Question:
Is it true that with Distal you will lose more weight?
I'm confused on this matter of distal or proximal. I could be way off but it seems to me that with distal RNY you lose more weight. This refers to the amount of intestine you have taken, 150, 200 etc. Is this correct? Are there more complications from one verses the other? I want to get the most benefit from my surgery. I realize a lot has to do with my own behavour after. What do you think?? — Joan R. (posted on May 18, 2003)
May 18, 2003
It may not be the losing that is easier with a distal, so much as the
maintenance is a little easier. The nutrition is a little more tricky. But
I never had a problem putting things IN my face, it was keeping them out
that was the problem.
— vitalady
May 18, 2003
Distals have more trouble with malabsorbtion. I have a friend who started
with a 76 inch waist. He is distal and fights anemia. His waist is now 38.
At goal:)
— bob-haller
May 18, 2003
The other thing I forgot to mention is HOW distal and HOW proximal. Since I
see we are neighbors, the distals offered in this area are adjustable. You
work with the docs & they adjust to fit your lifestyle. You've got
about 20 ft to play with there, so choosing HOW distal or HOW proximal is a
negotiation with 2 of the surgeons in the area.
— vitalady
May 18, 2003
no, not true always. im distal and im a slooowwww loser. 95 lbs in 9.5
months and 47 1/4 inches. my doc bypassed 90% of stomch and 250 cm of
intestines. but i also have had no problems what so ever.
— amanda W.
May 18, 2003
According to my Dr. it depends on how overweight you are. The distal
bypasses more so that you absorb less but in the long run it does run its
course with malabsorbtion issues. If you are 100 lbs overweight vs 300
overweight you are more likely to benefit with a proximal because of
longterm complications that occur with malabsorbtion.
— crisjenn73
May 18, 2003
There are many factors that can influence how much weight anyone who has
WLS will lose. The most important one doesn't have much to do with which
surgery you have, whether you're proximal or distal, or any of that stuff.
The biggest factor is what you, as an individual, do with the tool you are
given through WLS. All types of WLS can be defeated, but all can also be
quite successful. The bottom line is that it depends on you.
— garw
May 18, 2003
Unfortunately there are no national standards for the definition of
proximal, medial, distal, long limb so the interpretation of these terms is
left up to each physician.
<p>Some surgeons consider 150cm bypass distal while others call it
medial. The only thing that seems to be somewhat consistent is that a
proximal usually is 75-100cm bypassed. When looking at the amount
bypassed, and whether it will be a problem in the future, you need to
factor in the size of pouch also. A longer bypass with a larger pouch
should be pretty safe. You will always have to take vitamins and b-12 but
we all do. Recently I heard of a surgeon that will do a 100cm common
channel with a RNY which as approx. 500cm bypassed. No I am not referring
to a DS - I wish I was. This long a bypass without a huge pouch is a death
sentence in my opinion. Unless of course if you are willing to live on
protein drinks multiple times each day for the rest of your life. With the
high degree of malabsorption a person could never eat enough food to keep
themselves alive because the typical pouch (1/2-1 oz) is so small. You
literally would not be able to get in enough food.
<p>From my reading and research I have found that most doctor's do a
100cm bypass for the MO and a 150cm bypass for SMO person. Put whatever
names you want on them. The 150cm bypass is considered safe for long-term
and will aid the people 200+ lbs to lose in getting the weight off. There
are not a lot of people with longer than 150cm RNY bypasses so it gets more
difficult to have long-term statistics to know how safe it really is.
<p>These are just generalizations as I have heard of other
combinations - 75cm bypass and larger pouch and the person still has lost
about 180 lbs. It truly comes down to how each person embraces the surgery
and how they choose to use the tool. One last clairification - you refer
to the intestine being taken. I have never heard of it actually being
removed. The portion that is bypassed is connected up further down the
intestine as it allows stomach acids etc. to combine up with the food from
the pouch and aid in further digestion in the small intestine. Hope some
of this helped. Chris D.
— zoedogcbr
May 18, 2003
Just for clarification, my common channel is 100cm (40") and I have a
small pouch. I'm about as distal as it gets with RNY. I agree that it CAN
be a death sentence without some guidance. There are a handful of docs
doing these around the country. My doc now does 60" vs these 40's. I
made it my focus to find out what I need, how to absorb it and how to watch
my labs to remain healthy. NONE of these surgeries is a freebie. We work
at each one. Sugar or grazing will still fatten me back up to pre-op size.
I work at my nutrition. The only difference between then & now is 150#
that have not found me yet.
— vitalady
May 18, 2003
I'm a distal, 14 months psot-op started out at 287 and am stuck at 195 for
5 months, so no it doesn't always mean it's too much and you'll have
problems. I wanted the best chance i had to get the weight off and keep it
off, my bloodwork has always been perfect, no malnutrition issues with me,
I just take my vitamins which is crucial for all of us! I have plenty of
energy, etc....my plateau is the carbs, I've never dumped, ever...I went to
my surgeon's support group meeting yesterday, looking for encouragement and
motivation to get back on track and get this weight loss started again :)
— Lisa F.
May 19, 2003
Joan, some good info below from the other posters. Distal or proximal or
the term medial is used to describe how much intestine is bypassed, with
100 or so cm. being proximal, and 150 or more being distal, with medial in
the middle. The more weight you have to lose, the more the docs seem to
bypass, however, I'm not sure I have ever seen statistics that show distals
have lost more of their excess weight than proximals. We all seem to lose
well, especially the first year. What would concern me is that the more
intestine bypassed, the less nutrition/vitamins/minerals from food is
absorbed. Severely bypassed individuals often are anemic and have other
problems like early osteoporosis because they can't absorb enough calcium,
or iron, even when supplementing. And if they can't keep up the
supplements, its even worse. I would prefer less bypassed to give me a
better chance of absorbing those important vitamins from food. I have
heard of many with just 75 cm bypassed and they do well with weight loss
too. A good friend of mine has a 75 cm bypass RNY and lost to goal in just
9 months (over 100 pounds). I think how well you use your pouch post-op is
more important to successful weight loss.
— Cindy R.
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