Standard AI length

DawnNYC

Active Member
ive met with several doctors about doing an rny conversion to a traditional DS. If they don't do the Hess method, what is a standard AI length?

It seems like most are saying 150 but just had someone say they do 250 AI and 100 common channel. What impact, if any, would that have on weight loss?

Thanks for your help!
 
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Larra

Well-Known Member
My guess is that the surgeon who said 250 cm is doing a SADI, aka loop DS aka modified DS aka some other names as well. This is an experimental variation on the standard DS for which long term data is minimal. Most of us hear feel that it is unlikely that long term results will be as good with this variation because you lose the benefit of selective fat malabsorption, which helps us so much to maintain our weight loss.
I have a "cookie cutter" DS with a 100 cm common channel. I think, for most of us, that works out well, though given a choice I would opt for the Hess method (the surgeon I had did go to the Hess method prior to his retirement). I don't know your whole story but clearly you are not satisfied with the results of your prior operation or you wouldn't be seeking revision, so I would recommend going for the best operation you can get in terms of well known long term results for both excess weight loss and especially for maintenance of that weight loss, and that's a standard DS with 2 anastomoses.
 

DonRobbie

Well-Known Member
Generally the shorter the common channel the greater the weight loss and the nutritional deficiencies. As for if a particular length will work for you that probably depends on the length of your small intestine (generally correlates to height) and what the ratio of common channel to total length winds up being.

https://www.ncbi.nlm.nih.gov/pubmed/27236379
This is a bigger jump than 100 to 150 but still it illustrates how common channel length affects outcomes.
http://bariatricfacts.org/threads/common-channel-length-specifics.2109/
Worthwhile reading.
 

DawnNYC

Active Member
My guess is that the surgeon who said 250 cm is doing a SADI, aka loop DS aka modified DS aka some other names as well. This is an experimental variation on the standard DS for which long term data is minimal. Most of us hear feel that it is unlikely that long term results will be as good with this variation because you lose the benefit of selective fat malabsorption, which helps us so much to maintain our weight loss.
I have a "cookie cutter" DS with a 100 cm common channel. I think, for most of us, that works out well, though given a choice I would opt for the Hess method (the surgeon I had did go to the Hess method prior to his retirement). I don't know your whole story but clearly you are not satisfied with the results of your prior operation or you wouldn't be seeking revision, so I would recommend going for the best operation you can get in terms of well known long term results for both excess weight loss and especially for maintenance of that weight loss, and that's a standard DS with 2 anastomoses.
Thanks Larra,

It's not a SADI or Loop DS. The common channel would be 100 but had never heard of a 250 AL before.
 

DonRobbie

Well-Known Member
http://www.soard.org/article/S1550-7289(17)31018-3/fulltext
An interesting study about alimentary limb length. Dr Cottom's reply (link is on the right side of the page) is worth reading (and is much more readable). The interesting thing is the common channel is the same length in both control and test groups. To grossly oversimplify they flipped the the biliary and alimentary limb (100cm common channel, 100cm biliary limb, 570cm alimentary limb vs a standard DS' 100-150 CC, 600 BL, 150 AL) The operation described is waaay more of a deviation from the norm than you're describing (100 CC, 500 BL, 250 AL) but it might be illuminating.
 

DawnNYC

Active Member
A 100 common channel is fairly common in the cookie cutter world. A 250 Alimentary would also be pretty standard.

My concern is who are you talking to? The list of known RNY to DS surgeons is here: http://bariatricfacts.org/threads/current-list-of-known-rny-or-lapband-to-ds-surgeons.1403/
Thank you Southernlady! This is very helpful. I think I'm going to use Dr. Antanavicius (Dr. G) at Abington Hospital in PA. He's done several hundred conversions and over 2,000 bariatric procedures. I'm surprised more people don't talk about him and Dr. Bonnani as they are SO pro-DS.

After I left my consultation last week, I realized I had two questions about things I hadn't heard before.

