Common channel length RNY vs DS

Tying to prepare my argument for a revision to the DS.  Can someone tell me what is the average bypassed amount for each surgery?

Read the studies on DS and that the research is based on 100cc.

From my understanding the longer the length the more nutritional issues you have.

I am wanting my surgeon to do the DS with a common channel about the same as the RNY, but don't know if that is possible.

There are surgeons doing DS with a 200cm common channel. The longer the common channel (where food and digestive juices mix), the more nutrients you are suppose to be able to absorb. You still have the same vitamin and mineral issues an RNYr  has, such as A, D, E, K, calcium and iron. The jury may still be out as far as long term success for the majority of patients with the longer common channels. It's been so far so good for the few folks here that have the longer common channel.
Gina
 

It is possible - I have it, though unintentionally. My weight loss is fine so far, but I fear whether I will be able to maintain my loss long-term, which is really the biggest selling point of the DS, IMO (well, maybe after comorbidity resolution). I do not cherish the idea of possibly requiring a future revision to shorten my common channel to what it should have been in the first place.

 From what I've seen printed and written on OH, I think there's a difference in how RNYers and DSers define their small bowel plumbing. RNYers generally talk about how much small bowel is bypassed where as DSers talk about how long their common channel is. When you're talking about a common channel of 100 cm for the DS, that means there is only 100 cm of small bowel where food and bile are mixed. RNY 100 cm bypass means that there is 100 cm of small bowel that is bypassed where food doesn't go through it.

It's a bit complicated; and to really understand what the DS does you need to study this page:

http://www.dsfacts.com/duodenal-switch-procedure.html

In my case, I had a small bowel length of 730 cm which was divided into an alimentary limb of 175 cm and biliary limb of 430 cm and a common channel of 125 cm; my stomach was reduced to a volume of 130 mL.

Trying to define my plumbing in the same terms as you would a RNY procedure would be pretty difficult unless you're talking about a Distal RNY where more small bowel is bypassed than is usually done in a Proximal RNY. 

It takes a bit of reading and study to get this all straight, so I recommend you do just that, read and study up everything you can find @ www.dsfacts.com and www.duodenalswitch.com 

Kerry

I'm not understanding why you want to fix what ain't broke here?  If you want regular restriction, why bother getting a DS at all?  The malabsorption of the RNY is compensated by the body after only a couple of years.

Just to expand on what Val stated since she brought up another excellent point, you will still malabsorb NUTRIENTS (vitamins and minerals), so you will have to take supplements for life, but you will not always malabsorb CALORIES, which is why the DS has MORE bypassed - to ensure malabsorption of calories long term, which likely plays a role in maintenance of weight loss.

I want the DS with less issues.  Dr. Barker said something about 250... which I guess is confusing me.  But if the RNY and DS measure things differently, I am going to have to learn some math!!!

A 250cm common channel would provide less malabsorption than a typical DS yet more malabsorption than a typical proximal RNY. That is, assuming you have an average length (or longer) total small bowel.

I am confused by a lot of this post.... so, what would help me is to know what you mean by "less issues".  Nutrient absorption issues?  Calorie absorption long term?  Malabsorption rates of protein, fat, and/or carbs?  Possible bowel issues that the RnY surgeons try to scare potential DSers with?  Gas issues?

" From my understanding the longer the length the more nutritional issues you have. "

In theory, and this is completely individual and no surgeon has a crystal ball to know in advance how your individual system will respond, but this statement is wrong --- it needs to be exactly the opposite.  The longer your common channel (your common channel is where your food meets up with the digestive juices and where absorption takes place (except for sugars, which start in the mouth --- and I am simplifying this just to serve as an example) -- the more you will absorb, calories and nutrients.... thus the less nutritional issues you should have.

Yes, the basic common channel is 100cm, but this varies by surgeon, how a surgeon determines the common channel (Hess method or simple measurement), it varies by open -vs- lap (lap will be more approximate), and it varies by the needs of the individual and if enough intestine is available to bypass.

As you see, this is a complex procedure --- thus the need for a VERY experienced DS surgeon, and a lot of thought about what YOU will need based upon a true understanding of what you do know about your eating habits and metabolism should be an in depth conversation with a skilled DS surgeon.

I don't know what "issues" you're worried about, but most DSers like me have no "issues" what so ever. Not only that, but just because someone has a longer common channel is no guarantee they will not have some "issues". We have seen people with longer common channels have "issues" and people with short common channels have no "issues". We're all different and how your body will react to the revised plumbing of the DS is any ones guess.

If the "issues" you're talking about are bathroom related; it's literally a real crap shoot and there is no way to tell what you will have. For me, I have no "issues"; my habits are somewhat different than they were with the old RNY, but in most cases I consider them to be better. I'm much more regular than I ever was before; I can almost set my watch by when it's time to go. I always get up at 5:00AM and I go once; big time and always by 5:30AM, then sometimes a hour or so later another fini**** off poo and then I'm done for the day. The one thing that is a little worse is the propensity to get gassy if I eat certain foods; this is completely controllable, but it is there. If I eat a plate of Pasta like I did last night, within 2 hours, I'm making gas like no body's business. It's not particularly smelly, but there is a large volume and in the right company something you can really brag about; other company, not so much.

If your "issues" are about taking supplements, well, you're just going to have to be prepared to deal with those issues. You need to take supplements no matter which WLS you choose. To me, whether I take 16 pills or 20 pills a day makes no difference; I'll take as many as I need to take to be healthy.

Kerry