distal bypass

[kat44]

Does anyone here have a distal bypass? If so what are your results? Considering it.

[larra]

Back in the day when I was on course for RNY I considered it too - not that the surgeon would have been willing to do it, not that my insurance would have agreed to it, but it had a certain appeal compared to the usual proximal RNY. However, there are no studies to show that people with distal do any better than those with proximal, or that revising from proximal to distal for people not doing as well as desired show any significant improvement with distal.
Now, there is also the ERNY (E for extended) which goes very distal, and probably does do better for weight loss, but combines the nutritional issues of gastric bypass with those of DS, and still has all the "pouch issues" of potential dumping, food getting stuck, stoma enlarging too much, reactive hypoglycemia, can't take NSAIDs that any gastric bypass has. And I have not heard of this as a primary operation, only as a revision.
In the end, I realized RNY was not for me, and had the DS. Best decision I ever made.

Larra

[msbatt]

GET a DS instead. The DS has the VERY BEST long-term, maintained weight-loss stats, and the very best stats for resolving or preventing co-morbs like diabetes and high cholesterol. And it retains the pylorus and all normal stomach function---something I find very comforting. (*grin*)

[losingsally]

I had a distal or extended RNY as my primary surgery. I'm almost 7 years out ( in August).
I had this in India, I don't think anyone does this in USA. I don't have any extra issues, I have the advantage of excellent cholesterol levels, A1c of 4.8, and easy maintaince.
I think distal in USA means like 150cm bypassed, but mine meant 200cm common channel. So the usual " distal" doesn't help with anything. The real key tp maintaining weight loss is the short common channel, and avoiding some carbs.

[Joanne]

I'm going to quote Dr Roslin's opinion on the distal gastric bypass (ERNY) below. I took it from his Keynote address here earlier this week:


"I think the best answer that I can give to this question is that those that don’t know history are doomed to repeat it. In order to have a distal intestinal bypass, a common channel of 100CM, or 150CM, or a common channel less, then for most patients you have to preserve either the fundus of the stomach or the pylorus. Preserving the stomach is done in the Scopinaro procedure, where the volume of the stomach is about 200-300cc. Dr Scopinaro has trained a lot of Italian surgeons, and actually that was the operation that was used in the most recent trial in the New England journal. All those patients had open Scopinaro procedures, and he does a 100CM common channel and a 200cm alimentary limb. So, the point is in order to tolerate a distal bypass you either have to preserve the fundus of the stomach, or the pylorus. The pylorus is called the gatekeeper.

If you do not have one of those two structures, then what is going to happen is you are going to have a rapid emptying system and basically uncontrollable diarrhea in a subgroup of patients. Obviously there is individuality and certain people can tolerate that. So when people try to do these procedures, the actual risk of protein malnutrition is above 20%. I have not had to, in my DS practice, move anybody more proximal. Occasionally there have been people that have had other ailments like pseudo membranous colitis, and have had diarrhea where I’ve had to institute therapy and then once they got over their acute illness they were able to restore their protein levels. That would be a huge concern if you move standard gastric bypass that’s based on the lesser curvature of the stomach and hasn’t preserved the fundus, if you take it and you move it distally, then you are going to have a 1 out of 5 chance of having protein malnutrition.

So this is a very easy operation, but a very, very, very poor choice and demonstrates a lack of understanding of the sophisticated physiology of the gastrointestinal tract. Again, long term, I would wager to guess that over years the majority of patients that this is done to would have to be reversed, especially if they had another medical problem. And I’ve seen a number of these patients from Brooklyn where they needed reversal 5, 7, or 10 years after it was done, because they couldn’t overcome other medical issues. So I would not recommend this as an approach."

[smileyjamie]

May 18, 2012 6:29:02 GMT -5 Joanne said:

I'm going to quote Dr Roslin's opinion on the distal gastric bypass (ERNY) below. I took it from his Keynote address here earlier this week:


"I think the best answer that I can give to this question is that those that don’t know history are doomed to repeat it. In order to have a distal intestinal bypass, a common channel of 100CM, or 150CM, or a common channel less, then for most patients you have to preserve either the fundus of the stomach or the pylorus. Preserving the stomach is done in the Scopinaro procedure, where the volume of the stomach is about 200-300cc. Dr Scopinaro has trained a lot of Italian surgeons, and actually that was the operation that was used in the most recent trial in the New England journal. All those patients had open Scopinaro procedures, and he does a 100CM common channel and a 200cm alimentary limb. So, the point is in order to tolerate a distal bypass you either have to preserve the fundus of the stomach, or the pylorus. The pylorus is called the gatekeeper.

