Alimentary, my dear Watson....

[meecestopieces]

Hello Everyone,
I recently had revision surgery from RNY to DS in the UK (28th November 2015).
Thank you for all your support and best wishes on the revision forum.

According to my surgeon, my cc is 100cms which I am happy with, it seems to be the most common, common channel length. I have just discovered that my alimentary limb is 300cms long which I was rather surprised at. Mr Kerrigan, my hugely respected and experienced surgeon tells me that this 300cm length minimises future protein deficiencies etc and makes very little difference to the amount of weight loss or maintenance.

I think the lengths were pre-determined rather than measured ala Hess.

Any observations would be most welcome.
Thank you in advance,
Regards
Les

 

[hilary1617]

Congratulations on your revision. I have a standard cookie cutter 100 cm common channel and have done well - am exactly at the weight I want to be. Hope you are feeling well. Best wishes on a speedy recovery!

 

[meecestopieces]

Congratulations Hilary. I'm genuinley pleased for you. You must feel as well as look wonderful.

 

[DSRIGGS]

Hello and welcome Wes,

I had to have a revision to my original DS because I was having severe malnutrition that required me to take 400,000 IU of Creon daily (a metric shit ton) to help me absorb enough to keep off of TPN. This was because my original DS was done with a 100 CM CC and a 150 CM CC AL (way too freaking short) because my surgeon did the cookie cutter DS on me (the cookie cutter can work for some but for others can have dire consequences).

I know there is a misconception out there that the AL does not absorb protein and that it doesn't matter how long it is. THAT IS 100% INCORRECT. Even without digestive enzymes the AL absorbs nutrients including protein. What is important is that the combination of the AL + CC length = the BPL Length in order to get the proper balance (that is Dr Gary Atone's theory).

What will be important for you to find out is your total small bowel length. My original DS if done to the standards of the Hess method should have had an AL of 290 CM which Dr K said would have been rounded up to 300 CM and then a 75 CM CC but he would have rounded that up to 100 CM. I say this because my total SBL was 725 CM so 40% of that would have been the proper AL length and 10% for the CC (most will not go below 100 CM CC at least for men so that is typically rounded up). I firmly believe had this been done the first time I would have been fine.

I don't know if your surgeon did a measurement of your total small bowel, but if he didn't there is a fairly strong correlation to height and SB length. Taller people usually have longer small bowels than less taller people. I am 6'2 and had a 725 CM SB as measured by Dr Keshishian on my revision. Your surgeon may have done cookie cutter but I do think that he has given you protection from malabsorbtion with the 300 CM AL (unless you have a really long SB). It would be interesting to see if your surgeon did measure SB length to see how your Al/CC combo compare to what it would have been under Hess.

 

[meecestopieces]

Hello Scott,
Thank you for the reply.
It does sound like my surgeon has erred on the side of safety which is certainly fine by me, I was concerned that it may have been at the cost reduced weight loss and tougher maintenance.
The measurements don''t appear to be too alarming thanks to your explanation and examples. Thanks Scott.
I'll ask him at my next appointment if he made any measurements as you suggest.
There's certainly knowledge in abundance on this site!

Regards
Les

 

[DSRIGGS]

Sorry I called you Wes instead of Les. Me no read so good somtimes.

This site is a wealth of knowledge. Some of these fine ladies are well over 10 years post op so a great deal of experience of living with the DS on this site. BTW, I don't know what kind of nutritional and vitamin supplement information you were given by your surgeon, but a good many of the US surgeon's offices absolutely suck at that advice so please check out the vitamin page to get an idea in that regard.

Best of luck

 

[aaa]

Glad it went so well. I'm 100 cc as well.

 

[Revision]

Congrats on your revision surgery! I am gearing up for step 2 of my revision to DS (from RNY). I also had a lapband, so it was felt best to be done in 2 stages. I am planning on a 75 cm cc. How are you doing with vitamin/iron supplements? Cheers

 

[DSRIGGS]

Congrats on your revision surgery! I am gearing up for step 2 of my revision to DS (from RNY). I also had a lapband, so it was felt best to be done in 2 stages. I am planning on a 75 cm cc. How are you doing with vitamin/iron supplements? Cheers

@Revision Can I be so bold as to inquire how you came to the decision of wanting a 75 cm CC? Do you know your small bowel length? And what about your AL length?

 

[Revision]

Thanks for the question...yes, I will bring up the measuring and customizing CC length and AL length with the surgeon prior to the procedure. I spoke with Gagner about it before, and I believe he opts for a fairly standard 100cm CC length. I'm going to a different guy for the second step (Dennis Hong - excellent surgeon, solid experience with DS, closer to home and covered by insurance). I've read Dr. K's notes on the pitfalls of using standard measurements and the benefits of the customization approach and it seems sensible. Cheers.

 

[DSRIGGS]

Thanks for the question...yes, I will bring up the measuring and customizing CC length and AL length with the surgeon prior to the procedure. I spoke with Gagner about it before, and I believe he opts for a fairly standard 100cm CC length. I'm going to a different guy for the second step (Dennis Hong - excellent surgeon, solid experience with DS, closer to home and covered by insurance). I've read Dr. K's notes on the pitfalls of using standard measurements and the benefits of the customization approach and it seems sensible. Cheers.

Good deal. Best of luck with your revision.