Look at Dr K's Blog that he just Published

[DSRIGGS]

Any of this sound familiar?

http://www.dssurgery.com/blog/?p=1124

BPD/DS, CALCIUM, CALCIUM DEFICIENCY, CALORIE COUNT, DEHYDRATION,DUODENAL SWITCH, MALNUTRITION, MEASURE SMALL BOWEL,UNCATEGORIZED
BOWEL LENGTH IN DUODENAL SWITCH
NOVEMBER 9, 2015 ARA KESHISHIAN LEAVE A COMMENT


Malnutrition is one of the most feared complication of the duodenal switch operation. It may present years after surgery. What is common is a mix of nutritional deficiencies which include fat soluble vitamins, and protein calorie malnutrition. These all point to possible excessive shortening of the common channel. In my practice we have seen patients that have had lengthening of their common channel to improve their metabolic picture. What is very obvious to us, is that we see disproportionately higher number of cases coming to us for revision from practices where the common and alimentary lengths are done as a “standard” numbers with no specific adjustments made for the patient, their anatomy and situation. I have said for years, that the length of the bowel that is measured to be become the common and the alimentary limb should be a percentage of the total length of small bowel, rather than a pre-determined measurement. Here is a visual description of how this works.

If a common channel and the alimentary limb is measured to be a percent of the total length then the chance of protein calorie malnutrition is minimized since this will take into account the bowels absorptive capacity which is being reduced. This decrease in the absorption is done as a fraction of the total length.

Raines et al. published a study in 2014, that showed how small bowel length is related more closely to a patient’s height and not weight. And yet, some surgeons totally based the length of the common channel and the alimentary limb arbitrarily based on the patient pre operative BMI and nothing else. Could this be the cause of why I see some patients coming to us for revision of their duodenal switch for malnutrition?

 

[Clematis]

Excellent "visual description" video. Thanks for posting, Scott

 

[Charris]

Awesome I wish he would have talked explaining instead of that awkward music. Lol

 

[Munchkin]

That doesn't explain people like me and there are quite a few of us. I guess it's because we are/were superabsorbers and would do just fine with NO CC at all! We inhale calories from the air we breathe!

 

[Charris]

I don't mean to sound like an idiot but @Munchkin I'm just curious how do you know you're a super absorber? Is there a test they do? I had never even heard the term super absorber until you said it some time ago.

 

[DSRIGGS]

That doesn't explain people like me and there are quite a few of us. I guess it's because we are/were superabsorbers and would do just fine with NO CC at all! We inhale calories from the air we breathe!

I am trying to remember if I was the two of us who were discussing total SBL and then the ratio of BPL length to the combination of the AL+CC Length? If your BPL is shorter than the combination of the other two then you would be absorbing more than a patient with a BPL/(CC+AL) at 1 or over.

I know many believe that the CC is the only part of the DS that absorbs nutrients but it absolutely does...so the AL length relative to SBL is very important too. The AL absorbs nutrients even without digestive enzymes, and seeing that you are nearly 13 years post DS I am sure that your AL & CC have hypertrophied and you are absorbing more now than you were earlier on Post DS.

That could explain your absorption.

 

[Honeybeeblue]

Thank you for the Great Post