Question:
Need Opinion On Surgery Types
I can't seem to make up my mind on whether to have the RNY proximal, medial, or distal. At first I was going to do the distal, then I changed my mind to proximal, and contemplated the medial. I think I'm really interested in the proximal for the less evasive operation and less side effects. What I want to know is.....how much people have lost and the amount of time they lost it in. I'm 5'2 at 270 lbs, so if anyone in that range could give me info I would really appriciate it. Thanks, Ter — TLLessor (posted on January 26, 2003)
January 26, 2003
Well if I had to go with a RNY I would have chosen a Distal because that
one has the most malabsorption to it.In other words you would be least
likely to regain your weight once you lose it.Everyone is always worried
about less invasive surgery, I was more concerned with getting the most
effective surgery. I chose the Duodenal Switch.which has the reputation of
being the most envasive surgery, butit is actually the most natural., in
that it leaves your stomach functioning as a stomach should . I have also
not seen as many complaints of side effects with a Ds which is exactly
opposite of what the doctors who do the RNY tell their patients.Rnys Dump,
Go hungry,get their stomas plugged, Vomit constantly,eat only enough to
keep a bird alive, and even after they loose weight , still have to diet
and exercise like crazy to maintain their loss.If I could have dieted to
get and keep the weight off I would have done it instead of being cut
open.DS allows you to eat normal amounts of food and lose weight never to
regain. I am 8 months out from my DS I have lost 70 pounds And Have a year
left to make my goal of 100 pounds down.Most of the DSers I know have lost
weight even faster .I am now loosing about 3-4 pounds a month.I am very
happy with my DS. If you want more info on the DS you can go to
duodenalswitch.com It is full of info . Laura Wilkins
— Laura W.
January 26, 2003
RNY distal medial or poximal are all the same surgery as far as evasivness
of the suregeery!!!! these terms are only refering to the amount of
intestines bypassed the more bypassed the more malabsortion....but the
surgery itself would be the same invasiveness!!!! to compare evasiveness
you must compare to DIFFERENT surgerys ....Lap band being the least
invassive compared to a vbg vbg less invaassive compared to rny
exctra....see what i mean...
i wishh you luck in your choice of SURGERY...but the amount by passed
(proximal,distal.medial...) that choice is made by the doctor based on
starting height and weight...and i deal height and weight.....not by you
the patient.
— bekka K.
January 26, 2003
Original poster here. Just wanted to clarify myself. I know that all
three surgies are the same and are evasive. If I'm understanding things
right.. you will have a faster and more rate of loss with the distal than
the proximal. The proximal is done laposcrop...(can't spell) where the
medial & distal is open. So the recoop time for the proximal is
faster. So are there people out there that has had the proximal that has
gotten down to their ideal weight and have stayed there?
As for the DS surgery. I don't believe my DR does that one. But I will
look at that website.
Thanks all, Ter
— TLLessor
January 26, 2003
All three, proximal, distal and medial can be done either open or lap.
Usually, the surgeon makes the decision as to which one he/she will do.
Sometimes they will do a distal for people who are super MO because it does
cause more malabsorption. However, the distal can have more problems with
vitamin and mineral deficiencies because of that. All three are invasive
if done open, but not so much if they are done lap.
— garw
January 26, 2003
I strongly disagree that the patient should leave the choice of something
as important as limb lengths solely up the surgeon's judgment. Don't make
this decision until you've read every bit of research you can possibly find
and you've talked dirctly with dozens and dozens of patients who have had
each of the surgeries you're considering. Also make sure that you consult
with more than one surgeon. This is a decision that will affect the quality
of the rest of your life -- make it a good one. The surgeon I first went to
offered only proximal and medial Roux-en-Y bypasses (never more than 150cms
bypassed). The more I researched, the more I feared the *significant* late
regain issue with these procedures. So I cancelled my RNY surgery date and
traveled hundreds of miles to have the laparoscopic Duodenal Switch with
the surgeon of my choice. Today I'm seven months post-op, and I couldn't be
happier! I've lost 98 pounds (18 right before surgery) and now I'm just 17
pounds away from having a "normal" BMI. I can eat and drink
anything I want, as long as I make certain to get adequate protein (70+
grams daily) and take my vitamin & mineral supplements. As far as I'm
concerned, the Duodenal Switch (BPD-DS) is the best-kept secret in weight
loss surgery circles! Yes, the procedure is more technically complex than
the RNY, so fewer doctors offer it. It's also newer and significantly
malabsorptive (that's what makes its weight loss stats so good), so some
insurance companies won't cover it (similar to the distal RNY). And it does
require more careful follow-up and adherance to a good supplement regimen,
because the malabsorption issues could lead to serious health problems for
those who aren't compliant. But if you know you can take your vitamins and
be reasonably diligent about protein, the Duodenal Switch is without a
doubt the best thing out there! It offers the highest quality of life and
the best long-term weight loss results. Please don't have surgery until
you've fully investigated this option.
— Tally
January 26, 2003
tally,
what you did was to chose a different surgery all together.....if you are
having a rny...you SHOULD listen to the doc sugestion for limb length...if
you are a light weight you could be asking for severe health problems if
you are given a distal....let the limb lenght FIT the weight problem
...other wise you will have people insisting on distal that dont need it
and have touble stabelizing there weight and lose TOO MUCH because they
should have ben proximal based on there begining wweight...you switched to
a ds wich is wich is simaler to a RNY distal btu with one big difference
you....your pouch is left way larger so you CAN eat more and abssorb less
but if you have a distal rny your pouch is left smaller so you can not eat
as much but are STILL absorbing less that is why distal i usualy reseved
for the more severly obese....
bekka
— bekka K.
