question about procedures from a support person
Hello everyone…
I have been following my girlfriend’s research on the different
weight loss surgery procedures that are being done, and based on what
I can see, except for the “lap band”, they are all pretty complicated
and have various unpleasant side-effects.
A thought occurred to me, and I am putting it out for anyone to
comment on:
======================================
Wouldn’t it work to simply shorten the small intestine by some
percentage (maybe 25-30%), and leave all the rest of the “plumbing”
as it is?
======================================
From what I can underst and, the stomach seems to be not much more
than a holding tank for the food to filter out of through the
pyloric valve. The RNY procedure slices off the top of the stomach
leaving most of it hanging there nonfunctional, and the Duodenal
Switch changes it from a kidney bean shape to a banana shape, not to
mention the re-routing of the digestion process. If the stomach was
left alone, none of the side-effects of reshaping it would be
problems… no bleeding, leaking, staples popping,
pyloric valve problems, vomiting, dumping, etc.
All the procedures (except the lap band) ALSO rely on malabsorption -
having the food and digestive enzymes spend less time together in the
small intestine…
It just seems far simpler to accomplish that by shortening the small
intestine and leaving all the rest of it alone.
Any opinions????
Ira
July 31st, 2004 at 10:20 am
If you do not reduce the gastric volume with the shortening of the intestine,
then you are likely to have more diarrhea due to the higher volume of food.
Also the great thing about the DS is that there is Macro or selective
malabsorbtion. The procedure mostly malabsorbs fats, but leaves us with much
opportunity to absorb other nutrients. With only shortening of the small
intestine you have malabsorbtion of everything in equal proportions.
Also the way the DS is done all intestine is kept active in some way. It
either carries the bile or the food. Therefore, it is still viable tissue so
that if it ever needs to be put back the old way none has been removed or
left to atrophy. Furthermore in the old Julio-jeno (sp) bypass some
intestine was left dormant in the body and it caused severe health problems
due to bacterial growth.
Dawn–far south suburban Chicago, IL area
Dr. Hess, Bowling Green, OH
BPD/DS
4/27/00
www.duodenalswitch.com
267 to 160 5′ 4″ O.K. The 5 pounds I lost end Dec./Beg. Jan has stayed off so
I changed it!
size 22 to size 10
have made size goal
no more high blood pressure, sore feet, or dieting
July 31st, 2004 at 1:31 pm
Well, some of us pay big bucks for the “unpleasant side effects” (like
dumping, not being able to eat formerly normal-sized meals, lactose
intolerance, etc.) and wouldn’t not want them.
It would not work for me. I was a volume eater pre-op (eating between
8000-10,000 calories a day… 3000+ calories at a time) and *need* the
teeny tiny pouch that I have to help me maintain control over my mind’s
voracious appetite. I paid for a teeny tiny pouch (15cc as opposed to the
usual 25-30cc… my pouch having the ability to stretch much less than
other pouches)… researched for 2 years to find the perfect surgery that
would fit me and my desired post-op life and the Roux en Y Gastric Bypass,
proximal, transected is what I chose and what has been saving my life the
past 15 months; I made the right choice.
I chose not to only have a malabsorptive procedure because I did not want
the possibility of living with chronic gas and/or diarrhea for the rest of
my life (I had Irritable Bowel Syndrome pre-op… did not want to continue
with that malady post-op!).
I also need to say that I wish I had a dime for every person under 100
pounds overweight that asked me if they couldn’t just have what I had, but
with a bigger pouch… or less intestines bypassed. I answer them with a
THIS IS MAJOR SURGERY… and NOT to (just) look better, but to save my
life!!!!!!! This isn’t like taking Dexatrim for a month to be able to fit
into a dress for your cousin’s wedding. This is a life changing, life
altering, BODY altering, FOREVER operation with very real, very serious
possibilities for problems… and that weighing those risks versus the
benefits of even going under the knife are imperative to come to the right
answer for each person. Gadzooks, this isn’t like putting on acrylic nails
until you get tired of them… this is CUTTING and SEWING and SLICING and
healing and re-learning and dealing with a plethora of difficult, painful,
joyful, fantastic changes… whether it is just cutting the intestines down
a notch or separating 9/10 of your stomach from your new pouch.
