Hello everyone!

[Tblues]

Hi all! I am 5 days po DS. I initially had the SADI on 3/21/23 and loss over 100lbs. It was planned by my surgeon that if I did not reach the desired loss that we would do the second connection. I also had my gallbladder removed during the recent procedure. I’m serious about taking my vitamins(logged daily since first surgery) and my labs are good he had no qualms. Just a bit of stats. HW:375, SW:316(first surgery) SW: 249.5(DS) I’m happy to be here! Excited to glean as much information to continue to lead a healthy life.

 

[hilary1617]

HI and welcome @Tblues! I saw your post on the "kissing x" thread and wanted to note that procedure is intended to essentially undo / decrease the selective malabsorbtion portion of a DS - in effect, revising a DS to a sleeve. A kissing x has the opposite effects of the revision you've had (SADI --> DS). Wishing you good health and interested in hearing about your progress.

 

[southernlady]

Welcome @Tblues
I agree with what @hilary1617 said. A kissing X is actually a revision to add more common channel to someone who has lost too much weight or having trouble maintaining their labs so they can gain weight.

You had a revision. I don’t know if your surgeon called it a kissing X but if he did, he was wrong.

Make sure you get a copy of both your operative reports, your original SADI and your revision.

 

[Tblues]

HI and welcome @Tblues! I saw your post on the "kissing x" thread and wanted to note that procedure is intended to essentially undo / decrease the selective malabsorbtion portion of a DS - in effect, revising a DS to a sleeve. A kissing x has the opposite effects of the revision you've had (SADI --> DS). Wishing you good health and interested in hearing about your progress.

Ok thank you! 😊

 

[Tblues]

Welcome @Tblues
I agree with what @hilary1617 said. A kissing X is actually a revision to add more common channel to someone who has lost too much weight or having trouble maintaining their labs so they can gain weight.

You had a revision. I don’t know if your surgeon called it a kissing X but if he did, he was wrong.

Make sure you get a copy of both your operative reports, your original SADI and your revision.

No he did not. I was curious about the eating part since my sleeve was not touched and concerned that something maybe wrong because I was so hungry and have been since the “all liquid” protocol began. I thought something may be wrong. You’ve assuaged my fears, so thank you!😊

 

[Tblues]

I was able to access my operative report for the revision and there’s some wording that alarmed me. Should I start an entirely new post to seek assistance on what I read or is it ok to post here?

 

[JackieOnLine]

it's OK to post it here

 

[Tblues]

Here is a portion of my operative report.

The peritoneum, both anterior and posterior, to the triangle of Calot was excised and extended with cautery. The cystic artery was identified  Possibly branching off the right hepatic artery.  This was skeletonized and the right hepatic artery was preserved.  The cystohepatic window was completely opened, delineating a space between the neck of the gallbladder and liver bed. The critical view of safety was obtained. 
 
Two hemolocks were applied was placed proximal across the cystic duct and one distal. The duct was divided sharply. The cystic artery was identified and clipped as well. The gallbladder was then dissected from the liver with caution to avoid bleeding.

After this was accomplished, the cecum was identified, and we run the bowel from the terminal ileum in a retrograde fashion and a second stage ileoileostomy was done using a stapler 150 cm from ileocecal valve to create the Roux-en Y anastomosis. For this the small bowel was divided just proximal to the duodeno-ileostomy.
There were adhesions around the previous duodenoileostomy which were released from surrounding attachments to avoid kinking to the previous sleeve.

The Ileoileostomy mesentric defect closed using non absorbable VLOC. In running fashion.
Patient tolerated the procedure well and was transferred to recovery in stable condition.

So my question is why would the surgeon say a Roux En Y anastomosis if it’s the second connection? Did he do a Gastric Bypass? All the cpt codes show TDS second part. I don’t meet with him again until 10/7. Per our last meeting before surgery we were on the same page as to what I wanted. Also I don’t see the measurements outside of the 150 cc. My SADI report shows measurements I believe. I appreciate any assistance because I feel a bit confused here. TIA

 

[Larra]

No, he did not do a gastric bypass. Unfortunately, gastric bypass has been referred to for years as RNY. In reality, roux en Y refers to a specific configuration of the small intestine that could be part of a number of different operations, NOT just gastric bypass. The configuration of a true DS is a different roux en Y that that of a gastric bypass. Keep in mind that the overwhelming majority of gastric bypass patients are not medical professionals and thus some medical terms are used loosely.

 

[Tblues]

Oh my gosh you have no idea how much relief you’ve brought me! I was so worried that he didn’t do the procedure that we agreed upon. Should I be concerned that there are no measurements for the alimentary limb but only the cc at 150? I will meet with him on the 7th and I’d like to know if there are other questions that I need to ask surrounding the op notes. It doesn’t seem that detailed as I assumed it would be.

 

[Larra]

You can ask about the lengths of the alimentary and BP limbs. It does seem like if he measured them, it would be in the report, but who knows. Overall, it's a well written report, compared to a lot of the ones we've seen over the years.

 

[Tblues]

Thank you so so much for taking the time to assist. I was allowing my anxiety to carry me away with thoughts of not having the procedure that was requested. I saw the term Roux en y and immediately started to panic.😩

 

[Larra]

I get it! So many people use RNY as shorthand for gastric bypass. Another pet peeve of mind is WLS as shorthand for bariatric surgery. I almost always use the correct terms, but I can't fix the internet.

 

[goalbmi]

No, he did not do a gastric bypass. Unfortunately, gastric bypass has been referred to for years as RNY. In reality, roux en Y refers to a specific configuration of the small intestine that could be part of a number of different operations, NOT just gastric bypass. The configuration of a true DS is a different roux en Y that that of a gastric bypass. Keep in mind that the overwhelming majority of gastric bypass patients are not medical professionals and thus some medical terms are used loosely.

That's an important clarification! It's essential to understand the nuances of surgical terms like Roux-en-Y, especially since many patients may not be familiar with the specifics. Regarding gastric bypass insurance coverage, it’s crucial for patients to verify with their insurance providers what is included, as policies can vary significantly. Some plans may cover the procedure if it’s deemed medically necessary, while others may have specific criteria that need to be met. It’s always best to do thorough research and speak with healthcare professionals to navigate these complexities effectively.

 

[Tblues]

Right! I was revised to TDS. Well actually he added the second connection. I did not want the Gastric Bypass so when he noticed the term Roux en Y I was a bit confused because I’ve read that the aforementioned was for a Gastric Bypass.