January 26, 2003
oh also the DS is not newer...just done less often because of the
signifigant malabsorbation issues...and i am not saying it is a bad surgery
just that that is why it is done less frequently and why alot of insurance
question there coverage of it ....
bekka
— bekka K.
January 26, 2003
Terrie, I have the impression that the type of surgery you should choose
depends on where you are now (M.O. or super-M.O.), what your pre-op eating
and exercise habits are, and how willing/able you are to change those
habits as a post-op. The more you have to lose, the more seriously you
should consider a distal RNY or DS (and this is just my uneducated
impression!).<P>At a BMI of 49, I don't think you need to go
"distal" to get to goal, but a lot may depend on how committed
you feel you will be, as a post-op, to making permanent changes in eating
and exercise habits. I have seen other DS'ers post and say that they eat
whatever they want and don't see the re-gains that some RNY or band people
get. That leaves me wondering if they're actually saying, "Hey, you
don't need to change your eating habits if you have DS" (with the big
exception of the absolute need to stay on top of your supplements). With
the exception of surgical failures, which are relatively uncommon, I think
many of us regain because we have a hard time holding onto the good habits
we learned (or should have learned) as early post-ops.<P>I know that
my pre-op eating habits were terrible -- binging on huge amounts of carbs
and fats, despite knowing darned well how I *should* have been eating. And
of course, little or no exercise, because I was tired and depressed all the
time, because my nutrition was bad and I felt bad for having no control
over food. At a starting BMI of 42, I wasn't an appropriate candidate for
a distal RNY or DS anyway, but -- oh, PLEASE don't flame meeee) -- I also
had no interest in any type of surgery that would "enable" me to
continue eating so poorly. I gotta believe most DSers, like the RNYers and
banders, "get religion" about their health and become more
serious about what they eat as a result of undergoing WLS. Especially
since they've got to be dead-on serious about their supplements, as we all
should be. Any DSers care to comment?
— Suzy C.
January 26, 2003
Bekka, I didn't mean to imply that you shouldn't "listen" to your
surgeon. I absolutely think you should. Listen very carefully, ask
questions, take notes, and then go do your own research. What I intended to
communicate is that you should not let your surgeon have the final word. If
you're not happy with the answers you're getting or the options that are
being presented, find a different surgeon. This decision is too important
and life-altering to let a doctor make the big calls for you. And I'm not
implying that people should run off and demand a distal RNY. I agree that
wouldn't be the best choice for most "lightweights." However, I
think that everyone needs to know about all of their options, and not rule
anything out just because their surgeon doesn't offer a particular
procedure or variation. The proximal RNY can be very successful for many
people, but there are *significant* issues with late regain of weight for a
large minority of patients. I think people need to know that going in, and
they need to factor it into their decision-making process.
<br><br>
And, I'm sorry, but your information about the DS not being newer than the
RNY is incorrect. The first BPD-DS was performed in 1988 by Dr. Douglas
Hess. It has an excellent 15-year track record at this point, but insurance
companies are reluctant to pay for anything they don't have to, and some of
them are still trying to get away with calling it
"investigational." It won't work forever -- too many patients and
surgeons LOVE this surgery and won't settle for less.
— Tally
January 26, 2003
Ya know, this whole idea anyone can "get religion" after any WLS
and somehow change (for the rest of their life) their eating behavior is a
fallacy of gargantuan proportions, in my opinion. How many of us have
dieted successfully in the past? How many of us have KEPT the weight off?
Very few. And the reason diets ultimately fail is the very same reason that
some WLS procedures have more long-term regain than others. Having WLS
doesn't suddenly turn us into food saints. Someway, someday down the line,
the old tendencies will return. Perhaps the restriction and dumping will
help curb those tendencies. Perhaps not. WIth little malabsorption, you are
completely dependent on behavior modification to stay successful. I didn't
want to be in that position. I knew myself better than that. With the DS
procedure, my observation for nearly 4 years now has been that we don't
have to fundamentally change our food behavior very much. The stomach never
expands to pre-op size, so we cannot continue to eat the same quantity of
food as pre-op. At the same time, there is significant malabsorption of
fats (this selective malabsorption is unique to the BPD and DS), and
moderate malabsorption of protein, carbs and other nutrients. We don't
malabsorb sugar, but we'd have to work very hard to sabotage ourselves with
sugar. It's no joke. This procedure gives us NORMAL better than any other
option, and normal includes being just as imperfect as the never-been-fat
person standing next to you people.
— mmagruder
January 26, 2003
tally
thanks for slarifying that it seem we actualy shre the same opinion after
all just needed a little clarification ...i agree with you that you need to
100% educate yourself and know what you need but your doc does have to play
arole in you choices...also also i consider that since the ds has been here
since 88 rather then say the lap band wich Just had fda aprooval in july
last summer that it is not a NEWER surgery....and has been preformed enough
here ion the states for insuraces and doctors to gather pertainant info on
its outcomes both good and bad....and most insurances will look vey very
closly at aproval for this surgery do to the signifigant malabsorbtion
factor...they need to KNOW that the patient can be 100% compiant with the
nutritnal suplements because of the type of procedure it is . so i wanted
to clarify what i meant by it is not a newer surgery
bekka
j
— bekka K.
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