Not that I have done ten tons of research on past procedures, but I can
sure tell you that infinite variations on the weight loss surgery theme
have been done (and are continuing to be done) and what you are speaking of
has been explored… and proven not to work in the long run. People have
parts of their intestines cut out all the time… because of cancer and
such… so there is plenty of proof regarding whether this would help those
folks lose weight or not. This empirical evidence occurs all the time…
like Wellbutrin showing promise as a weight loss drug (although, not for me
or many others, as previously discussed) or that Rogaine, originally used
for treating high blood pressure, re-grows hair. Doctors have tried
varying lengths of bypasses, varying sizes of pouches/stomachs, varying
closing off methods, etc. and while perfections will always be being made,
I am thankful that I had my WLS in this day and time instead of 15+ years
ago. I am sure those that have WLS in 10 years will say the same thing as
I just did, too, because it is normal… and right… for advances to
always be made. We depend on them!
Anyway, interesting that you would be working in your head about this issue
as you read and learn. It shows you are caring… and really paying
attention! It is also really great of you to ask us… those who live with
these anatomical changes everyday… what we think.
Good luck to your friend.
Barbara Herrera
San Diego, CA - 41 years old
Open RNY April 5, 2001
Dr. Julie Ellner, Alvarado Hospital, San Diego, CA
04/05/01: 344# / BMI: 63/ Body Fat%: 75%
04/05/02: 172# / BMI: 31.6/ Body Fat%: 28%
06/29/02: 164#/ BMI: 30.0/ Body Fat%: 26%
One Year Re-Birth Day: healed of ALL co-morbs, mobile beyond every
expectation, every pre-op dream surpassed a million-fold, and smaller than
any memory.
August 2nd, 2004 at 6:52 am
In a message dated 7/21/02 9:44:22 PM, c_raia@… writes:
<< Plus the amount of malabsorption that takes place decreases
Hmmm…..I’ve not heard this one before either. Your stoma stretches and you
can eat more, but I’m not sure you malabsorb any less.
Vicki
open RNY 6/28/01
140# and loving life!
August 2nd, 2004 at 4:43 pm
I never heard this before either. As a matter of fact I thought it was
permanent. If it is due to a reduction in our small intestine why would it
decrease? The intestine does not grow back.
I am going to have a lot of questions when I see my surgeon on Fri.
Take care
Janet M
August 3rd, 2004 at 6:15 am
I believe this can occur - the further out from surgery we are, the
more our intestines attempt to absorb. This is what I have been told.
Loopy
August 3rd, 2004 at 7:57 am
Actually my nutritionist at BTC mentioned that malabsorption does decrease a
bit as the body begins to compensate for the surgery and becomes adjusted.
It never goes completely away but instead of malabsorbing 25% you may only
continue absorbing 10% of the body. There is still some but you should not
count on it to provide all your weight loss.
Denise Rasley
mailto:drasley@…
BTC, Columbus, 10/7/98
Lost over 90% of excess and maintaining
Gained a beautiful daughter on 8/9/00
August 4th, 2004 at 1:01 am
My doctor told me that after 12 to 18 months, the enzymes sent from
the liver would increase. In other words, if he makes the common
channel 100 cm, the extra enzymes would increase as if it were 200
cm. There would still be malabsorption, just not as much. The body
relearns to compensate for almost everything you can do to it.
August 5th, 2004 at 4:50 am
Your stoma stretches and you
My question is how can your stoma stretch when mine, at least, is a
round metal staple??? My surgeon told me it is almost an inch wide
and metal, so how can it stretch?
Are some stomas just skin?
Thanks for input…
Pamela L in MN
August 6th, 2004 at 5:15 am
From what my surgeon tells me, the idea is that the
Amber
flesh grows through the mesh and heals as scar tissue
around the ring. This way it is a permanent fixture
that never moves. The “complication” that Ray is
reffering to has only happened once to my surgeon in
23 years of doing this. I’d say it is worth the risk
with as many posts as I see here about stoma’s
stretching. The reason this happened to this person
was because she had, had previous stomach surgeries
(like 5 of them) and her stomach was so scarred that
the ring was “rejected” after 7 years. All this
required was an endoscopy to remove the ring and the
stoma is still just fine by itself. My surgeon has
many other surgeons studying his procedure to start
implementing it in their surgeries. You will probably
start seeing it more often in the future. After 23
years, and numerous national awards, he must be doing
something right. Just my opinion
A complication that can develop from
August 6th, 2004 at 10:32 am
In a message dated 7/23/02 12:32:10 PM, plent@… writes:
<< My question is how can your stoma stretch when mine, at least, is a
round metal staple??? My surgeon told me it is almost an inch wide
and metal, so how can it stretch?
Are some stomas just skin?
Yep, there are no metal pieces in mine….just an opening in the stomach
pouch leading into the newly attached piece of small intestines. All tissue,
no metal.
Vicki
open RNY 6/28/01
140# and loving life!