1. He uses 100 cc and 250 AI. I've seen multiple images where the AI is only 150 so I'm concerned about the impact of the longer AI in relationship to weightloss

2. He says he removes the current roux-limb I have because it might not be strong enough for conversion. He then uses fresh small bowl to create the AI. I've never heard of that before.
 

southernlady

Administrator
Staff member
This is very helpful. I think I'm going to use Dr. Antanavicius (Dr. G) at Abington Hospital in PA. He's done several hundred conversions and over 2,000 bariatric procedures. I'm surprised more people don't talk about him and Dr. Bonnani as they are SO pro-DS.
They are very pro DS but have not heard of either of them doing a revision. Can you ask them how long and how many RNY to DS they’ve each done.
 

DawnNYC

Active Member
They are very pro DS but have not heard of either of them doing a revision. Can you ask them how long and how many RNY to DS they’ve each done.

Dr. G said he would guess several hundred. He said he would have to go back to figure out the exact number because they don't separate their revisions numbers by original procedures.

I can ask about how long they've been doing RNY revisions. When I initially spoke to the program coordinator, she said “several years” and they did 2-3 revisions a week now.

I almost didn’t go see him because he’s not on your list but I’ve had a hard time finding someone on the east coast who still does the traditional DS vs SIPS AND will do it as one surgery. Plus, I love he is in my network!

The did just lose their BCBS Blue Distinction Center and I’m not sure why. They say they hope it will be reinstated over the next few months. I know Dr. Bonnani has been out multiple months so I don’t know if they didn’t reach the number of surgeries needed to qualify or if something else is going on.
 

Larra

Well-Known Member
I haven't heard of removing the old roux limb before either, but it's very short with typical proximal RNY so you won't be losing much small intestine even when it's removed (especially considering that with the DS so much of our small intestine is deliberately bypassed anyway).
Regarding revisions, there are a lot of sleeve to DS and lap band to DS revisions being done, so total number of revisions isn't the number you want to know, it's specifically RNY to DS revisions. It would be great if they are doing them as there are so few DS surgeons taking this operation on, and we need as many good resources as possible.
 

DianaCox

Bad Cop
I just want to make sure the discussion above is comparing apples to apples.

Some surgeons refer to the alimentary limb/tract an mean the ENTIRE length between duodenum and colon. In that case, if they say they are giving you a 100 cm common channel and 250 cm AL, then what you ACTUALLY have is 100 cm CC + 150 cm ALIMENTARY ONLY section for a total of 250 cm of ABSORBING intestine (you absorb some protein and carbs in the ALIMENTARY ONLY portion, because there are some protease and carbohydrolase enzymes secreted by the intestine itself).

However, if they mean 250 ALIMENTARY ONLY plus another 100 cm of common channel, then you've got 350 cm of absorbing intestine, which I personally think is too much.

Make sure you know what they mean.
 

DSRIGGS

Yes, that is chocolate covered bacon
Like Dianna said, the AL sometimes means the entire absorbing track.. It took me several years to realize with the Hess DS that 10% CC & 40% AL was referring to the CC + what we commonly call the AL. So I now refer to the small AL to describe the limb in which food travels before connecting to the CC & then the big or Total AL to describe the goal food absorbing limb o r CC + Small AL.

I am very, very, very biased about feels ng the Hess DS is the only DS that should ever be performed. Why? Because by not measuring my total SBL and giving me a standard 100 + 150 limb length pacjage Dr Marshall did great harm to be and caused many years of unnecessary suffering for me to due malnutrition from too short of a Total AL. There are many people who get a standard limb DS who never come close to goal weight because they should have had a shorter total AL. Do yourself a favor, especially since you're being revised (not sure what you have now) but go see DrK and get a Hess DS that you know will work.

Cookie cutter can and first work for many but why risk malnutrition or insufficient weight loss. Had I found Dr K earlier my life wouldn't be so fucked up now.

Best wishes and feel free to PM me if you have questions that you aren't comfortable making in the groyg or if you are, then ask away.
 
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