Question:
Information on the RNY procedure ....

Information on the RNY procedure for our Members Deciding!! Open Roux en Y (Rny) The Stomach is separated into two parts. The small Stomach pouch(A)receives food. The lower part of the stomach(B) received most of the gastric juices coming from the liver and other organs. The small intestine is carefully measured and cut.One end(C) is connected to the small stomach pouch. The other end(D) is reconnected to the small intestine, forming a "Y". Roux-en-y Gastric Bypass Surgery offers a successful combination of weight control with minimal nutritional or other risk, when follow up and nutritional guidelines are followed. Many obesity experts consider the surgery to be the "Gold Standard" of modern obesity surgery the benchmark to which other bariatric operations are compared. The operation achieves its effects by creating a very small stomach, from which the rest of the stomach is divided and separated. The small intestine is "attached" to the new stomach, allowing the lower pan of the stomach to be bypassed. A thorough description, including diagrams, of the operation will be provided to you during your consultation or as part of the free seminar we encourage potential patients to attend. Suffice to say, that no bodily functions are altered as a result of the operation, and it is completely reversible if it ever needed to be. Complete descriptions with illustrations of the surgery are presented by your surgeon at time of consultation. Following surgery, there is little interference with normal absorption of food. The operation restricts food intake and reduces the feeling of hunger. The result is an early sense of "fullness" followed by a sense of satisfaction. Even though the portion size is small (2 to 6 ounces per serving), there is no hunger and no sense of being deprived. Patients continue to enjoy eating all types of food after surgery. They just eat a much smaller portion than they used to. The Roux-en-y Gastric Bypass is an excellent tool for achieving longterm control of morbid obesity (the state of being 100 or more pounds over ideal body weight). Weight loss of 80-100% is achievable by most patients, as internal and external outcome studies demonstrate. The Roux-en-Y Gastric Bypass Surgery helps you lose weight in three ways 1. You eat less (Volume restriction) With a separate small stomach pouch, you feel full after eating a small amount of food. This approach is much more effective in restricting food volume than other surgical techniques, such as stomach stapling. 2. Your appetite changes (Behavior modification) The procedure reinforces a change in your eating habits. After the procedure, most patients find that their body will not easily tolerate foods that are high in refined sugars and fats. With this built-in control, called "the dumping syndrome," which produces short-term discomfort and flu-like symptoms, you naturally learn to avoid these foods. (Our Bariatric Treatment Centers nutritionists help you avoid the foods that may cause discomfort and help you choose from a wide variety of foods you can enjoy.) Other surgical procedures don't provide this important benefit of behavior modification. 3. You absorb fewer calories (Malabsorption) Food bypasses part of the small intestine and digestion occurs in the lower part of the small intestine. These two factors reduce the amount of calories your body absorbs from the food you eat. The reduced stomach pouch size, change in eating habits and absorption of fewer calories allow patients to be successful at long-term weight loss, as opposed to short-term weight loss programs or diets that rely on willpower, costly meal replacements, or dietary supplements. ============================================================ Laparoscopic Roux-en-Y same as open Roux-en-Y except instead of opening you with a long incision on your stomach, Surgeons use a pencil thin optical telescope, to project a picture to a TV monitor. Having surgery this way, smaller scars , usually 3 to 4 small incisions. Quicker recovery time and less pain. ============================================================ Distal Gastric Bypass The Gastric Bypass operation can be modified, to alter absorption of food, be moving the Y-connection downstream ("distally"), effectively shortening the bowel available for absorption of food. The weight loss effect is then a combination of the very small stomach, which limits intake of food, with malabsorption of the nutrients which are eaten, reducing caloric intake even further. Patients have increased frequency of bowel movements and increased fat in their stools (bowel movements). The odor of bowel gas is very strong, which can cause social problems or embarrassment. Calcium absorption may be impaired, as well as absorption of vitamins, particularly those which are soluble in fat (Vitamins A, D, and E). Vitamin supplements must be used daily, and failure to follow the prescribed diet and supplement regimen can lead to serious nutritional problems in a small percentage of patients. We. and others, have noted an increased incidence of ulcers post-operatively, in patients having this procedure. Michelle C. a/k/a www.Vitalady.com has had the most distal of RNY ask her about this surgery she seems to be doing just fine.. ;-) — Victoria B. (posted on April 6, 2000)

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April 6, 2000
Thank you for posting.
— Lady C.

April 6, 2000
Vicki, thanks for your post! I want to add a word of caution to people reading this report. The phrase, "Weight loss of 80-100% is achievable by most patients, as internal and external outcome studies demonstrate," does not conflict with Vicki's earlier postings on this matter, which demonstrated a lower average weight loss. While most patients (which means 50% or more of patients) lose 80%-100% of their excess weight, many lose considerably less, which makes the average weight loss lower. This should clarify the discrepencies between Vicki's posts. Standard disclaimer: WLS is a tool, and how much you lose is dependent, to a large extent, on your willingness to exercise in conjunction with your new eating habits, in addition to the type of surgery you choose.
— Kim H.

