How much small bowel is bypassed with RNY?
There's a lot of discussion about RNY malabsorption and I've looked and looked to try and find how much small bowel is bypassed with proximal RNY, with little success. When you look at the illustrations of how RNY is done, it looks like there is somewhere between 10-20 cm bypassed, but I can't find any numbers to confirm this.
If you have your surgical notes, please read them and let us know how much of your small bowel was bypassed. This should give you and everyone a good idea of how much malabsorption you really get with RNY.
I don't have anything from my 1980 bypass, so I don't know how much was bypassed back then, but I do have them from my revision to DS and I have 430 cm of small bowel bypassed of a total of 730 cm.
To be quite honest, I just do not think a proximal RNY has much if any caloric malabsorption. I know it's talked about as if there is, but I really can't see how that's possible with so little small bowel being bypassed. It makes no difference to me either way, but I think it's important to know and understand how your surgery really works and not just pass hearsay and myths on.
When I look at how the surgery is done, it seems clear to me that you lose weight with RNY for the first year or so because you can't eat enough to maintain or gain weight; as your pouch stretches, you eat more and your weight loss slows, then stops, then you battle the re-gain.
My personal experience with gastric bypass was just what now seems so clear to me, but at the time, I didn't have a clue what was really going on. The surgeon who did my bypass, was disbarred within about 6 months of when I had the surgery done and I only saw him once after the surgery and that was about a month after. He never counseled me or explained much about how the surgery would work, so I just sort of figured things out as I went.
Some of your RNYers may look at this as an attack, but that's just silly. I would think anyone who has gone through WLS would want to know and understand how their surgery actually works and not rely on hearsay and myth. The important thing is to live your life as healthy and happy as you can and to do this, knowledge is power. This is all about gaining knowledge about how RNY really works.
So the question is; how much of your small intestine was bypassed?
Kerry
If you have your surgical notes, please read them and let us know how much of your small bowel was bypassed. This should give you and everyone a good idea of how much malabsorption you really get with RNY.
I don't have anything from my 1980 bypass, so I don't know how much was bypassed back then, but I do have them from my revision to DS and I have 430 cm of small bowel bypassed of a total of 730 cm.
To be quite honest, I just do not think a proximal RNY has much if any caloric malabsorption. I know it's talked about as if there is, but I really can't see how that's possible with so little small bowel being bypassed. It makes no difference to me either way, but I think it's important to know and understand how your surgery really works and not just pass hearsay and myths on.
When I look at how the surgery is done, it seems clear to me that you lose weight with RNY for the first year or so because you can't eat enough to maintain or gain weight; as your pouch stretches, you eat more and your weight loss slows, then stops, then you battle the re-gain.
My personal experience with gastric bypass was just what now seems so clear to me, but at the time, I didn't have a clue what was really going on. The surgeon who did my bypass, was disbarred within about 6 months of when I had the surgery done and I only saw him once after the surgery and that was about a month after. He never counseled me or explained much about how the surgery would work, so I just sort of figured things out as I went.
Some of your RNYers may look at this as an attack, but that's just silly. I would think anyone who has gone through WLS would want to know and understand how their surgery actually works and not rely on hearsay and myth. The important thing is to live your life as healthy and happy as you can and to do this, knowledge is power. This is all about gaining knowledge about how RNY really works.
So the question is; how much of your small intestine was bypassed?
Kerry
There are two types of RNY; proximal and distal. Proximal bypasses a smaller section and, in my understanding, is more widely used. You generally los about 18in (30cm) in this proximal.
The intestine is divided approximately 18-inches (30-centimeters) into the small bowel. A40-inch (100-centimeter) Roux limb of small intestine is created and attached to the stomach pouch.
http://www.ohiohealth.com/freshstartbody_3.cfm?id=4293
The intestine is divided approximately 18-inches (30-centimeters) into the small bowel. A40-inch (100-centimeter) Roux limb of small intestine is created and attached to the stomach pouch.
http://www.ohiohealth.com/freshstartbody_3.cfm?id=4293
That sounds like what I'm seeing and reading Tony. I think a lot of people think they have more bypass than they do because their surgeon tells them a figure that's the combination of bypass and Roux limb.
It also squares with what this looks like:
www.baileybariatrics.com/img/rny.jpg
Kerry
It also squares with what this looks like:
www.baileybariatrics.com/img/rny.jpg
Kerry
To answer your question, I have no idea but since I am going to see my surgeon today, guess what I am going to ask him.
I have read quite a few of your posts and understand your dismay at your rny several years ago. My question to you and I mean this with no disrespect but do you think at all, there is a possibility that the surgery may have progressed since you originally had it? You had mentioned your surgeon was disbarred in your post, could he/she had made a mistake? I would be angry had I been in your shoes and gone through what you went through.
