Question:
Proximal or Distal, is there really that great of difference?

Seems to me that all seem to have the same successes and the same problems. But boy, some have had great results with just a small amount being bypassed so why would you choose the distal and risk the malnutrition problems? I really am asking this for my family member who is considering surgery. I've already had mine, and do understand what she is saying after reading so many profiles, Thanks in advance.    — Joan R. (posted on November 22, 2003)

November 22, 2003
I think some are of the mind set that one gives you a greater chance of losing and maintaining than another. Personally, I know those that are distal that have constant vitamin absorbtion problems and liver problems to boot. The surgery, whether distal or proximal will offer the same benefit, providing WE make good use of it. It aint a free ride!
   — Happy I.

November 22, 2003
Well, I personally have chosen the DS, which is mostly a malabsortive procedure. I chose it for several reasons, and the fact that it seems to have the best long-term success rate is only one of them. Anyone who has weight-loss surgery of any kind is going to have to take vitamins and certain mineral supplements for the rest of their life, so why not opt for a surgery that's going to give the very best results? I chose the DS because it will leave me with a fully functional stomach, no stoma (and therefore no stomal strictures or ulcers), the ability ro eat small-but-normal-sized portions of ANY foods I want (even though I'll still have to exercise good judgement in choosing my food), and very, very few DS patients ever gain back a significant portion of their lost weight. If you have specific question, please feel free to e-mail me directly---I'd love to talk with you.
   — MsBatt

November 22, 2003
I just had my surgery consult a month ago, but when I was there the surgeon mentioned a recent study that listed the best outcome LONG TERM was between such and such cm's. Problem is, I certainly can't remember what the measurements were! What technique my surgeon uses happens to be right in those measurements...if I could remember what it was. Anyways, have your family member talk to a surgeon and see if they have heard of such a study. When I call back to the surgeons office next time I'll see if they can find out the answer for me. As far as why some would have distal and some proximal, the surgery is just like everything else in life....there is no cookie cutter answer for everyone.
   — M. Me

November 22, 2003
Some of us didn't really have a choice, back in the olden days. We were issued what we got. I am very distal, as distal as a BPD with or without DS. But I am RNY. Nutrition issues do not HAVE to result in problems with a good plan. Not all proximals regain their wt, of course. Many do, but part of the problem is a bad program. Then they never had any tools in their tool box and that's SO not fair. Some distals regain, too. You really can't tell what you've got til about the 5th year, I don't think. I work with lots of post-ops and knowing what I know today, I would still opt for my distal. I work at the nutrition end, but do not have to work quite so diligently at the maintenance end. It's not a freebie, of course, but I spend more energy on nutrition IN than calories OUT. If you know what I mean.
   — vitalady

November 22, 2003
This is difficult to answer because you have not defined your definitions of Distal and Proximal. If you are talking strictly in amount bypassed then I am assuming you are meaning Proximal is around 100cm bypassed and Distal is 150cm bypassed. I am 150cm bypassed and do not have manjor malabsorption making me unhealthy. It is very easy to get in the nutrition I need at this amount bypassed. It has worked well to get the weight off and hopefully help me some long term although less because our small intestines will regrow some villi increasing our absorption. The only problem I have run into is it appears I have been malabsorbing some of my Celexa, depression medication, and it didn't surface clearly until about 8-1/2 months PO. There were symptoms starting around 6-7 months but I did not recognize it then. We ended up increasing the dose and I'm back feeling like I should. However, I'm not sure if I was only bypassed 100cm if it would have been any different. For me I had 242 lbs to lose so I'd rather take a larger dose of something I am already taking and have the greater malabsorption to get through this early phase. <p>If you are talking Proximal being say 100cm bypassed and Distal being around 100cm common channel then I am with you on questioning ones reason for doing it. I am referring strictly to an RNY surgery. A DS is designed to have that short common channel and therefore leaves the stomach larger and with normal function etc. So it is matched up properly. An RNY with a 100cm or so common channel is very risky in my opinion. It is not a mainstream surgery and there is very little data out there to know what the long term effects will be. Like Michelle said, you must be diligent on your calorie/food intake with that combo. From what I have read of people who have that combo they MUST live on many protein drinks a day just to get in enough nutrients to stay healthy. So much is malabsorbed and the small RNY pouch makes it IMPOSSIBLE to eat enough food to stay healthy. That right there would be enough for me to never consider it. Proud to say I am 9-1/2 months PO and have never used a protein drink. I will eat part of an occassional protein bar, but that's it. My plan was real food from the start, which for me was ideal. There is nothing wrong with protein drinks, just not something I was interested in. <p>Some feel the DS is the only surgery for the SMO, but I disagree. There is nothing wrong with it but I needed a new relationship with food and being able to eat lots and not make any changes, other than more protein, was not in my best interest. I needed volume reduction. I also was scared of the potential bowel issues with the DS. For most any problems settle out within 6 months but I already had a history of irritable bowel syndrome etc. and did not want to risk it. It reminded me too much of the 2 months of hell I spent on Xenical. A number of the DS people I know eat upwards of 3000-4000 calories a day and that's not normal in my mind, but each has to figure out what will work best for them. I had lived on 1200 healthy calories before when I lost 200 lbs and knew that quantity of food, when healthy items are chosen, is quite a bit of food. I was very comfortable with that being a normal eating day for me, as I assumed I would end up somewhere around there and likely will. I don't count calories anymore but have an idea of what I am doing and most days are 800-1000 calories. To stop the loss I expect I will have to go to 1200-1300 calories. I'm still losing around 10-15 lbs a month yet at 9-1/2 months out and 45 lbs from goal, but I am trying to get off as much as possible before PS in Feb. If I was to slow it down to the 5-8 lbs a month, it would normally be by now, I'd have to add considerably more calories. It appears I will go into goal weight quickly and then I'm guessing will struggle for a number of months trying to find the right level of food to maintain. While this isn't normal, I can't help how my body has lost. I truly feel my body has always wanted to be smaller and the two times I gave it the chance it has gone for it full blast. The 200 lbs I lost before came off in 13 months. This time in 9-1/2 months. <p>One needs to research each procedure with their eyes totally open and decide which they can work with best long term. There is no "one surgery fits all" solution. I know SMO who have lost well on 75cm bypassed, 2oz pouch or had an AGB. For them it was the right surgery and therefore they could embrace it and make it work for them and that's all that matters. So tell your family member to look deep into their soul and figure out why they eat and what it will take to be successful. For me I was fine with smaller quantities of food as long as it was real food I was eating.
   — zoedogcbr