DS CC length

[CaitlynR]

Anyone have info (preferably research studies) of CC length variations with otherwise traditional DS (two anastomoses) and effect on outcomes? I would particularly like to see any studies using longer lengths (150 to 300).

I share ray's surgeon (from the surgery report thread) so trying to figure out how I feel about longer CC lengths. I have a lower BMI than some DS preops at 44 if that makes a difference.

 

[southernlady]

Mine is 175 and it's plenty long enough for me. My starting BMI was 35.2 and I did not lose too much weight. IF I had had my druthers, I would have preferred a slightly larger sleeve with a 100 common channel. My sleeve is tiny...even after 6.5 plus years.

 

[Duckman]

I got 150. My surgeon said over the years in his practice he has backed off to longer and longer CC because the risk of revision goes down with a longer CC and the difference in EWL is small.

 

[Munchkin]

Mine is 75 and I wish it was shorter. A lot shorter. If it ever WAS 75 in the first place.

 

[Clematis]

Mine is 100 but should have been 75 based on my bowel length. My BMI was just barely 40 if I slouched to reduce my height. (The surgeon made it longer b/c of my age, all the while swearing he would do Hess Method.)

The key is understanding bowel length is in understanding the reasons for the Hess Method and its common channel based on total bowel length. A standard 100 works very well for those of average height with average bowel length. However someone tall, such as a man, may have a much longer total bowel length and so 100 will leave these people struggling to keep on weight. Conversely petite women with perhaps short bowels will end up with a too-large percentage of total bowel as common channel and struggle to ever reach goal weight.

I don't have studies to produce regarding these longer common channel lengths some surgeons are recommending because they say there are fewer nutritional problems. BUT THE REASON THERE ARE NUTRITIONAL PROBLEMS IN SOME PEOPLE IS THAT SURGEONS/NUTRITIONISTS UNIFORMLY GIVE BAD, DANGEROUS NUTRITIONAL ADVICE.

Fight for a traditional DS and read everything here so that you can assure the surgeon that you know how to take care of yourself.

 

[galaxygrrl]

I found this CC issue very confusing and I still do. There are some people that do well with a longer CC and others who don't. Mine is 100.

I did find this study before my surgery and it helped. The study is old though and I would defer to @Larra and @Munchkin to help triangluar this study with other data out there.

https://www.ncbi.nlm.nih.gov/pubmed/15862492

Common channel length predicts outcomes of biliopancreatic diversion alone and with the duodenal switch surgery.
McConnell DB1, O'rourke RW, Deveney CW.
Author information
Abstract
BACKGROUND:
The optimal common channel (CC) length for malabsorptive weight loss surgeries is unknown even though these surgeries were developed in the 1970s (biliopancreatic diversion [BPD]) and the 1990s (biliopancreatic diversion with a duodenal switch [BPD DS]). We hypothesized that the length of the CC correlates with a successful weight loss result.

METHODS:
We evaluated 3 groups of patients based on the length of the CC whose duration of follow-up evaluation was at least 1 year. We reviewed all patients who had either an open BPD (5 patients) or a BPD DS (119 patients) from August 1998 to October 2003, for which D.B.M. was the participating surgeon.

RESULTS:
Group I comprised 15 patients: their preoperative body mass index (BMI) was 53.9 kg/m(2); 73.3% of patients had a BMI more than 50, and the CC length was 150 cm. Group II comprised 76 patients: their preoperative BMI was 54.25 kg/m(2); 73.3% of patients had a BMI more than 50, and the CC length was 100 cm. Group III comprised 33 patients: their preoperative BMI was 60.1 kg/m(2); 84% of patients had a BMI more than 50, and the CC length was 80 to 90 cm. The mean weight loss in group I was 45 kg (44% mean excess weight loss). The mean weight loss in groups II and III was 55.8 and 61.5 kg, respectively (a 57% and 54.8% mean excess weight loss, respectively) (all P < .05 by analysis of variance). A weight loss of greater than 50% of excess body weight occurred in 40% of patients in group I versus 63% of patients in groups II and III combined (P < .01 by chi(2)).

CONCLUSIONS: The length of the CC contributes significantly to successful excess weight loss in BPD and BPD DS patients. In general, the length of the CC should not exceed 100 cm.

 

[Munchkin]

Small study means big margin of error. I used to write these and figure out the damn statistics. Back when you had to do the math. I used a slide rule.

What we have really learned in the past few decades is we are not even close to understanding obesity. There are so many different variables we know nothing about. We are just scratching the surface. Years ago Dr. Buchwald and I were discussing obesity and he said he completely believes when we find the cure, it will be a pill. And I agree with him. The surgery we have today treats the symptom because we don't know the cause.

Saying CC determines weight loss is a gross over simplification. There is another study out there by a doc named Noyes on the switch only for diabetes. Usually with a very short CC @ 50. Well guess what, most patients lost weight initially but then slowly gained back a lot of what they lost. Those results would be impossible if CC determines weight loss. And this was, again, a small study.

 

[CaitlynR]

Munchkin, I believe it. Which makes being an informed patient more difficult. Being the somewhat obsessive person I am, I am delving into medical textbooks and databases I have access to from work. I am trying to wrap my head around the theorized physiological changes of the surgeries as well as as much understanding of current outcomes research. I come away from that concluding the DS is the way to go but nothing more beyond that. Confusing. Stuff I find on CC length is typically comparing shorter lengths or (50-100) or DS like surgeries.

