-200, which I will carry quite well at 5'9. I carry my weight quite evenly, which helps a lot. <p>With 150-175 lbs to lose I would not be happy with an 85cm bypass. There is really no more malabsorption risk between a 100 or 150 bypass so I would want at least 100 and closer to 125-150, if I was in your shoes. I realize you can be totally successfull at an 85 cm bypass but my feeling why have to work so hard for the rest of your life to maintain when just another 12-18" of bypass will give you more help and not harm you. But that's my opinion. My surgeon generally does a 100cm bypass on people up to a 50 BMI and a 150 above that. He also does a 1/2 ounce pouch, which is really just as critical as to the amount bypassed. Yes at 10-1/2 months I can eat lots more but I still reach a limit that is tons less than it used to be. My weight loss has slowed but that is normal for the stage I am at. 2 months ago it dropped to 14 lbs a month and last month to 10, but it's still dropping. I'm having my first PS on Feb 23rd and plan to have another 20 lbs off by then which will put me 15 lbs from goal weight. Since they figure there is at least 15 lbs of skin to remove I will likely come out of surgery below goal weight. YEAH! <p>I would ask your surgeon why he chooses to do the 85 and definitely know what size pouch he is doing. If it's too large you may likely have to live on a diet and watch very carefully what you eat for the rest of your life when in maintenance. With my setup I know I will not need to diet but just listen to my small pouch tell me when to quit. That will be hard enough at times. I do not feel I am on any kind of a diet. I just eat smaller quantities of anything I want and can tolerate. I even had a turtle chocolate yesterday but only 1 and was totally satisfied with that one. I had one cookie on Christmas eve too and that was fine. Sweets just don't call me too much any more.
   — zoedogcbr

December 25, 2003
Thanks for everyone's response. I do have a lot of concern with my doctor's choice of 85cm bypassed. He talked as if he bypasses this amount on everyone. Also, he said the pouch would be about the size of a golf ball (so would that be about 2oz.?) Dr. Smith said the pouch would eventually stretch to the size of a tennis ball. Does this sound about average? Obviously, I am not a good dieter! So, I really am worried about spending the rest of my life continuing to battle with diets. I am prepared to change the way I think about food and to make better life choices, however, I do have a fear of strict dieting since it has always brought about failure for me. Now I feel as though I should look into other surgeons, even though Dr. Smith has a wonderful reputation and comes highly recommended. Any other advice or suggestions are welcome :) My personal email is [email protected]. Thanks and continued success to everyone!!
   — ktnjp

December 25, 2003
Kristi, Here's my two cents :-) I only had 100 lbs to lose. I didn't even know what distal or proximal was when I had my surgery yet, for reasons I still don't know, my surgeon chose to perform a distal on me, 150cm. I reached my goal weight in 7 months. I'm 5'7" and went from 260 to 160 and now, 9 months out, am 155 and have maintained that for two months. On Monday I will have a lower body lift which will remove 10 more pounds which puts me well below goal weight. I'm thrilled with the distal results BUT, that said, I know I have to be ever-so-diligent daily about my protein, vitamin and supplement intake. I can truly say I've never missed a day since surgery where I veered off path from my structured food/vitamin regimen. I know if I do, it won't be long until I'm doomed. No matter how you slice the cake, when you have this surgery, you are altering your life immensely and MUST follow all the rules to maintain your health whether you have a distal or proximal. Hope this helps!
   — Vicki S.

December 25, 2003
P.S. I have never dumped with my distal bypass. Don't know if that has anything to do with it but wanted to add that to the other posters stats.
   — Vicki S.

December 26, 2003
My surgeon only bypassed 25cm. I started out as a lightweight with onlly 105 lbs to lose and at 8 months out I am down 95 lbs. Many of my surgeon's patient were a lot heavier than me, and they have all lost just fine. The less bypassed, the less malabsorption that occurs. I do not have to take any type of supplement other than a daily vitamin. Barb 4/07/03 235/140/130
   — Barbara C.