April 6, 2000
Kim: Your're welcome... Yes. Kim, this is accurate as to their finding: Weight loss of 80-100% is achievable by most patients, as internal and external outcome studies demonstrate This was from the Right Weight Clinic: And this is their Study I suggest if you doubt their finding,,Write them!!! I'll continue to post Anything I find of interest to the members...
— Victoria B.

April 6, 2000
Kim: States; WLS is a tool, and how much you lose is dependent, to a large extent, on your willingness to exercise in conjunction with your new eating habits, in addition to the type of surgery you choose. I totally agree Kim.. As in any surgery type we have to dedicate ourselves to using that tool the rest is up to us.. good point. ;-)
— Victoria B.

April 6, 2000
Please, please, please check out www.asbs.com. Read and research this surgery for yourselves. This is the only way to filter possibly incorrect information.
— Courtrina Amur W.

April 6, 2000
Courtrina: I absolutely agree, every chance I get I post the findings from ASBS website..It's a very informational site. If you look at my last posting most information came from that site on the different surgery types. Excellent source of information..
— Victoria B.

April 6, 2000
I'd like to warn people considering a specific surgery type need to use a little caution when evaluating responses to questions - for example, not all responses here are from people that have had the rny and may not have the knowledge and experience that someone that actually chose this procedure could offer. For myself, 'I generally' would not respond to a post about a surgery type that I did not personally have, yet if I felt I could contribute something, I would preface my remarks to indicate that I had another type of wls surgery than the one I was providing info about. Opinions are extremely valuable in evaluation -- sometimes you need the facts, too. Just a suggestion.
— Toni B.

April 6, 2000
Vicki - I don't question for a moment the accuracy of their statement "Weight loss of 80-100% is achievable by most patients, as internal and external outcome studies demonstrate." Let me clarify my point. If you have a group of 100 people, and 33 of them lose 50% of their excess weight, 33 lose 60% and 34 lose 80-100%, then you can truthfully and accurately say that the most people lose 80-100% of their excess weight. I only caution that people read ALL information that doesn't come from peer-reviewed sources with a critical eye. But this is just the biostatistician in me coming out. :-)
— Kim H.

April 7, 2000
I think what's important to note is that statistics can be massaged, depending on the stance of the researcher. Having access to the data would definitely paint a clearer picture. We also have to remember that the majority of people who post on this site are not MDs and their responses, though highly valued and greatly appreciated, should be corroborated with an inquiring individual's surgeon(s) of choice. There are so many variables from individual to individual - pre-op height/weight, age, comorbidities, preexisting health problems unrelated to morbid obesity, eating habits, post-operative motivation to adhere to diet and exercise, etc. We're all different people with different needs, and we can't expect one surgery to be pre-packaged to fit us all. Maybe Eric should add a disclaimer as a heading on the Q&A page that members should not construe posts and responses as medical advice. Vicki keeps up on the latest publications, and it's great that she is willing to post them on AMOS for us to conveniently read. Perhaps other members who have the time to research would be willing to do the same.
— [Deactivated Member]

April 7, 2000
I agree that the website ASBS.org is probably one of the very best, professionally accurate, and most reliable site for information about weight loss surgery. And I encourage everyone I communicate with to check out that site first before any others! But (you knew there was something else, right?) in spite of their very accurate and educational information about the RNY there is a woefully dismal amount of information about the BilioPancreatic Diversion- Duodenal Switch. Yes there is information about the BPD but that is NOT the same thing as the BPD-DS and it is the DS which is the modern updated operation performed by almost every surgeon who offers BPD-DS. So sadly, if I refer a person to asbs.org because of all the great information, I always have to clarify the BPD vs BPD-DS. It is so confusing to people who truly have no idea about these types of surgery and so, who could blame someone for being confused. We have to lobby for more DS information in place of this helpful but obolete information on BPD classic.
— Fran B.

April 30, 2000
I ran across a rather disturbing webpage from a Nutrition Support Specialist.. I found it to be the most misinformed outdated ONE way thinking piece of garbage I have ever read concerning WLS Surgery. I responded to her commentary with a rather lengthy e-mail I hope you all do the same.. http://www.nutrigenesis.com/WLsurgery.htm Her e-mail address is: [email protected]
— Victoria B.

April 30, 2000
Vickie, thanks for the info on the web site below. I went out to the site and I have to agree with you...it is a piece of garbage. I have sent an e-mail with my opinion to them. If anyone would like to see what I wrote, please let me know [email protected]. Thanks!
— heidiinPA

April 30, 2000
I went to the site mentioned and as I expected, when you click on the home page, it is a site selling another weight loss product. Well if these products worked, we all wouldn't be here would we??? Most supplements and catalysts, I believe, only work at all based on the fact that you are dieting along with it and psychologically I think you make the product work to justify spending money on it. In the long rtun, when old habits come back into play, the weight loss stops or gain is inevitable.
— [Anonymous]

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