My 2016 DS Journal

[newanatomy]

My doctor does not use the Hess method. He told me that we humans are more alike than we are different. Luckily, I have had zero issues with not having had the Hess method.

 

[trace]

My doctor does not use the Hess method. He told me that we humans are more alike than we are different. Luckily, I have had zero issues with not having had the Hess method.

Thanks for chiming in, @newanatomy. Do you know the length of your CC?

 

[newanatomy]

Thanks for chiming in, @newanatomy. Do you know the length of your CC?

Sleeve was created using a 46 French Bougie; 100 cm on moderate stretch for the common channel and 250 cm alimentary limb.

Oops, I meant a 150 cm alimentary limb.

I am getting this from my operation report. I am no doctor, obviously!

 

[DSRIGGS]

The Dr Keshishian study I referenced.

https://www.dssurgery.com/wp-content/uploads/2016/03/albumin-abstract-1.pdf

As far as patients being more alike then not, here is a study of small bowel length of that shows a significant range of length and a correlation to height (Shorter people tend to have shorter SBL and taller people tend to have longer SBL).

http://meetings.ssat.com/abstracts/2014/Mo2053.cgi

If one is lucky enough to fall with in a certain small bowel length then they will be fine with a standard limb length, however; for those with shorter than normal small bowels or longer than normal small bowels that is where the problem arises.

Results: In our group there was a wide variation of length (630-1510cm), with the average being 998cm. Linear regression analysis showed a statistically significant relationship between bowel length and patient height. (p=.025) Males had a longer intestinal length than females, (p=0.007).

Chart showing that variation and by height

For the record the standard limb can and does work for many. I would have been okay if my original DS surgeon who reported my lengths as CC 100CM, AL 150 CM had given me the length of @newanatomy 100 & 250 CM. I have a total SBL of 725 so my absorbing path should have been roughly 363.5 CM so the the 350 CM length would have been fine for me. For somebody with a 500 CM SBL (a couple of the Esquerra patients said their SBL was that length ..I think Jim and Clematis if I remember correctly) the 350 CM would have been too long for them as they needed rough 250CM of absorbing intestine. That 350 would have put their ration at 70% absorbing to 30% non absorbing, which for them would have been to little malabsorption and they likely would not have lost as much weight as they desired. @Munchkin is on record as saying that she never lost as much as she wanted and she has been very compliant with diet and vitamins. I suspect that "too long scenario" happened to her.

All of this is just food for thought and discussion with yourself and your Dr. As far as the DS "being dangerous" please see the Dr Keshishian study I linked that shows no protein malnutrition at 2 years for any patient in his study and an average BMI of 27.6 (that shows the Hess if anything errors to the safe side when it comes to weight and malnutrition). This information and my discussion is not meant to denigrate anyone or their DS because it was standard limb length. If it worked for them that is great, but there is absolutely and element of risk in that method that is greatly reduced by using the Hess Method. That is all I am trying to say.

Best wishes

 

[DS fan]

I did not have the Hess method. I have a 100cm common channel and 150cm limb. They used a 38 French bougie on my stomach.

 

[newanatomy]

I only "chime" in because, I wouldn't want someone to forgo the life saving procedure that is the DS due to the fact that their chosen surgeon doesn't use the Hess Method. I would bet there are tons of patients out there who have a non Hess DS, all doing fabulous.

 

[trace]

@DSRIGGS Thank you. I totally get what you're saying, and I appreciate your passion! I really do. Everyone's responses are making me just that much better informed.

I did not have the Hess method. I have a 100cm common channel and 150cm limb. They used a 38 French bougie on my stomach.

Thanks for letting me know. May I ask how tall you are? I'm 5'9", and I wonder what that might mean for my ideal measurements. @DS fan

I only "chime" in because, I wouldn't want someone to forgo the life saving procedure that is the DS due to the fact that their chosen surgeon doesn't use the Hess Method. I would bet there are tons of patients out there who have a non Hess DS, all doing fabulous.

I get it, and I feel that way, too. @newanatomy I guess I'm trying to figure out how to approach this with my doctor. Since he told me he is open to considering a different length for me, but if it's going to be a standard cut rather than Hess, then do I push it? Do I go with his 150cm standard? If I ask for a shorter CC, and things go haywire, then I'm going to be disappointed. But if the 150cm doesn't provide optimum weight loss for me, I'm also going to be disappointed. GAH!

 

[k9ophile]

I only "chime" in because, I wouldn't want someone to forgo the life saving procedure that is the DS due to the fact that their chosen surgeon doesn't use the Hess Method. I would bet there are tons of patients out there who have a non Hess DS, all doing fabulous.

I would agree as I'm also had a non-Hess method DS and am doing quite well, TYVM. When Dr. Houston was doing the DS he used a standard size bougie and the 100 cc common channel. I heard that before quitting performing, he went to a bigger bougie, but stayed with the 100 cc common channel. I know of one patient who thought she was losing too much and had him revise her common channel. I'm willing to bet that even if everyone had their DS with the same size bougie and same length common channel, we'd still have some differences in our supplementation routine. For example, I don't take iron after taking it from the beginning and having consistently high results. I'm also willing to bet that those who have to get iron infusions have excellent levels of something I have to tinker with continuously.

 

[DS fan]

@trace I am 5' 6.5" tall.

