Common Channel Length...Specifics

[robs477]

Ok, it’s a cool and lazy rainy day here today, so I am catching up on some things I’ve been wanting to post.

I know CC lengths in general have been discussed over and over, but, I need some more exacting opinions as it may apply to me in the specific. I have said many times that I am a self-diagnosed, self-described extremely efficient absorber of what I eat. I crashed what little metabolism I had 30+ yrs. ago through starvation diets and subsequently; I know my body has evolved as a survival mechanism to store everything I eat instead of burn.

My Surgeon only does his DS patients common channels at 150 cm, no custom Hess method etc. I must admit, I am a little bit worried that since I feel like my small intestines have evolved to maximize food absorption, IMHO…..I worry that maybe that length is too long? I don’t think he will budge on this subject either. I am 5’11”, 350. If I only lost 100-130 lbs, I would be ok with that and actually don’t want to be too thin, so, would the longer CC affect initial and total WL, i.e., the final ending number, and or the ability to keep it off long term, or all the above.

I know it’s almost impossible to say because we all react differently, but, need opinions.

 

[DianaCox]

It's your body, your choice, with the doctor's ass covered by his informed consent document. If he won't do what you want, find another surgeon. Who is your surgeon anyway?

 

[robs477]

It's your body, your choice, with the doctor's ass covered by his informed consent document. If he won't do what you want, find another surgeon. Who is your surgeon anyway?

Dr. Erik Wilson. Do you think a 150 cm CC is too long? If so, is it too long generally speaking or maybe in the specific as it may apply to my described "Physiology"?

 

[DianaCox]

Personally, yes, I think it's too long for someone with a documented superlow/high efficiency metabolsim. 100 cm (or 10% of your entire small intestine) is a better number. I would want no smaller than 3-4 oz stomach to start (no matter what the "bougie" size, because stomachs vary in length) and no more than 125 cm cc. Tall men tend to lose more (or too much); people who have ruined their metabolism/are high efficiency absorbers lose less. At your age, I wouldn't worry about not losing enough - you are older and will want to have reserves in case of illness later on. You want to lose enough to make your knees happy; your metabolic issues will resolve no matter what because of the switch. Too small of a stomach will likely only make you miserable for 2-4 years, at which point it will likely stretch out to the same size anyway - why suffer for no reason?

From dshess.com (Parameters):

The proper measurements when performing the Biliopancreatic Diversion with the Duodenal Switch are very important for good long term results. If the common channel is too long or the stomach is too large the patient may not have good sustained weight loss. If the alimentary limb is too short the patient may not be able to absorb adequate protein and may require a revision. The patient must be able to eat, the duodenal stoma should not be small, but wide open, so the patient can take in protein.

We have measured the total small bowel length in more than 1400 patients we have operated and there is a large difference from the shortest (12 feet) to the longest bowel (38 feet). You can see that one size does not fit all! In our experience a common channel of 10% is the best size. We use three sizes: 50 cm, 75 cm, and 100 cm whichever is the closest to the ten percent mark. This way we have three sizes of common channels and we can group them together to evaluate the lengths. The length of the common channel determines the degree of malabsorption of fat. You will, however, absorb enough fat for all the essential fatty acids needed for life.

The alimentary limb (the portion of small bowel which the food passes through) is formed nearest to 40% of the lower part of the small bowel, always in increments of 25 cm (10 inches) from 250 to 350 cm as shown below. The most common size used is 75 cm for the common channel and 275 cm for the alimentary limb. For example: the common channel length is 100 cm in only 7% of our cases, 75 cm in 67 %, and 50 cm in 23 %. From this you can see we feel that using a 100 cm common channel is not correct in most cases.

We believe measuring the total bowel is very important for good long term results (see our ten year graphs). If you don't count you don't know!



Volume of stomach100 ml (+ or - 15 ml)

Common Channel10% of total small bowel length, 50, 75, 100 cm

Alimentary limb 40% of total (SBL) 250, 275, 300, 325, 350 cm

The above chart shows what happens if you use the improper limb lengths.

