A longer common channel?

[Settledownnow]

I'm looking for more education on the common channel. I am wondering about a RNY to DS revision with a longer common channel to lessen malabsorption related issues. I thought I read once someone had a common channel of 125 cc for this reason. My reason is that I am not bubbling red hot for meats or fat. There I said it. Bacon - gross. Sausage - double gross. Tons of butter and cream - gross and more gross. Eggs - yummy. I do not know if it is my RNY, gallbladder with sludge or just a personal preference. Also, I keep reading about DS issues related to bacterial overgrowth and the need antibiotics and how quickly someone can develop protein malnutrition.

Is a longer channel defeating the purpose of DS? I would love to be free of this tiny pouch and the blind stomach so perhaps it is not defeating the purpose for me specifically.

Please help educate me!

 

[Larra]

Different DS surgeons have different philosophies on this, and I don't know who is right, or even if there is just one right answer for everyone. 125 cm sounds reasonable - the classic cc is 100 cm, but more surgeons are now using the Hess method to determine the right cc and limb lengths.
As far as fat goes, no one is required to eat bacon or any other fatty food. People talk about bacon because it's something we can eat now that most of us never ate before. But if you prefer eggs and chicken breast and other lean proteins, that's just fine, as long as you eat enough protein overall. Protein malnutrition does not develop overnight, and if you stay on top of it and use protein supplements if needed, you will probably be ok. But it's good that you're aware of the possibility of protein malnutrition and ready to avoid it. Also, with a RNY to DS revision, most surgeons put in a feeding tube to help you through the difficult first weeks in case your stomach function is slow to return. That helps a lot.
And get that sick gall bladder out!

 

[Munchkin]

Doesn't matter. If you prefer lean protein, great.

Like @Larra said the debate rages on about CC length. My thoughts are that it relates directly to why you are heavy. If you are just an overeater, 125 would be fine. If you have real metabolic issues, 125 may not get you where you want to go. I always use myself as a bad example. My CC is supposed to be 75cm. I never saw a normal BMI and most likely never will. And even with that CC I have never had any deficiencies/overgrowth/issues. There is no way to quantify weight loss to CC length.

 

[DSRIGGS]

As a person who suffered from sever malnutrition requiring a revision primarily to extend my ALIMENTARY LIMB and while in there a small add to the CC, please understand that although weight loss boards focus very heavily on the common channel the alimentary limb also absorbs protein and carbs and yes we need both of those... Don't ever believe differently because it is patently false. I am a firm believer in the Hess method and believe it should be the only standard of care for the DS.

Why do I feel so strongly? Compare two people who have a standard 150 cm AL and 100 CM CC, but patient A has a 500 cm total small bowel length(sbl) and patient B has a 1,000 CM SBL. Patient A has 50% of their old SBL for absorbtion whereas patient B now has 25% of their old SBL absorbing. Guess what is going to happen to patient B? Yep, extreme malabsorption and a future revision.

The Hess method would not allow that to happen unless there were extenuating circumstances of which the surgeon was not aware.

Don't focus on CC length only. It is important, the AL is just as important and it is even more important that the AL + CC lengths = 50% of the total SBL.

 

[Settledownnow]

@DSRIGGS so is the purpose of the Hess Method to have 50% of the old SBL for absorption? Then those who ask for a common channel of 75cc common channel have the belief this will result in more malabsorption. My question is then, for those who had the Hess Method what is your experience with malabsorption in terms of bowel habits and amount of supplements needed? Is there any difference? I may be asking the wrong questions here and I suspect these are all surgeon questions, but I my thought is "what if I could have less malabsorption, not more"?

 

[DSRIGGS]

@DSRIGGS so is the purpose of the Hess Method to have 50% of the old SBL for absorption? Then those who ask for a common channel of 75cc common channel have the belief this will result in more malabsorption. My question is then, for those who had the Hess Method what is your experience with malabsorption in terms of bowel habits and amount of supplements needed? Is there any difference? I may be asking the wrong questions here and I suspect these are all surgeon questions, but I my thought is "what if I could have less malabsorption, not more"?

http://www.dssurgery.com/about/publications/albumin-abstract.pdf

I can't remember the researcher's/surgeron's name, but Dr K said there is a guy who argues that it doesn't make any difference the make up of limb lengths for the AL & CC but that the important thing is that it is done so that the Bilopancreatic Limb is 50% of the SBL Poke around Dr K's site there is lots of good stuff there.

 

[DSRIGGS]

@DSRIGGS so is the purpose of the Hess Method to have 50% of the old SBL for absorption? Then those who ask for a common channel of 75cc common channel have the belief this will result in more malabsorption. My question is then, for those who had the Hess Method what is your experience with malabsorption in terms of bowel habits and amount of supplements needed? Is there any difference? I may be asking the wrong questions here and I suspect these are all surgeon questions, but I my thought is "what if I could have less malabsorption, not more"?

Hon my understanding is that patients revised from RnY to DS typically don't have the same weight loss results as virgin DS patients so I really don't think you have too worry about too much malabsorption. The opposite could be the case. Note that I said could.

The key thing about the Hess Method is that it individualizes to each patient. The Standard method can work well for most but for people like me on tail end of the normal distribution for SBL it can end up in not enough or to much malabsorption.

Look at the study I posted from Dr k (that is the hess method) and the results.