Question:
this is for the doctors on the site
For the doctors.... why is it that most doctors are performing the RNY and not the duodenal switch? For those of us who have had the DS and have researched WLS ad nauseum feel this is a superior intervention in comparison to the RNY. Also, regarding open surgeries, why is it that all North American physicians (from my understanding) do vertical incisions? I had a transverse incision about 2.5" above my navel and did not have a hard time with it. No morphine pump, no epidural...only one pain shot the whole time I was in the hospital. I was in for 7 days due to the distance I had to travel (from Germany to Spain). Do you think the transverse incision contributed to my feeling so well after surgery? Thank you for your time. Kris — Kris S. (posted on September 12, 1999)
September 14, 1999
Duodenal switch is a lot more surgery than the RNY, with a long gastric
staple line.
Also, it relies on malabsorption to effect weight loss to a greater extent
than
the RNY, which could lead to, in my mind, nutritional deficiencies of
vitamins and minerals
to a greater extent than RNY. That is why I won't do it until I see a long
term followup
study from a couple of centers.
— Bruce B.
September 14, 1999
Thanks for answering my question, Dr. Bodner. You know that this type of
surgery has been going on for about 22 years so far, right? Have you tried
contacting physicians who have performed this surgery? My surgeon has been
performing this type of surgery for over 14 years and is always happy to
share his stats with anyone. His email address is [email protected]
In addition, could you please address the question about transverse
incisions?
Thank you! Kris
— Kris S.
September 15, 1999
I am confused, Dr, why you say that absorption is not as good with
the DS - in the DS, some of the duodenum where
vitamins are absorbed is left connected. Would the malabsorption
be worse with the RNY where no duodenum remains and there is
little to no absorption of vitamins etc? Also, the stimulus
which gets several digestive enzymes to flowing is the
presence of food in the duodenum. Would not those enzymes
flow better in the duodenal switch where some of the duodenum
is left attached and functional than in the classic RNY
where no duodenum remains attached? As for absorption of
digested nutriants, even though the DS is distal, quite a
bit of intestine is left in tact - my understanding is that
in all gastric bypasses, the malabsorption is accomplished
through the chyme not getting digested rather than the
inability to absorb (as was true in the earlier 'intestinal bypass'
which only left 12 inches or so, of small intestine). Your
explanation would be appreciated. Thanks.
— [Anonymous]
September 21, 1999
Just to make sure that we are talking about the same surgery, you are
referring to the Biliopancreatic bypass and duodenal switch? I hope so...
<G> That's what I'm going to talk about. I am NOT a doctor, so be
warned. I am, however, going in for that particular surgery just as soon
as I win the lawsuit with my insurance company. The reasons why most
doctors feel that the BP bypass and DS is not as healthy is due to the
original surgery that the current one is based loosely off of. The jejunal
ileal bypass was probably one of the worst surgeries ever done in the
history of WLS. I only know of one patient who is still alive after going
through his (he's a cousin of a friend of mine who just had the new,
updated version and is doing great), and even though he has to eat 6,000
calories a day, and has massive gas and diarrhea, he has stated that if he
had to do it all over again, and be forced to choose between being obese
and having that surgery, he'd have that surgery.
Unlike the jejunal ileal bypass, the Biliopancreatic Bypass is actually
quite safe, and the success rate has been reported so far to be as high as
the Roux-n-y surgery. The doctor I'm having the surgery from, Dr.
McConnall, is only one of 9 in the US that do this surgery, and has managed
(in my mind) perfect the surgery. He has actually found a way to measure
out the intestine so that there are very little, if any, side effects
(vomiting, gas) but still a high weight loss rate (up to 80% excess gone
after 18 months).
The surgery itself consists of cutting the excess stomach physically off,
leaving a long tube about 150cc's large. This allows for the stomach to
have a typical grinding action. Then, about 5cm down from the duodenum,
the small intestine is cut. The duodenum side is then re-attached about
100-150cm up from the colon (this length depends upon how much weight the
patient needs to lose, and what their health conditions are), and the small
intestine is hooked up to the pancreas to shunt those juices into the lower
intestine. Everything works relatively "normal", and weight loss
is mainly achieved by malabsorbtion. Dr. McConnal does NOT recommend this
for anyone who's BMI is under 45, as he feels (and most probably correctly)
that the malabsorbtion would be too severe for patients with BMI's lower
than that.
I'm sure other Dr's may wonder why I would choose this surgery over the
Roux-n-y, and I'm happy to tell you. I researched this for a year before I
put up the idea to my PCP. I also found that, while my insurance would not
cover VGB or stapling (any form of Roux-n-y), they would cover obesity
surgery if the patient's life would be measurably improved. On top of
this, I currently go to a support group, and every one of the patients
there who've had the Roux-n-y has had some form of physical problem forcing
them back into the hospital and under the knife again. I want ONE scar,
and one scar only, thank you. Besides the fact that, if the insurance
covers obesity surgery, they will ONLY cover it once... Anything else is
yours to pay for. Those patients I've met who had the biliopancreatic,
have had relatively no side effects, are leading perfectly normal lives,
and are losing amazing amounts of weight while looking and feeling great.
It's up to you. I agree, however, choose what feels right for YOU. It's
your body. --Molly
— Molly S.
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