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Dr K's FB post of Dr Hess "Proper Parameters of the Duodenal Switch"

Discussion in 'Duodenal Switch' started by DSRIGGS, Jan 19, 2016.

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    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    I know you are probably sick of hearing me preach this, but this is an excellent post from the Central Valley Bariatrics Facebook page on the Hess method. Please click the links on the page and you will see results for EWL for patients 10 years or more out. Additionally I am copying a study of Dr K's from his own DSSURGERY.COM page showing nutritional outcomes of a group of patients he operated on back from 99-02, Percentage based Bypass of small intestine results in exceptionally low protein malnutrition presented at the 20th ASBS annual meeting, June 19th 2003..

    http://www.dshess.com/Parameters.htm

    http://www.dssurgery.com/about/publications/albumin-abstract.pdf
     
    OrganicLife and Revision like this.
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    Revision

    Revision Member

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    great resource...many thanks!
     
    DSRIGGS likes this.
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    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    You are more than welcome. I feel compelled to share important information when I see it so people can hopefully make well informed decisions about the Bariatric procedure that is right for them.

    This information that Dr K shared is one of the many reasons I love him so much..... That and he is just a genuinely nice man. He is a plethora of knowledge and is always looking for data and scholarly articles that he shares in a humble and unassuming fashion. He truly wants the best for his patients as well as those who aren't his patients.
     
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    Marquis Mark

    Marquis Mark Well-Known Member

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    Thank you. Keep 'em coming!
     
    DSRIGGS likes this.
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    Susan in Tennessee

    Susan in Tennessee Well-Known Member

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    Great article, and I was even able to follow it! Thanks, I'm bookmarking.
     
    DSRIGGS likes this.
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    Razbry

    Razbry Well-Known Member

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    Help me out. Then why do we have to be so careful with our protein intake?
     
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    aaa

    aaa Well-Known Member

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    That's what I was taught, too.
     
  8.  
    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    I guess I don't understand the question? What in those studies that demonstrate that those who were given the propper percentage based channel lengths had good outcomes would suggest that eating properly and supplementing properly isn't necessary? Dr k tells patients the importance of being compliant with the diet and supplement regimens required for a DS patient.
     
  9.  
    Spiky Bugger

    Spiky Bugger Well-Known Member

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    @southernlady

    This post, who has a lying sack of shit author, is STILL a post directing people to a Medical Tourusm website...as do his/her other two posts. The claim is that the site mentioned is "similar to this one," but the Magic Google Machine CLEARLY identifies it as a medical tourism site, based in Colorado.

    Just sayin'...

    Mod note: Edited the quote to reflect my edits
     
    Last edited by a moderator: Feb 23, 2016
    Razbry likes this.
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    southernlady

    southernlady Administrator Staff Member

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    Yeah, I know...I'm hoping if he gets edited enough he will either stop or learn.
     
  11.  
    CaraOC

    CaraOC Credentialed Bitch

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    Scott, reviewing my surgical report I don't see the term "Hess Method", but since I'm a paranoid NICU nurse help me figure this out. I'm afraid I'll need revision surgery!! Below is the summary of lengths and stuff in the pic. I remember them telling me post op that I had an unusually short bowel. Whatever that might means. Small bowel measured from Treitz angle to ileocecal valve 4.7 meters. Is this enough info? I could send the full report??? Am I safe from fix it surgery???????
     

    Attached Files:

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    Clematis

    Clematis Well-Known Member

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    You're fine @CaraOC. MBC doesn't mention Hess in the report -- I doubt few reports from anywhere mention "Hess". I have a 100cc, 200 alimentary (bebezed has same lengths as I recall) -- my surgery report has no mention of small bowel length or biliopancreatic length. I'm 5'5" -- bowel length is often by not always related to height. In the end, I'll never know whether he measured my bowel or not -- he obviously measured yours, though. That's a good sign.
     
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    DSRIGGS

    DSRIGGS Yes, that is chocolate covered bacon

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    So your total SBL = 470CM, AL = 150 CM, CC = 100 CM and BPL = 220 CM

    This means your ratios are as follows:

    CC/TSBL 21%
    AL/TSBL 32%
    CC & AL/TSBL 53%

    So yes your CC appears a bit over the 10% guide & your AL is a little short compared to the 40% AL guide. That being said your overall absorbing intestine is 53% of the total small bowel length. Remember the Hess method says as a guide (not written in stone) the CC should be around 10% and the AL around 40% with AL + CC = BPL. Although your CC is double the 10% value a 50 CM CC (10%'sh) would probably not have been advisable. The total absorbing intestine is very close to the 50/50 ratio so I think you are going to be just fine. Personally I would have rather had to much than too little.

    I don't think you really need to worry about anything. I have a feeling you will lose just fine and shouldn't have any nutritional issues. Again the percentage based or Hess method DS is just and approximation and I believe Dr K rounds the CC up to the next 25CM increment when doing his, so the numbers don't come out to exactly 10% and 40%. The idea is to be in that relative ball park and not give somebody a 10% CC and a 24% AL for a way underabsorbing intestine (34% was what I was and I paid a dear price) or a way overabsorbing intestine of say 65%.

    Does that make sense? It is Science but not to the nth degree exact science. Dr E could have seen something about your make up that caused him to give you a little long CC, in order to be safe.
     
    CaraOC likes this.
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    CaraOC

    CaraOC Credentialed Bitch

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    Thanks!! You rock !!!
     
    DSRIGGS likes this.
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    Rhondajs

    Rhondajs Well-Known Member

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    Do you know if dr. K has published this information? If so I'd like to share this with my surgeon.
     

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