However, I do not believe that one surgery is the best for everyone. I researched all groups and I know what was available to me through my insurance. I chose what I think was best for me, and I know I am still a babe in the woods being this early out. But I assure you that many at my support group, which is held at the hospital, are several years out and doing quite well. (10 years +) and even then I know that science and surgery is ever evolving.
No one likes to be insulted or have "my surgery is better than yours" shoved down their throats and you don't seem to be doing that in this post. But I am curious, why do you ask this question since you have had your revision and are happier with it.
All my best.
I have read quite a few of your posts and understand your dismay at your rny several years ago. My question to you and I mean this with no disrespect but do you think at all, there is a possibility that the surgery may have progressed since you originally had it? You had mentioned your surgeon was disbarred in your post, could he/she had made a mistake? I would be angry had I been in your shoes and gone through what you went through.
However, I do not believe that one surgery is the best for everyone. I researched all groups and I know what was available to me through my insurance. I chose what I think was best for me, and I know I am still a babe in the woods being this early out. But I assure you that many at my support group, which is held at the hospital, are several years out and doing quite well. (10 years +) and even then I know that science and surgery is ever evolving.
No one likes to be insulted or have "my surgery is better than yours" shoved down their throats and you don't seem to be doing that in this post. But I am curious, why do you ask this question since you have had your revision and are happier with it.
All my best.
There is no question that there are differences between the RNY I had done and what is done today. When mine was done, they didn't separate the pouch from the stomach; they just stapled off a pouch, cut a stoma in it and looped the small bowel up to the stoma. There were problems with the staples coming undone or tearing out because the stomach tissue never grows together where it's just stapled. This is why modern RNY cuts the pouch away from the rest of the stomach, that way the pouch grows back together and the staple line doesn't end up being the only means of maintaining the pouch.
The way food travels though and the amounts of bypass are the same, so it worked the same way, nothing there has really changed. The mechanical part of how things are put together is better these days.
I don't know why the surgeon was disbarred and my PCP assisted in the surgery and told me it was done right and that everything went well, so I'm not really upset at him about things. I just never had any follow up and very little information about how to make it work best. I figured that out on my own.
I also don't believe that any one surgery is right for everyone; my dismay is that so many people just get RNYed without really knowing what they're getting into and what all the choices are. I think far too many are just sold a bill of goods about it being the "gold standard" when the stats do not support such claims.
I ask the question because I'm all about understanding how things work and how they're done, I like facts, figures and science. And it seems to me that these facts about RNY are being hidden or bypassed in order to sell more surgery.
Kerry
The way food travels though and the amounts of bypass are the same, so it worked the same way, nothing there has really changed. The mechanical part of how things are put together is better these days.
I don't know why the surgeon was disbarred and my PCP assisted in the surgery and told me it was done right and that everything went well, so I'm not really upset at him about things. I just never had any follow up and very little information about how to make it work best. I figured that out on my own.
I also don't believe that any one surgery is right for everyone; my dismay is that so many people just get RNYed without really knowing what they're getting into and what all the choices are. I think far too many are just sold a bill of goods about it being the "gold standard" when the stats do not support such claims.
I ask the question because I'm all about understanding how things work and how they're done, I like facts, figures and science. And it seems to me that these facts about RNY are being hidden or bypassed in order to sell more surgery.
Kerry
Sorry I have been trying to get this typed out but I have a pissy 3 month old on my hands who wants my undivided attention and my DH is asleep.
At my first meeting with the RN in charge of us and the nutritionist, we were explained all 4 procedures and the pros and cons. I was completely informed about the "honeymoon stage" with the RNY and even had to write a letter to my surgeon explaining how and why it works and for how long, thusly having to maintain using what I have learned after the honey moon stage. Nothing was hidden or lied about in my opinion to anyone who was in the room with me. I never have felt that one surgery was "sold" to me what-so-ever. In fact when I had my surgery consult, my surgeon asked me what I had decided and then we proceded from there.
I faith that I chose the right surgery for ME and ME alone. I know that I don't dump, I have a nice glass of milk every night a few hours before bedtime. But I was not relying on that for my individual case, I have never been a huge sweet eater. ( mind you there are times that I swear I will turn into a werewolf if I do not get a piece of chocolate) My issues are a combo, of genetics, a work injury for 3 years till I had surgery, and severe lack of exercise due to injury.
As for the label *gold standard*, that was never mentioned to me, I heard that here. In my opinion a reliable surgeons office does not do that, mine did not do that to me at all. If I am one of the lucky one, I am happy with it. I like science as well but I did question your reasons for asking and posting due to your post on the ds forum, that many rny-ers will think this is a personal attack. And just maybe some rny-ers might think that due previously more insulting posts.
*edit* sorry my little princess is finally asleep and I needed to add that again I do not see any possible hostility brewing. I am due at the surgeons in an hour and will ask him. He may have told me but for the life of me I cannot remember. I have been told that my surgery was textbook but he was concerned that I was very "leaky" which I attribute to taking NSAIDS for years and subjected me to the vile leak test before letting me eat or drink anything.
