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Post by nyuboi on Jun 20, 2012 17:42:28 GMT -5
Don't go off on me about the pylorus valve!! :-) I GET IT -- I agree with preserving it, and frankly would rather have 30% of a stomach than a pouch. (BTW, is it usually 70% removed or does it vary from patient to patient?) What I am a little confused about is how they vary in terms of the bypass malabsorption components. It seems both reduce the common channel, which I am very familiar with from DS. However, with RNY they seem to preverse the dudoenal. SO IS THE IDEA BEHIND THE BYPASS THE SAME THING? Not sure where the jejunum plays a role aside from achieving the same end result of not having the common channel where food and digestive juices mix as long? Anyone know a good site/source for comparing the two from a intestinal bypass point of view? Paul   |
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Post by newyorkbitch on Jun 20, 2012 18:38:25 GMT -5
There is a post on this very forum with a video explaining how the DS works.
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Post by Deleted on Jun 20, 2012 20:35:50 GMT -5
In RNY you have no duodenum left in the food channel. This is terrible for B vitamin and iron issues.
In DS you have more total intestine bypassed for food, therefore you have a higher degree of malabsorption that lasts longer and far better (for caloric malabsorption).
In both RNY and DS you will have to take a shitload of supplements daily and get regular bloodwork done for the rest of your life, regardless of the degree of caloric malabsorption. So with RNY you can regain your weight but still have malnutrition.
Doctors have no clue how to deal with these micronutrient issues, so you need to learn how to do it yourself. This takes time, ongoing effort and some small degree of OCD to do it right.
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Post by valgroce on Jun 21, 2012 10:56:44 GMT -5
What Elizabeth said.
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Post by angelcake on Jun 21, 2012 14:17:42 GMT -5
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Post by downsize54 on Jun 21, 2012 20:44:01 GMT -5
I don't understand the Vit B absorption. Isn't the duodenal portion switched, or does it still work with Vit B/iron issues as it will be carrying digestive juices to the common channel?
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Post by Deleted on Jun 21, 2012 21:07:38 GMT -5
The DS bypasses most of the doudenum. only about 4 cm of doudemum remain ( the 4cm with the pyloris vavle inside.)
the other part of the doudenum is left with the Biliary ducts intact, but not in the flow of food. (Biliopancreatic limb). Without food in the doudenum, it cannot and does not absorb any nutrients. Bile and enzymes from the pancreas are tranported all the way to the bottom with out touching food. This is the TRUE bypassed part of a DS.
In the food path ( alimentary limb) only certain nutrients are absorbed. Protein (60%), sugars (100%), a few other nutrients that do not require bile to break down the food first for digestion.
At the bottom where food and Bile mix is called the Common Channel. This area is where normal digestion takes place, but because it is so short, the bile and food do not have enough time to break down into absorbable peices (also why it is important to chew your food till there is nothing to swallow) before it is ejected out of the small intestine and into the large, where it is dried out and compacted (normally).
simplistic but gets the point accross.
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Post by msbatt on Jun 21, 2012 22:37:09 GMT -5
Okay, I'm going to take a stab at this, and forgive me if I've misunderstood your question.
In the RNY as it is most commonly done today, VERY LITTLE of the small intestine is bypassed, but that very little includes ALL of the duodenum. The common channel in the average RNY is roughly 400-550 cms long (based on an average small intestine length of 600-700 cms.), but the average common channel length in the DS is between 75-150 cms.
AS you know, the DS retains the pylorus and, therefore, all normal stomach function. This means that instead of just holding food for a while, like the pouch does, the post-DS stomach churns food, mixes it with digestive enzymes, and continues the mechanical breakdown that started with chewing, and then ejects it into the small intestine in small boli.
Now, different places in the small intestine are best-suited for absorbing specific things, most notably micronutrients (vitamins and minerals). There's a chart floating around the web that shows where these places are. The duodenum is sort of a hot-spot for micronutrient absorption, especially iron and calcium.
Oh, and by bypassing the bottom of the stomach, the RNY separates food from intrinsic factor, making absorption of the B vitamins VERY difficult---hence the reason RNYers take sublingual or injected B vitamins.
Things any clearer now? I'm completely at a loss as to what "However, with RNY they seem to preverse the dudoenal." means
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