Munchkin
Full of Fairy Dust
I wouldn't want anything longer than 100cm for the CC. If you want the Hess method, all the lengths will be determined by the length of your whole small bowel.
DS or SIPS? The new question of the day...
- Thread starter Stefanie S.
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Larra
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I agree with @Munchkin. My surgery was done cookie cutter fashion (not Hess method) with 100 cm cc and worked out fine. The whole point of the switch part of the DS is to provide both metabolic changes and significant malabsorption. We know, from experience with purely restrictive operations over the years, that restriction alone doesn't work. I would not want an operation that short-changed me on the malabsorption. Yes, that means I take a whole bunch of vitamins every day and eat lots of protein, but I was very ready to make that commitment, and it was well worth it to get the weight loss and health benefits that I got.
Stefanie S.
Well-Known Member
Thank you! Last time I talked to her, she was leaning towards 300 cm. I think she suggested that due to my extreme concerns (at that time) about the bathroom issues and malnutrition. However, after reading these boards and talking to all of you, I am no longer overly-worried about those things. I want to go in and talk to her intelligently about my wishes.
Munchkin
Full of Fairy Dust
300cm is usually SIPS. Don't think I have ever seen one that long with a true DS. Honestly I don't think you could lose the weight and keep it off with a CC that long. Your body would adapt too easily.
Let me give you a bit of the history(ancient) of how WLS came to be. You can thank mostly soldiers who fought in WWII. The first war after antibiotics were invented/discovered. Penicillin let soldiers who had been gut shot survive wounds that would have been fatal. So they had all these people walking around without portions of their small bowel. At first there were dire predictions they would die from malnutrition. Then over time, they started noticing that not only did they do well, but they tended to gain less weight as they aged and had lower cholesterol/blood lipids too. Studying these people led to what would become WLS.
This is more than just numbers. You don't need to discuss this here but the real question is, why are you fat? Only you know the answer. If you are fat because you eat too much, the surgery will be a success as long as you can commit to eating less and different foods long term. If you are fat because you have metabolic issues, then push for the most drastic surgery you can get. I would guess you are the latter because the sleeve, restriction alone, did not work long term.
No matter whether RNY or DS or SIPS, all malabsorptive procedures involve a level of small bowel adaptation of macronutrient absorption - after two years, most RNYers with proximal and medial bypasses are absorbing about 100% of the calories they ingest, and most DSers are finding that they are not able to eat AS MUCH as before and still lose, and most of them are experiencing some "bounce-back" if they don't rein it in.
ONLY the DS (and distal bypass, which is a miserable operation to live with - all the negatives of the DS, with dumping and NSAID restrictions and ulcers, more micronutrient malabsorption, etc.) continues to provide significant malabsorption and metabolic correction.
300 cm doesn't sound like a long-term solution to morbid obesity and metabolic dysfunction.
ONLY the DS (and distal bypass, which is a miserable operation to live with - all the negatives of the DS, with dumping and NSAID restrictions and ulcers, more micronutrient malabsorption, etc.) continues to provide significant malabsorption and metabolic correction.
300 cm doesn't sound like a long-term solution to morbid obesity and metabolic dysfunction.
Stefanie S.
Well-Known Member
Incredibly helpful and interesting! And yes... definitely metabolic issues (PCOS plus years of yo-yo dieting), but also I just eat too much
Stefanie S.
Well-Known Member
Thank you so much. I need these affirmations before I go in to talk to my surgeon again. I am not trying to be too skinny... but I most certainly want to drop at least 100-125 pounds and keep it off.
Larra
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Actually, even distal RNY doesn't do much better than proximal RNY. Some people end up (as revisions) with ERNY, with E for extended, which has a common channel about the same as a standard DS. And while some people can make it work, for many that's where you get the worst of both worlds that @DianaCox described.
DSRIGGS
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You can't know what your lengths should be before surgery because you don't know your small bowel length. That is why it is important to have a HESS DS other it is a shot in the dark. For a Hess DS the surgeon must measure your entire small bowel and then he/she will make the CC approximately 10% of that length and the AL 30% of that length. So for sake of easy presentation lets assume a 750cm total SBL that means the surgeon would do the following for a Hess DS:
CC 75 cm
AL 225 cm
BPL 450 cm
Absorbing path 40%
Non absorbing path 60%
The example above the lady has
Absorbing path 62%
Non absorbing path 38%
She is not going to lose anywhere near or keep off anywhere near the weight she wants to because the surgeon left he with way too much absorption. Honestly I have no idea what the guy was thinking because I won't be surprised if this lady struggles to stay at a 35 BMI...absolutely not what she is expecting from the DS.
