Question:
When does proximal become distal? How many feet qualify for each?

I don't want to have distal RNY because of the gas and diarrhea problems. I would prefer the proximal RNY. However, the doctor I went to yesterday said that she "bypasses" 2-3 feet of the small intestine (for digestive purposes) by routing it to the new stomach pouch. The gastric juices come in after the anastomosis at the 2 to 3 foot mark. So is that considered proximal or distal RNY?    — [Anonymous] (posted on February 28, 2001)

February 27, 2001
Proximal is anything less than 6 feet and Distal is anything over 6 feet. Most surgeon's who perform the proximal, however, only remove between 2 - 3 feet. These paients tend to have less difficulty with dumping and "handling a variety of food". Distal's are usually only for extremely high weight patients (i.e. 600lbs or more). Hope this helps!
   — Rachael R.

February 27, 2001
Disclaimer: I am NOT a medical professional and the following is based solely on my understanding and reading! Given an approximate average intestinal length of 20 feet, a 2-3 foot bypass is proximal. Because there can be such a large variation in an individual's intestinal length, it is usually more accurate to describe the surgery in terms of how much common tract is left, not how much is bypassed. Typically, a distal procedure leaves in the neighborhood of 100 cm of common tract (40 inches). A proximal procedure can leave up to 15 feet of common tract. The distal procedure is not just for patients in the 600 lb. range (although it may be a good option for them). It is also appropriate for patients at much lower weights who have what I call phenomenal metabolisms, and who will need a strong malabsorptive procedure to maintain weightloss. With some people, reducing intake to 1200 calories per day will not result in a sustained loss, there needs to be ongoing malabsorption (provided in a distal procedure) for successful, sustained loss. - Kate -
   — kateseidel

February 28, 2001
I am a Open RNY distal 5'6 and starting weight 260 My sister Lap RNY distal 5'2 starting weight 209 my Friend Lap RNY distal 5'4 starting weight 265 my other sister Lap RNY distal 5'2 starting weight 184 not all are over 600 lbs My Doctor perfers doing a distal for long term weight loss yes there are some side effects ...but nothing that is not controlable if I am going out socially I dont eat gassy foods or foods with a high Fat content..I always carry a spray with me I am 4 months post op and have experienced no problems none of us have... yes my Bowel Movements stink to bad but I use the bathroom at the back of the house and use candles and sprays.. if i was out in public i would keep flushing the toliet and use sprays to control the order I only get really gassy if i drink milk having a distl gives me a better chance of reaching my goal weight a Proximal will get you to with in 75% of your goal a distal 94% of your goal and in 5 years a Proximal will have a 50% chance of regaining 1/2 of there weight back that is not All but a percentage will a distal ensures a better chance of keeping the weight off and I have always failed at every diet so I wanted the extra insurance against regain.. so I will live with the side effects Truely there are not that bad and I am a 100 cm common channel...Doc says he measures 100 cm and then cuts there
   — Kathleen M.

February 28, 2001
I had distal RNY -- same surgeon, exactly same procedure as Kathy McA, pre-op BMI 38. I must have one of those "phenomenal metabolisms" described by Kate (thanks for giving it a name), since I didn't lose at all on 1200 calories + mega-exercise before, but now am losing steadily with 1500 cal/day and moderate exercise. I even had to add some sugar and fat to my typical pre-op eating style because I wasn't getting enough! Diarrhea and gas are NOT inevitable with distal bypasses. I've had none at all, and no bad smells in the bathroom. It's my understanding that the gas/diarrhea thing affects only about 8%. Don't base your decision on hearsay -- check out all the procedures thoroughly before you decide which one's best for you.
   — Linda B.

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