Different types of RNY?

I just read a post by someone who said they had a Minimal RNY and I've seen posts regarding proximal and distal RNYs.  Can anyone explain the difference and why you would do one over the other?

I'm schedule for RNY on 2/26 but we never talked about what type of RNY I was having. 

Thanks

Deb

Most RNYs done these days are proximal. 'Proximal' simply means 'near to', in this case the stomach, and 'distal' means 'distant from'. It refers to how much of the small intestine is bypassed.

Obviously, the more bypassed, the more malabsorption there is. Because of bad outcomes with much malabsorption of certain vitamins and minerals, especially when patients either aren't compliant with taking the necessary supplements or are never educated about that sorts of supplements they need, most surgeons only do proximal RNYs. This means there's very little malabsorption of calories, and even that is temporary.

You might want to spend the next few weeks reading about the various forms of WLS to be certain you're choosing the best one for your needs, especially since so many insurance companies are putting a lifetime limit on WLS to one per customer.

Well!  THIS explains why I'm losing so slow!!  I was telling my husband yesterday that I'd be losing the same amount (probably more) by eating the same amount of calories WITHOUT having had the RNY!!  I feel like I don't have any malabsorption.  If I had, I would have lost a lot more while eating 600-800 cals per day!  It's really been frustrating me, but I am getting smaller...just a lot slower than I had hoped.

At least I'm not hungry all the time!  I get full quickly and I'm satisfied with small amounts of food!  That's ALL due to RNY.

In addition to Ms Batt's details, I've also heard of "Medial" where they bypass a little more than Proximal, but less than Distal.  This minimal term, though, is  a new one to me.

That was my post you read.  Over the years I have learned that people received 1/2 to 4 oz. pouches, 40 cm to 250cm bypassed and different size stomas to begin with.  Often the surgeon does not tell the patient what they are going to do before surgery.  I had a 2 oz. pouch, large stoma hole punch (he told me he started using a smaller punch after me), and 70 to 100 cm bypassed.  It really never helped me.  I needed more restriction and malabsorption.  Like you, I knew I was getting a RNY and assumed a 1 oz. pouch, 150 cm bypass and a little stoma.  I didn't ask because I didn't know they are different.  I finally decided to go for a revision and learned my insurance company has a once in a lifetime policy.  BCBS does also (I have Humana).  Others will probably follow.  We need to be given an informed consent before surgery.  Dr. Roslin in NY who does revisions said that saving the pyloric valve (as in the VSG and DS or some new surgery) will probably replace the RNY.  Tri

I finally decided to go for a revision and learned my insurance company has a once in a lifetime policy.  BCBS does also (I have Humana).  Others will probably follow.

You are probably correct but some of it also depends on what the company BUYING the insurance is willing to put in their version of the policy.

And THAT may be the key to get revised...looking at the copy of the policy YOU have from your Human Resources dept. See if there is ANY wiggle room.

Liz

I don't know the measurements in those terms.  They said the pouch would be egg-sized after surgery, 1/4 cup at 3 months, 1/2 cup at 6 months and 1 cup after a year.  They said it can be stretched further if you are not following the lifestyle.

I do have a 2nd opinion tomorrow but this doctor really feels DS is too malabsorptive for my size and he won't do it.  I lost some weight and my BMI was down to 39 at the last appointment and I have lost another 3 lbs.  He is concerned I will be too thin.

My appointment tomorrow is with a doctor who is know for DS so I'm curious to see what he says.  I did speak with his NP and she also said the DS is not for everyone....so we'll see....

Deb

She's right when she says the DS isn't for everyone---but she's wrong when she says it's based on size. I know lots of folks who've had a DS with a lower BMI than you, and they're not too thin.

The DS absolutely requires good compliance with taking vites and supps, and getting---and understanding!---labwork. People who won't or can't do this absolutely should NOT get a DS.

This doctor who says the DS is too malabsorptive for you---who is he? Sadly, there are a lot of "bait and don't Switch" surgeons out there who clam to do the DS, but once you're in their office they find all sorts of reasons they shouldn't do it for YOU.

Honestly, if the DS it "too malabsorptive", maybe you should be looking at the Sleeve. The more time I spend reading here and on other WLS-centered boards, the more long-term problems I see people with the RNY having, and they're mostly related to bypassing the pylorus. I can totally see the RNY being phased out in favor of the Sleeve. There's a lot of be said for continuing to have a fully-functional stomach.

She's right when she says the DS isn't for everyone---but she's wrong when she says it's based on size. I know lots of folks who've had a DS with a lower BMI than you, and they're not too thin.

And my husband and I are TWO of them! His pre-op BMI was 38, mine was 35.2. Both of us reached a normal BMI in the first year. My current weight is 131 and my BMI is a 22.5 now, dh is a BMI of 22.9.

He's 25 months out, I hit 24 months in a week.

When did you get your surgery done?  I spoke to the NP at the doctor whom I have a 2nd opinion tomorrow.  She said her surgery was 10 years ago and they have changed the surgery greatly since then although she maintains her weightloss.

deb