Question:
I am thinking about Jejuno-lleal Bypass Surgery, Help! I'm so confused.
I recently saw a doctor in Vancouver, British Columbia, Canada and was put on the waiting list for surgery. J-i bypass. I've been looking on the web for more information and have had absolutly NO luck. I came across a great web page and contacted Dr.Goodman (new york)by email. Within minutes he had replied and gave me him number. He called me within hours of my sending my email. he told me a lot about the surgery and how dangerous it is. A problem I found out, is that here in Canada our doctors are behind on surgeries. I want to know all I can about this surgery from those who have researched it, had it... anything. I'd concider going to the states for surgery, but my medical wouldn't cover it. I was so excited about this surgery, finally had hope of losing weight... and now this. Its best that I find out all I can. If it means my going without surgery... :( — Betty S. (posted on January 31, 2000)
January 31, 2000
Yes, the VGB and RNY may have 92% of the market, however, education is the
key. There is another surgery called the duodenal switch that has been
around for 24 years. With the modifications it has undergone, this is the
platinum of all WLS. The long-term quality of life is the most promising.
Surgeons in North America are starting to see this.
Again... education is the key. All WLS should be researched and decided
upon, depending on the needs of an individual. Kris
— Kris S.
February 1, 2000
Ava... as I stated before... individual needs. You are talking about
proximal that suited your needs.
Distal and distal is whole other subject. If a person has to get a distal,
then the quality of life IS more promising with the DS.
I am not trying to discourage anyone from getting the surgery they desire.
I am only trying to ENCOURAGE education. All that is ever talked about on
this site is the RNY and VGB... people need to know there are other options
out there and what the long-term results can be.
An informed decision is the best decision.
Regards, Kris
— Kris S.
February 1, 2000
Ava... please explain to me about the dangers and risks of the switch.
Also, please explain the dangers and risks of the RNY.
I look forward to your input.
— Kris S.
February 1, 2000
Here's a URL for a web site which contains descriptions and pictures of
both RNY and DS. The pictures clearly show the differences between the two
procedures.
http://www.hawkenet.com/wls/
This information comes from the brochure of Dr. Kenneth Welker, at Oregon
Health Sciences University, although this site is not his official site.
Don't think he has one. He performs the DS with a "lateral
gastrectomy" (removes a big portion of the stomach). I think other
surgeons may do something else with a DS.
For the possible side effects - check asbs.org. It looks like they list
the possible side effects for every major type of bariatric surgery.
I certainly agree with everyone on this forum who says education is the
key. Do your own research, find out as much about all the various types of
weight loss surgery you can - and then make your own decision. After all -
it's your body and your life.
Connie in Oregon
— Connie H.
February 1, 2000
Ava... I would like to see the reports and/or any information leading me
to find these studies. Could you provide this for me? Thank you!
Connie... Dr. Welker is a DS doc and other DS docs do remove a large
portion of the stomach as well. 80% of mine was removed...
— Kris S.
February 1, 2000
Ava... these anecdotes that you are speaking of... if you werent sure what
type of surgery they were.... Why did you throw them in there when I asked
you to explain the dangers of the DS and the RNY? My gosh... you throw in
these worst-case scenarios and mesh them in with these 2 procedures,when
you arent even sure. You were the one saying that "The RNY gives
nearly the same results, but without some of the risks and dangers of the
'switch'." All I want to know from you is the dangers and risks you
are referring to.
— Kris S.
February 1, 2000
Ava, I just had a surgical consult with Dr. Welker in OR. He does both the
DS and the RNY but indicated that he is currently doing 2 DS for each RNY.
He will not do either procedure without a distal bypass as he feels the
long term success at weight loss maintainance is not good without the
distal. He has found what he feels is a good balance in the length of the
remaining bypass, which allows for maximum nutrient absorption with minimal
fat absorption.
As to the issue of malnutriton, the protocol he has is not significanly
different than what I currently follow, multivitimin a.m., & p.m.,
additional calcium, vit. E. He requires blood work every 4 months for the
first year and then every 6 months for a couple of years than yearly.
There is some malabsorption of fat soluable vitimins which will require
taking extra of them.
As for the long term success, there are studies that show the long term
success rate at maintaining weight loss with the DS. Most RNY studies
(with a proximinal RNY) show a minimum of 15 % regain of the lost weight
and that calorie and food restrictions are necessary to insure long term
weight loss maintainence.
