Recommended long AL and CC lengths

[Cthulurscon]

Hi there,

So my surgeon has recommended a 200cm common channel and, I believe, a 300cm alimentary limb. Based on reading here and Dr. K's website, it seems the AL length measurement is standard, but that common channel length is rather long.

I'm 26, female, 5'10 or 5'11 depending on who you ask, and generally lose weight easily. I count calories and the expected amount of weight comes off. I have PCOS. I do not have prediabetes or diabetes. I have done one crash diet (which worked for a time, but also messed up my hormones. I seem to have recovered.) Keeping it off forever has been the problem.

I'm on depression and anxiety medications, have been basically my whole life (including most of childhood), and I'm guessing huge malabsorption would be significantly contraindicated in that situation.

I also have a rare condition for which absorption is not directly key, but the condition may require significant medical interventions in the future, and those interventions are going to require medicine. Medicine which, presumably, would need to be absorbed.

DS as a surgery is actually not contraindicated for my condition. But it seems like the longer length might be important.

So: I've seen a lot of posts here about anything above a 100cm cc being too long. Is it actually too long in my situation? It actually seems to me like this is a reasonable trade-off for my situation. But the reactions here are so very violent to >100cm lengths that I thought maybe a thread would be worthwhile anyway.

I'm most partial to research papers on the topic. I've read seemingly everything that's publicly accessible on the subject, including my surgeon's publications, but if anyone has access to paywalled things, please do let me know.

 

[southernlady]

So: I've seen a lot of posts here about anything above a 100cm cc being too long. Is it actually too long in my situation? It actually seems to me like this is a reasonable trade-off for my situation. But the reactions here are so very violent to >100cm lengths that I thought maybe a thread would be worthwhile anyway.

Part of the attitude is that we actually prefer the Hess Method but that is almost never done anymore, especially in surgeries done laparoscopically. The Hess Method is designed to be perfect for each individual.

The other reason is the CPT code for the DS specifically states 50-100. Not 150. It’s just cookie cutter surgeons have moved it to 150. Mine is 175 because I am a lightweight and I had mine almost 13 years ago. Starting BMI was 35.2 and my surgeon said 175-200. Day of surgery, I got him to agree to 175. I’ve done very well, mostly cause I’m anal about my own vitamin levels. Yes, my PCP pulls them but I’m in charge of them. I adjust as needed telling my PCP what I’m doing and why. This morning at 5’3, I weighed 120 which is a 21.3 BMI, perfectly normal and healthy.

As long as you are an educated patient and willing to go toe to toe with medical professionals, you can handle the DS.

 

[hilary1617]

HI and welcome Cthulurscon, seeing 200 cm makes me wonder. Is it possible that the surgeon with whom you me is proposing a modified procedure (SADI or Loop DS) rather than the traditional full, two anastomoses duodenal switch?

 

[southernlady]

HI and welcome Cthulurscon, seeing 200 cm makes me wonder. Is it possible that the surgeon with whom you me is proposing a modified procedure (SADI or Loop DS) rather than the traditional full, two anastomoses duodenal switch?

No, he’s a vetted DS surgeon but has gotten overly cautious in the last year or so. Dr. Srikanth is her surgeon. I recognize her from Facebook.

 

[Cthulurscon]

HI and welcome Cthulurscon, seeing 200 cm makes me wonder. Is it possible that the surgeon with whom you me is proposing a modified procedure (SADI or Loop DS) rather than the traditional full, two anastomoses duodenal switch?

No, it's definitely 2 anastomosis.

 

[hilary1617]

200 cm is very conservative common channel. I'm not sure how different the long term impact would be from a standalone VSG. I think you are asking the right questions. You are young and have a lot of years ahead of you.

 

[JackieOnLine]

Hello Cthulurscon

if anyone has access to paywalled things

a much more tech savvy friend gave me this advice when I complained I couldn't read a link to The Atlantic. take the URL to what you want to read and put it here:

https://archive.ph/

then scroll down to and click on a saved version
so far that has always worked: you can read an archived version of whatever it is.

 

[talitali]

I had my DS at 32 with a 150cm CC. The surgeon gave me a very small stomach with the longer CC to allow me more absorpotion which would (ideally) allow for less long-term nutritional complications. I am quite healthy and my labs are generally good. I think it worked. But, I also never got super low in weight and have been struggling this past few years to lose 15 pounds of regain (Mostly I’m lazy!).

If I could do it again, I’d go for a shorter CC like 100 or 125 at most. But honestly, zero regrets.

 

[John]

I have the single loop SADi DS with a 300cm cc. I would highly recommend considering the longer cc and I'm 100% convinced there's not a simple linear relationship between the length of your cc and the amount of weight loss. Everyone has an equilibrium for required nutrition vs calories burned and if your cc is too short, you'll risk various issues while struggling with weight balance. The longer cc burns more calories for me, and I read a lot of posts about 50-100cm patients who struggle like hell with their weight. Your current situation seems like a longer common channel may work fine and mitigate other health risk issues. Good luck with whatever you decide, and remember your doctor has never lived with WLS and can only guess based on what he has read. Only you know what's best for you.

 

[ShrinkingMyTiara]

I have a common channel of 175. My surgeon recommended 200 because of the issues he's had at his practice with vitamin deficiencies and bowel issues with the shorter lengths. He was also concerned because I have had past issues with iron deficiency anemia (since my teens) and very low chronic vitamin D. I also have a history of small intestine ulcerations and an autoimmune disease that affects my gut. I'm on meds for depression and PTSD.