One of my best friends who was totally against me getting surgery period had been asking how I have been and see's the obvious changes in me. I shared with her the in's and out's what I have been going through and she actually thought this was a "get out of jail free card". She needs wls so bad but knowing her I would never suggest her to get a rny. If she is interested I would send her straight to the DS board and hope she reads and listens.
Anyway I hope you have a great day.
At my first meeting with the RN in charge of us and the nutritionist, we were explained all 4 procedures and the pros and cons. I was completely informed about the "honeymoon stage" with the RNY and even had to write a letter to my surgeon explaining how and why it works and for how long, thusly having to maintain using what I have learned after the honey moon stage. Nothing was hidden or lied about in my opinion to anyone who was in the room with me. I never have felt that one surgery was "sold" to me what-so-ever. In fact when I had my surgery consult, my surgeon asked me what I had decided and then we proceded from there.
I faith that I chose the right surgery for ME and ME alone. I know that I don't dump, I have a nice glass of milk every night a few hours before bedtime. But I was not relying on that for my individual case, I have never been a huge sweet eater. ( mind you there are times that I swear I will turn into a werewolf if I do not get a piece of chocolate) My issues are a combo, of genetics, a work injury for 3 years till I had surgery, and severe lack of exercise due to injury.
As for the label *gold standard*, that was never mentioned to me, I heard that here. In my opinion a reliable surgeons office does not do that, mine did not do that to me at all. If I am one of the lucky one, I am happy with it. I like science as well but I did question your reasons for asking and posting due to your post on the ds forum, that many rny-ers will think this is a personal attack. And just maybe some rny-ers might think that due previously more insulting posts.
*edit* sorry my little princess is finally asleep and I needed to add that again I do not see any possible hostility brewing. I am due at the surgeons in an hour and will ask him. He may have told me but for the life of me I cannot remember. I have been told that my surgery was textbook but he was concerned that I was very "leaky" which I attribute to taking NSAIDS for years and subjected me to the vile leak test before letting me eat or drink anything.
One of my best friends who was totally against me getting surgery period had been asking how I have been and see's the obvious changes in me. I shared with her the in's and out's what I have been going through and she actually thought this was a "get out of jail free card". She needs wls so bad but knowing her I would never suggest her to get a rny. If she is interested I would send her straight to the DS board and hope she reads and listens.
Anyway I hope you have a great day.
110 cms was bypassed...My understanding is that most RnYs are "proximal", and between 90- 140 cms are bypassed in my case more than a yard was bypassed. a yard is 90 cms)..My surgeon explained to me that statistics proved over the years that not much more weightloss was achieved by distal RnY ( after the honeymoon period, it balances out) so the norm has been proximal for the last decade or so....
The reason why there is no malabsorption after 2-3 years is that the remaining small intestine grows extra villi ( little "fingers" which comb the food slurry going past for nutrients and therefore absorption) to compensate for the bypassed villi. The body is essentially making up for what was bypassed...
So that's the end of the "honeymoon weight loss" period, and any weight that comes off has to come off after that has to be done by strict dieting, however this time you have a "tool" to help: you can eat only smaller portions at a time, and you are not as hungry as you were before RnY, so dieting should be more successful whether it be continued weight loss or getting rid of regain( because you absorbed too much food and too many carbs over the holidays..the idea is to get rid of that regain immediately and not let it accumlate to hopeless volumes again!)....
The reason why there is no malabsorption after 2-3 years is that the remaining small intestine grows extra villi ( little "fingers" which comb the food slurry going past for nutrients and therefore absorption) to compensate for the bypassed villi. The body is essentially making up for what was bypassed...
So that's the end of the "honeymoon weight loss" period, and any weight that comes off has to come off after that has to be done by strict dieting, however this time you have a "tool" to help: you can eat only smaller portions at a time, and you are not as hungry as you were before RnY, so dieting should be more successful whether it be continued weight loss or getting rid of regain( because you absorbed too much food and too many carbs over the holidays..the idea is to get rid of that regain immediately and not let it accumlate to hopeless volumes again!)....
Do you know if the 110 cm is actually bypassed and now your Biliary limb? Or is that the combination of Biliary and Roux limbs?
If you look at the illustrations of RNY is sure looks like that would be right for both, but too much for the bypass or Biliary limb:
www.baileybariatrics.com/img/rny.jpg
Kerry
If you look at the illustrations of RNY is sure looks like that would be right for both, but too much for the bypass or Biliary limb:
www.baileybariatrics.com/img/rny.jpg
Kerry
According to my surgeon's site, on his surgery comparison chart, for RnY he indicates that "food and digestive juices are separated for 3-5 feet"...( 90 -150 cms, as 3 feet is 90 cms) Does this help? This would be the biliary bypass ( as food and juices do not mix), and not combined total for biliary and Roux limbs
http://www.weightlosssurgery.ca/en/surgicaloptions/comparisonchart
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