RNY "proximal" ????

I've looked all over to find the definition of Proximal and not really sure what it means....  are there different types of RNY surgeries?? and open and laproscopic is all i know.... hope someone clarifies  pls  thanks!!! ~Kelly

There's going to be some that have much better definitions than me, but there are 3 types of RNY: proximal, medial, and distal.  They refer to how much small intestine was bypassed.  Proximal is the least, medial is "middle", and distal is the most.  Each refers to a specific amount of centimeters, I believe - but I don't know them off the top of my head. One last tip - go buy Weight Loss Surgery for Dummies!  It has SO much valuable info - including this.

Where are you in WA? We have 3 support groups/mo in Puyallup. Next batch are the Tues/Wed/Thurs of the 2/14 week. Thursday is bands only.

I'll hang my own amatuer definition of distal vs proximal. If the amount bypassed is what is known, it is a proximal, by definition, since the measure is from the top, IN CLOSE PROXIMITY to the stomch. With distal, it's measured from the colon or AT A FAR DISTANCE from the stomach.

Another hint is that laps are always proximal, be it shorty proximal or what they call long limb proximal.

OK, here's my canned version:

Let's assume that we all start with 300" of (small) intestine. We don't, but we need to have a figure, so that's it. From the pix you've seen of RNY/gastric bypass, you know there is a left side, right side and tail of the Y. The "junction" of the sides is the determiner if a procedure is proximal or distal.

The original intestine comes out of the old stomach and carries the digestive juices that are manufactured in the old stomach. This piece is called the bileo-pancreatic limb because it carries bile from the gallbladder and pancreatic juice from the pancreas. There is no food here.
This is the LEFT side of the Y. This is the portion that is bypassed.

The alimentary limb connects to the pouch and only carries food, but cannot digest or absorb. This is the RIGHT side of the Y.

The tail of the Y is where both elements mix together and where digestion (if any) and whatever absorption will occur. This is the part that is still in use and is also referred to as the common channel.

If the junction of the Y occurs in near proximity to the stomach, it is said to be proximal. If the junction occurs as a far distance from the stomach, it is said to be distal. That said, neither word describes any actual measurements of anything, so the meaning is in the mind of the person speaking of the procedure. What is proximal to my doctor is considered distal by another.

Generally speaking, ALL RNY people will have to supplement at least the basic 8 elements*, though in varying doses. We are all missing the stomach and its normal digestive function.

Truly distal (with a lot bypassed, and a short common channel) people need to supplement in larger volume, but will achieve and maintain the better weight loss over time. Proximal (less bypassed, longer common channel) people still need to supplement the basics and can reach a reasonable weight, but after 2 years may have to work a little harder to maintain their goal weight.

My doctor measures what is in use, not what is not. So, in my case, I have a 40" common channel, then 60" was used to reach the pouch. The bypassed portion is then ABOUT 200".

Most procedures performed are measured backwards from that. The doctor will bypass 12 to 72", use 60-80" for the right side of the Y, and the common channel will be 100-200".

* the basic 8
protein
iron
calcium
A
D
E
zinc
B12

These need to be supplemented in specific ways to help absorption.

We also malabsorb SOME fats/oils and complex carbs.

We never, ever malabsorb sugar.

Some will have to supplement potassium or magnesium, but not everyone.

BTW, there are fewer than a half dozen surgeons in the US who do actual distal RNY.

The proximal guys may offer varying limb lengths of their proximals

Hello Kelly, Proximal means closer to the core of your body or the area in which the doctor is working. For instance, your elbow is proximal to your shoulder and your hand is distal to your shoulder. I hope this makes sence... Wendi

Actually, they use the heart as a reference.  Proximal is closest to the heart, distal is furthest away

 

Proximal is around 80cm or less bypassed, distal is around 150cm or more bypassed with medial landing in the middle... I dont believe there is a "set" answer, some people say 150cm is still medial with around 175cm+ being more on the distal side. No matter how much is bypassed we all achieve the same results - we all have the same chance to lose weight and keep it off - one is not more successful than other. However, typically those with more bypassed will lose quicker because they experience more malabsorption, but again we all get the same end result. Some people always want the most thinking its the best and that isnt always the case :-)

great info ladies!.......