I talked him down to 175 cm and he and my GI doctor agreed it would be a safe length. I could have gone lower if I fought for it but I was concerned given the above history so I felt like it was prudent to leave a longer common channel. Post surgery I started to malabsorb my depression meds and have withdrawal, so now I crush one (Pristiq) and take an easier absorbed form of the other twice a day (Wellbutrin). The Rexulti and my ADHD med Adzenys absorb just fine.

I have read that people who are taller often have longer intestines, which would give you a longer common channel with the Hess method. That's something to think about. It is possible if you went with a cookie cutter 100cm length you'd end up too short. This is why the Hess method is so useful. Intestinal length can be estimated with an MRI I believe if you were really curious before surgery and could get it approved. I'd try to argue him down to at least 175cm, I've seen a number of people who have that and lost all their weight. I'm only 2 months out and I'm losing a bit slowly but my body has always been VERY reluctant to let go of weight so I don't think it is due to the common channel. I have not had many bowel issues since a few weeks post surgery though and I suspect that is in part to my longer common channel.

Oh, and I recommend actually measuring out what those common channels look like. That's what helped me decide on 175cm. In my gut I knew 200 cm was too long for me, I'm only 5'4". When I converted the measurements to inches it made much more sense in my brain. I try to make the metric system make sense but I still can't visualize the measurements. LOL

 

[Cthulurscon]

I have a common channel of 175. My surgeon recommended 200 because of the issues he's had at his practice with vitamin deficiencies and bowel issues with the shorter lengths. He was also concerned because I have had past issues with iron deficiency anemia (since my teens) and very low chronic vitamin D. I also have a history of small intestine ulcerations and an autoimmune disease that affects my gut. I'm on meds for depression and PTSD.

I talked him down to 175 cm and he and my GI doctor agreed it would be a safe length. I could have gone lower if I fought for it but I was concerned given the above history so I felt like it was prudent to leave a longer common channel. Post surgery I started to malabsorb my depression meds and have withdrawal, so now I crush one (Pristiq) and take an easier absorbed form of the other twice a day (Wellbutrin). The Rexulti and my ADHD med Adzenys absorb just fine.

I have read that people who are taller often have longer intestines, which would give you a longer common channel with the Hess method. That's something to think about. It is possible if you went with a cookie cutter 100cm length you'd end up too short. This is why the Hess method is so useful. Intestinal length can be estimated with an MRI I believe if you were really curious before surgery and could get it approved. I'd try to argue him down to at least 175cm, I've seen a number of people who have that and lost all their weight. I'm only 2 months out and I'm losing a bit slowly but my body has always been VERY reluctant to let go of weight so I don't think it is due to the common channel. I have not had many bowel issues since a few weeks post surgery though and I suspect that is in part to my longer common channel.

Oh, and I recommend actually measuring out what those common channels look like. That's what helped me decide on 175cm. In my gut I knew 200 cm was too long for me, I'm only 5'4". When I converted the measurements to inches it made much more sense in my brain. I try to make the metric system make sense but I still can't visualize the measurements. LOL

Thank you! This was super helpful.

For the benefit of any people reading in the future, I got clarification that the TOTAL length would be 300cm. So, 100cm alimentary limb, 200cm common channel, for a total alimentary limb of 300cm.

I've decided after talking with my surgeon and my psychiatrist, and specialists in my genetic disorder, that this length is ok for me. I have a long time to live (hopefully...) and it's hard to predict the impact that serious malabsorption would have on my condition. So instead we'll go a bit longer than usual, and I'll just be extra vigilant about the diet.

Thanks everyone!

 

[ShrinkingMyTiara]

I've decided after talking with my surgeon and my psychiatrist, and specialists in my genetic disorder, that this length is ok for me. I have a long time to live (hopefully...) and it's hard to predict the impact that serious malabsorption would have on my condition. So instead we'll go a bit longer than usual, and I'll just be extra vigilant about the diet.

I'm glad you were all collectively able to come to a decision!! It is good you have doctors who were willing to weigh the options carefully and take your individual needs into considerations. Too many surgeons do bariatric surgeries without thinking about the individual they are working with and their medical and weight loss history. I wish you luck with your surgery!! Have you scheduled it yet or are you still in the planning/testing phase?

 

[Cthulurscon]

I'm glad you were all collectively able to come to a decision!! It is good you have doctors who were willing to weigh the options carefully and take your individual needs into considerations. Too many surgeons do bariatric surgeries without thinking about the individual they are working with and their medical and weight loss history. I wish you luck with your surgery!! Have you scheduled it yet or are you still in the planning/testing phase?

Still in testing sadly! Surgery would likely be April or May.

 

[KyahRose]

Still in testing sadly! Surgery would likely be April or May.

Don't worry, it will come faster than you think. I went from not having any idea when my surgery likely would be, to suddenly feeling like it's tomorrow!! My tentative surgery date is set for March 25th or 26th.....depending on what the surgeon says about hospital location. I want my surgery done at a hospital closer to where I live, as I am a nervous passenger. If we do it at a closer hospital it would likely be on the 25th; but the lady I was talking with was pretty sure the surgeon would want it at a different hospital, which would put my surgery date on the 26th. Either way, it seems my surgery date is coming much sooner than I originally anticipated.

 

[BigIsland Tammy]

FYI: I'm 5'8" and a member of the big bone family My surgeon measured and cut (Hess methodology --custom sized for me). I ended up with 150cm common, 175cm alimentary, and 655cm bilio-pancreatic loop, with a 110ml stomach volume. Weight loss was successful over a couple of years with expected regain/bounce putting me at a good weight.

Hope you're getting nearer to a surgery date!