So. I am somewhat torn between asking for a shorter CC and simply trusting the expert which is the surgeon. I do at the very least want to ask what the rationale for a CC over 100 (especially 200 or 300) given the vast majority of outcomes research on traditional DS is using a CC of 50-100.

 

[Munchkin]

These days, it will be hard for you to get one shorter than 100. I would go with as short as possible, 100 or less. You want the malabsorption. Otherwise it's just another diet with a smaller stomach. In other words the sleeve. The docs want to do the longer CC for 2 reasons. One is more absorption of vites and minerals. Two, it is making the SADI/Loop look more like a viable alternative and that's the surgery they WANT to do because it's easier.

It takes the body in the neighborhood of 2 years to adapt as much as it's going to. The traditional RNY doesn't bypass enough. That's why the regain starts @ the 2 year mark. Mine is 75 and I wish it was shorter. I have no problems with vites and minerals either and I am 14 years post. The shortest CC I know of is a woman in Australia, 40. And yes, she made it to goal and was maintaining. Yes the DS bypasses a lot more but always remember, the body wants to get back to the way it was before, fat.

Next, remember the surgeons say that 50% of EWL is a success. Well, you can bet that most everyone willing to be sliced and diced wants more than freaking 50%. Most of us did not go through all this to be satisfied with still being fat. Nope, we want the fantasy! Or at least to be NORMAL. And I don't think we should be thrilled with 50%.

You read about Ray's problem. Make sure in writing that your CC is what you want!!!! No surprises down the road.

 

[DianaCox]

The surgeons who did that study (OHSU) were - um - let's just say non-preferred DS providers to start with, and none of them stuck with the DS (to the good fortune of the locals).

I wouldn't want a CC longer than 125. Period. Mine is 100 and I never got outside of the overweight range, and even then, up until recently, I was solidly still obese. I started at a BMI of 49.

But the decisions are multifactorial. How old are you? How metabolically ill are you? How many crash diets have you done and failed? Male or female? How tall? How long is your small intestine? How active? Family history? Etc.

It is an art, not a science. And even then, YMMV. It's a crap shoot - but KNOWLEDGEABLE diet and nutrition information is what will keep you from becoming an uncontrollable crap chute.

 

[hilary1617]

My CC is 100 and I am delighted with it. Five years ago, pre-DS I was a size 30. I dropped to a size 10 for a brief time in the honeymoon phase and have been a 14 effortlessly for the past three years.

 

[DSRIGGS]

I get so frustrated that the DS patient community has perpetuated the myth that CC length is the end all be all of the DS surgery because there are two other small bowel segments that alone are pretty much meaningless as well. The CC length is important but so are the AL and the BPL lengths. I had a 125 cm CC and ended up with severe malnutrition that caused me nearly four years of shitty health Why,? Because my total AL (cc + small AL) was too short relative to my total SBL, therefore; I didn't have enough absorption and it did significant damage to my health. If I had it all to do over again I would have never had the DS unless it was done by a Hess DS surgeon, and specifically I personally would have gone to nobody who wasn't name Ara Keshishian. There are gid DS surgeons but I just trust him that much.


The most important thing is that your AL (cc + AL or other part of absorbing path) is roughly 40% of your total SBL. If that happens you will have a DS optimized for you individually. The CC should be roughly 10% of your SBL but less than 50 cm is not going to happen and 75 is as short as most will go.

By the way by strict hess parameters my CC should have been exactly 75 cm because my sbl was 750 cm. Yet even with a cc 50 cm longer than that I still had malnutrition and I was eating a ton of protein. All because my total AL was too short. So I am living proof that CC alone doesn't yield the end result.

 

[Ellie Mae]

My doctor gave me two numbers. He said he does a 100 and 150 common channel, a total 250. Not good, huh?

 

[Larra]

@Ellie Mae that doesn't make sense. Maybe he was saying the cc would be 100 cm and the alimentary limb would be 150 cm? if so, it sounds like a "cookie cutter" DS. @DSRIGGS and others talk about the Hess method, where the total length of the small intestine is measured to determine what each of the limb lengths and cc should be, but many surgeons still do the cookie cutter approach.
I have a cookie cutter DS. At a later point, my surgeon started doing the Hess method, which I agree is superior. but you know what? My cookie cutter DS worked out just fine - for me.
I would suggest clarifying what the surgeon meant.

 

[Ellie Mae]

@Ellie Mae that doesn't make sense. Maybe he was saying the cc would be 100 cm and the alimentary limb would be 150 cm? if so, it sounds like a "cookie cutter" DS. @DSRIGGS and others talk about the Hess method, where the total length of the small intestine is measured to determine what each of the limb lengths and cc should be, but many surgeons still do the cookie cutter approach.
I have a cookie cutter DS. At a later point, my surgeon started doing the Hess method, which I agree is superior. but you know what? My cookie cutter DS worked out just fine - for me.
I would suggest clarifying what the surgeon meant.

Yeah, I need to clarify. I hope that's what he meant and not 250 common channel.