Example (1): If you always use the 250 cm AL and 100 cm CC on all cases and the total bowel length is 500 cm the percent AL is 50%, this is too long for good weight loss. Also if you have a 100 cm CC there will be 16.7 %, too large an absorption of fat. This patient will not lose weight properly

Example (2): If you use the same parameters and the total small bowel length is 750 cm the AL is only 33.3 % and the CC is 16%; 33.3% alimentary limb is too short and the patient may have difficulty maintaining proper protein since the total alimentary limb is too short. Conversely the common channel is too long for the proper fat malabsorption.

Example (3): If the total small bowel length is 1000 cm as in the third example the common channel is proper, but the alimentary limb is very short and this patient will not be able to absorb adequate protein and will have difficulty. Most likely need to have a revision of the bowel lengths later.

Example (4): These parameters are all proper and will probably not have difficulty and should lose weight and keep it off for years.​

But - why Wilson? He's not a fan of the DS, and doesn't do them often. The less often the surgeon does them, the less skilled they likely are, and the less likely to have kept up with the science behind it.

 

[robs477]

@DianaCox......Great info, thxs for sending! Holy Crap!! 38 FEET for the longest length, that is amazing the variation thus the need to be calculated. More and more they are just hedging on the safest easiest approach, lowest risk for them I guess.

So, Re: But - why Wilson? He's not a fan of the DS, and doesn't do them often. During my two consultations with him, we covered quite a few specifics. He really is a good surgeon, one of the best in this area. And in Houston there are only two, him and Dr. Scarborough (who’s not on my plan) and the 3rd one is ....The infamous Dr, "S" word...can’t even start picking on that scab again, remember??....LOL He has done over 100 DS's he said since 2008 and really is a qualified DS surgeon and is on the DS fact list for all that’s worth. He told me specifically, that he limits doing the DS on less people because they simply have not educated themselves enough on the supplementation required and he feels that if they are not prepared, it is too high a risk for them and he won’t do it. I could accept that, he said it with a lot of vigor and conviction and it seemed like a really honest forthright reply. He said I was a perfect candidate for the DS and agreed it was the only surgery that could possibly help me. So, that’s about where we’re at. I’m just a little concerned about the CC length. I think I will still try to convince him to go shorter, we’ll see. BUT, like you said, I still should get a lot of benefits, metabolically, Type II diabetes, blood pressure and all the other stuff. Guess we’ll see. At this stage, it is what it is I guess.

 

[DianaCox]

I see your points - so long as he is willing to engage you in discussion about it, I guess that's OK. In any case, it's an art not entirely a science - you really can't predict exactly how anyone is going to respond to the procedure. But I would think that measuring the small intestine is very important - ask him if he does it.

 

[Munchkin]

Let me tell you your biggest plus. It's the Man Factor. Men just have better results with the DS. Yeah, I know this is just me talking but I have never yet seen a guy not have stellar results.

 

[robs477]

Let me tell you your biggest plus. It's the Man Factor. Men just have better results with the DS. Yeah, I know this is just me talking but I have never yet seen a guy not have stellar results.

Wow, that’s encouraging. Maybe something will actually go right for me. I think maybe Women in general have a harder time with adjusting their supplementation too because your bodies have already had to give up so much bearing children, i.e. calcium, Iron depletion etc creating lil humans. Also, the iron losses because of the monthly stuff. But, conversely, it also appears to me that men can get in trouble because they lose too much too quick and have to watch that as well, so, it’s just hard to say. Time will tell I guess.

 

[cboone]

Hi Diana,

I was reading your comments on the common channel lengths. Can you and if so how do you know or estimate the length of your small bowel?

 

[DianaCox]

Hi Diana,

I was reading your comments on the common channel lengths. Can you and if so how do you know or estimate the length of your small bowel?

The surgeon measures it intraoperatively.

 

[cboone]

Thanks I thought so and thanks for the thorough lesson on the common channel specs.