If you do not have one of those two structures, then what is going to happen is you are going to have a rapid emptying system and basically uncontrollable diarrhea in a subgroup of patients. Obviously there is individuality and certain people can tolerate that. So when people try to do these procedures, the actual risk of protein malnutrition is above 20%. I have not had to, in my DS practice, move anybody more proximal. Occasionally there have been people that have had other ailments like pseudo membranous colitis, and have had diarrhea where I’ve had to institute therapy and then once they got over their acute illness they were able to restore their protein levels. That would be a huge concern if you move standard gastric bypass that’s based on the lesser curvature of the stomach and hasn’t preserved the fundus, if you take it and you move it distally, then you are going to have a 1 out of 5 chance of having protein malnutrition.

So this is a very easy operation, but a very, very, very poor choice and demonstrates a lack of understanding of the sophisticated physiology of the gastrointestinal tract. Again, long term, I would wager to guess that over years the majority of patients that this is done to would have to be reversed, especially if they had another medical problem. And I’ve seen a number of these patients from Brooklyn where they needed reversal 5, 7, or 10 years after it was done, because they couldn’t overcome other medical issues. So I would not recommend this as an approach."

Thank you, Joann!!!! I am going to borrow this, to help answer a question on OH about the ERNY (this gal has an RNY, and is looking to revise to the ERNY...and I have shared about revision to the DS with her, but she is doing research)

THANKS!!!!!!!!!

[angelcake]

Bumped as well as bookmarked for future reference.

[sclawpoet]

I've heard good things and bad things about the Distal Bypass revision. My surgeon is wanting to perform a Distal BP after RNY 2 years ago where I only lost about 1/2 the weight originally advised. No matter what exercise, supplements, and proper eating I tried the weight loss stopped and after a leg injury the weight rapidly (less than three months) piled on about 70lbs worth. I've been researching but wanted the advise and or knowledge of this thread if it's worth it. The dumping and aliveness I got with the RNY all went bye bye about 6-8 months post op and after I had a hernia removal. Any input, advice, or knowledge is greatly appreciated.

[angelcake]

Check out Drs Rabkin, Keshishian or Roslin for a revision to the DS.

I also suggest starting your own thread for more answers and your question will get lost in someone else's post and you don't want to miss out on good input.

[CVHarris]

I had one in 2000. I lost all my excess weight about 220 pounds. It got rid of my diabetes......temporarily

My labs were terrible. I DUMPED ON EVERYTHING. I developed solid intolerance and could only eat the junk that made me dump. Around year 8 my HGA1C started to creep back up as the weight started to creep back up. Year 14 I was diabetic again and had regained 80 pounds. I was severly anemic for 12 years and then started having iron transfusions and blood transfusions. Year 14 I decided to have a revision to the DS since it truly resolves diabetes. Im only 6 weeks out but i'm believing the studys on the DS.

[larra]

To sclawpoet, and anyone else being advised to try distal bypass when the standard proximal bypass has failed...

the reason your surgeon is giving you this "advice" is because that's what he knows how to do. There is no, I repeat NO, evidence that someone who does not have adequate weight loss with a proximal gastric bypass will do significantly better with distal gastric bypass. I wish it were otherwise. As I said long ago in this thread, people do lose more weigiht with ERNY, but they run a high risk of serious nutritional complications from the bad combination of a pouch with a short common channel.

I would strongly advise you to get an opinion from a surgeon who does the DS. I have no idea who did your bypass, but I am confident that it's someone who does not do the DS, let alone have the skill and experience to revise RNY to DS, which is a very difficult operation. That is the one advantage distal bypass would have for you, that it's lower risk than revising to DS. But if it doesn't help you, what's the point of putting yourself to any risk at all? You always need to balance the potential risks with the potential benefits. If the potential benefits are not substantial, there is no good reason to subject yourself to the potential risks.

You can email the well known Ds revision surgeons for more opinions. That doesn't commit you to any course of action. The more you know, the better decisions you can make.

Larra