The side effects of each are a trade off. Both cause hair loss. RNY has
the risk of "dumping" which is a form of insulin shock. DS has
gas and loose bowels. RNY has the risk of the breakdown of the staple line
or slippage of the ring if the stomach is not transected. If it is
transected, how is that different than the DS gastrectomy? RNY has the
risk of ulcers and blockage. RNY requires you to be selective in what you
eat and how it is prepared, DS does not.
It seems that both have risks and both have benefits. I don't believe
one is inherantly better than the other. It is like comparing apples and
oranges, they both are fruit, but beyond that the similarity stops. What is
most improtant is to research each completely and pick which procedure
works best for you and your lifestyle, and not spread misinformation and
scare stories about eaither procedure.
— Barbara L.
February 6, 2000
Ava, I ask a doctor about dumping and the mechanics of it. He explained
that food is passed into the intestine directly from the pouch. Sugar is
rapidly absorbed in the intestine and cause a rapid rise in blood sugar,
which results in a rapid rise in insulin production. In a normal stomach
(one with a pyloric valve), the peristolic action alows only a portion of
the contents to be released at a time. The inital amount of sugar released
will indicate the balance that is in the stomach and trigger the production
of insulin based on the estimated total sugar. However in the case of RNY,
the entire content is "dumped" into the intestine, not a portion.
The body doesn't know that the amount is only a portion, so produces
insulin for the anticipated amount of sugar. This then cause the blodd
sugar to crash, since there isn't any additional sugar and then the
"dumping syndrom" occurs. Hence, dumping is a form of insulin
shock, cause by the rapid increase and deplietion of blood sugar.
The DS does not restrict the stomach by creating a pouch, it reduces the
size of the stomach by removing part of it along the exterior curve,
leaving the pyloric valve intact. A portion of the duodenium remanins and
the bypass in done in the small intestine. The pyloric valve remains
active and there is one less artifical opening with the accompanying
sutures etc.to cause irritation.
If you read my previous post, I indicated that ring failure and staple line
disrution are a possible side effect if the stomach is not transected.
Yours apparently was, if you have no staple line. When the ring is used,
the stomach is not transected, however recent changes in the surgery do
have it stitched in place, which does have a lower failure rate.
In the earily days ('70& earily 80's) the JI bypass surgery did over
restrict the absortion of nutrients due to an over drastic bypass, and
those folks had to be very careful of malnutrition. The procedure has been
revised to what is now the DS, which does not include such a drastic bypass
and far better nutrient absortion. Doctor who still do the old JI bypass
are few and far between if they even exist anymore.
I would think the RNY would aggrivate your diverticulitus rather than
improve it as food would be less digested than prior to the surgery. My
mom actualy had a modified bypass and removal of part of her small
intestine without the change in her stomach to assist in improving her
diverticulitus. She now has less of her small intestine, where the
diverticulitus occurs, hence less symptoms, and less diet restrictions,
then before her surgery. Prior to her surgery, the rule was.. "no
seeds, no strings and no skins" as these food items would get caught
in the small pouches in her intestine and get infected. I imagine that the
lack of digestion of food in the stomach which occurs with RNY would
further aggivate her symptoms more than the occassional gas and loose bm's
caused by eating too much fat that she has now. At least now she can eat
vegies, as long as the are without seeds and peeled.
— Barbara L.
March 22, 2000
— Patty A.
July 29, 2001
Jejuno-IIeal Bypass
I had this operation getting on for 30 years ago approx.
It has worked very well for me apart from the known side effects, which are
wind and loose motions which are a bit pongy.
I usually take Codiene Phosphate which control the looseness (can't spell
diarrhoea) that came up in spell check but it still doesn't look right.
My old man calls me Pongo. ha ha
It took me 6 weeks to feel anything like normal after the op but I was
about 24 stone at the start and very unhappy.
I am still slightly overweight (about 14 stone) but eat like a horse and
need to have vitamin injections once every three months.
I am very fit for my age and do a lot of heavy gardening and also have
sheep which keep me busy.
I do not regret having the operation as I was really miserable before and
the side effects get me fed up sometimes but not half as much as not
wanting to go out, not being able to get decent clothes, having the mickey
taken over my weight and the embarrassment.
Best Wishes to all
Patty Windsor
— Patricia Ann W.
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