 

[southernlady]

Since he told me he is open to considering a different length for me, but if it's going to be a standard cut rather than Hess, then do I push it?

Ask him how he measures the intestine...that makes MORE of a difference than the length for MANY. Example, imagine your intestine being a slinky. It can fit in a very small box for shipping but can extend a LONG way when kids play with it. It can even be stretched so hard, it never goes back to it's original shape.

So my surgeon may stretch it out and then measure, your surgeon may just lay it out, NOT stretch it and then measure. That small intestine could be one inch or 10 inches when let go and no longer stretched out.

 

[DSRIGGS]

I only "chime" in because, I wouldn't want someone to forgo the life saving procedure that is the DS due to the fact that their chosen surgeon doesn't use the Hess Method. I would bet there are tons of patients out there who have a non Hess DS, all doing fabulous.

I agree with everything but your last 3 words. Again the standard limb length can and does work for many. My beef is that the standard limb guys don't measure the small bowel and then make a decision based off of that measurement so they mitigate risk of malnutrition and or insufficient loss. It only takes an extra 15 minutes. A 6'6 man and a 5'6 man absolutely will require different limb lengths.

For the record I have two ex coworkers who had their DS with Marshall as well and they did very well. They are both about 5'5 which is 9 inches shorter than me so it makes sense why the limb length was fie for them and not for me.

I also think that Simpler who I believe did your DS is significantly mitigating malnutrition risk because if 100 and 250 are his standard CC and AL lengths that is very likely to not be too short. Marshall does 100 and 150 so he us not mitigating nutritional deficiency risk.

 

[DSRIGGS]

Ask him how he measures the intestine...that makes MORE of a difference than the length for MANY. Example, imagine your intestine being a slinky. It can fit in a very small box for shipping but can extend a LONG way when kids play with it. It can even be stretched so hard, it never goes back to it's original shape.

So my surgeon may stretch it out and then measure, your surgeon may just lay it out, NOT stretch it and then measure. That small intestine could be one inch or 10 inches when let go and no longer stretched out.

Yep definite measurement variation from surgeon to surgeon. What Marshall said was 100 cm was 125 as measured by Dr K so significant difference between those two.

 

[DSRIGGS]

I would agree as I'm also had a non-Hess method DS and am doing quite well, TYVM. When Dr. Houston was doing the DS he used a standard size bougie and the 100 cc common channel. I heard that before quitting performing, he went to a bigger bougie, but stayed with the 100 cc common channel. I know of one patient who thought she was losing too much and had him revise her common channel. I'm willing to bet that even if everyone had their DS with the same size bougie and same length common channel, we'd still have some differences in our supplementation routine. For example, I don't take iron after taking it from the beginning and having consistently high results. I'm also willing to bet that those who have to get iron infusions have excellent levels of something I have to tinker with continuously.

Bougie size can be misleading too because I am told that some surgeons suture very loosely and some suture very tight to the bougie.

Also, research has shown that smaller bougie size does not have any different weight loss results.

 

[DSRIGGS]

@DSRIGGS Thank you. I totally get what you're saying, and I appreciate your passion! I really do. Everyone's responses are making me just that much better informed.



Thanks for letting me know. May I ask how tall you are? I'm 5'9", and I wonder what that might mean for my ideal measurements. @DS fan




I get it, and I feel that way, too. @newanatomy I guess I'm trying to figure out how to approach this with my doctor. Since he told me he is open to considering a different length for me, but if it's going to be a standard cut rather than Hess, then do I push it? Do I go with his 150cm standard? If I ask for a shorter CC, and things go haywire, then I'm going to be disappointed. But if the 150cm doesn't provide optimum weight loss for me, I'm also going to be disappointed. GAH!

The truth is you can't know what is the proper limb length if he doesn't measure your small bowel length. It is a guess.

And you are welcome and please don't think I am pressuring you. I just encourage you to to ask him very tough questions and to show him the study I linked and ask why he feels that is unsafe. Being 5'9 you probably have a longer small bowel than many ladies, but that isn't for certain.

Finally if he does insist on non hess make sure you understand what he plans on doing for both the common channew and the alimentary limbs. They are both equally important and both do absorb nutrients.

If in the end he does standard length I think the 100 and 250 lengths like NA had with Simper is much safer in terms of potential malnutrition due too much malabsorptionthan the 100 and 150 I received.

Best wishes and I am glad you decided on the DS and are moving forward.

 

[newanatomy]

I agree with everything but your last 3 words. Again the standard limb length can and does work for many. My beef is that the standard limb guys don't measure the small bowel and then make a decision based off of that measurement so they mitigate risk of malnutrition and or insufficient loss. It only takes an extra 15 minutes. A 6'6 man and a 5'6 man absolutely will require different limb lengths.

For the record I have two ex coworkers who had their DS with Marshall as well and they did very well. They are both about 5'5 which is 9 inches shorter than me so it makes sense why the limb length was fie for them and not for me.

I also think that Simpler who I believe did your DS is significantly mitigating malnutrition risk because if 100 and 250 are his standard CC and AL lengths that is very likely to not be too short. Marshall does 100 and 150 so he us not mitigating nutritional deficiency risk.

I made a typo mine is 100 and 150. I get why you bang the Hess drum. I just haven't seen a lot of people with the troubles you have had.