Roux en Y at low BMI

I see how it all works now.

& thanks Nini, I always wondered how the hell some Doctor decided to chop part of the stomach off and / or join it somewhere else.  Now I know that as with many other things, necessity is the mother of invention.

Good Luck Shrinking Violet.  If this is the path you take, I hope it sorts out your issues for you.

The bypass can allow more food if the opening between the stoma (stomach pouch) and bowel stretches too much. If this happens it is like you have a very long stomach tube. Same with sleeve you can drink all your calories and eat things easy too swallow like chocolate and cookies and crackers.

With all WLS and even non-WLS when trying to lose weight it is mainly a mental game. For me I reckon it is 90+ % lol. WLS helps give a kick up the bum so you lose a good amount to get you started so you can move more and feel better about what goes in your mouth.

WLS will be like any other diet if you go back to your old ways. It is damn hard work.

I once heard that 70-80% of healthy lifestyle and diet change is FOOD and the balance is exercise. Makes sense to me as I have been sick nearly 6 weeks and feel horrible. Haven't been able to exercise and food choices aren't the best. At least I am aware of it now and my WLS allows me not to give up even though I have again gained weight.

Shrinking Voilet - send me another PM with qs for your surgeon and I can add mine. I saw my surgeon 4-5 times before I had to go from sleeve to bypass. If you have to do the same, do so.

Sounds like a good idea to make another appointment (apart from the cost). It's too much info to take in all at once. Perhaps make a list of questions and concerns to ask him. You can learn a lot about a Dr. by the way he takes time to answer your worries. 

But saying that I know a lot of dick surgeons with absolutely no bedside manner but are brilliant technical surgeons. But it's much nicer if you have a  rapport with your doctor. 

Nini.

I don't know Nini...the conversation didn't get around to post op details much. It wasn't until afterwards that I thought about the question of even more weight loss post surgery. Maybe they'll leave the NJ tube in for a while. I have a portocath that's been in for over 8 years so TPN wouldn't be a problem though.

If I decide to go ahead, and I think I will, I'll make another appointment and ask more questions. Hopefully with more structured thinking.

I'm starting to feel embarrassed when I go out in public because I look very obviously emaciated. you know you must look pretty damn awful when even the charity collectors don't ask you for money in the shopping centres!

Hi Shrinking Violet,

I have been thinking a lot about your plight since you posted and I am so sorry that you having to decide between a rock and a hard place. It seems from your comments that you feel that you really don't have a choice as to continue as you are doesn't sound like an option. 

While we think of current WLS as only treatments for obesity most of them (apart from the band) started out as being life saving operations for patients dealing with cancer and other serious gastro-intestinal disorders. It was only down the track that surgeons realized those life saving operations could also help with weight loss.

It sounds like you need time to establish confidence and build trust in your new surgeon as this is such a big step for you. It may help that another surgeon has supported his opinion. Would they be giving you TPN feeds to build you up after surgery to prevent further weight loss while your new stomach is healing?


hugs Nini

Thanks Sally. Apparently my problem will be that I've had two previous hiatal hernia repairs and a lap Nissens Fundoplication plus there's not much stomach that's not deformed to make the pouch from. That's why it would have to be an open surgery.

He said he would have to attach the bowel very high on the stomach.

Heres a picture of the bypass, pictures always help :D You can see why its called a roux-en-Y from the shape the intestine forms ;)

With the bypass, you get a smaller stomach, a pouch, rather than the longer sleeve. The rest of the stomach is then left behind to produce digestive juices which joins your food further down the intestine than usual.

Hi, yes, I asked about this too. The surgeon wants to cut off the last three quarters of my sleeve but he's going to leave it inside me. Then he will attach the small bowel to the first part of the stomach. (He thinks he can find enough u damaged stomach but will do further testing to make sure) I assume that some portion of the small bowel will remain attached to the dissected part of the stomach but I didn't ask because by that stage I was a bit shell shocked and wasn't listening to most of it or asking any questions.

Food won't have to try and get through the corkscrew then...just slip straight through to the small bowel.

I will ask what is probably a stupid question.  How will the Roux en Y help you eat more food?
What I mean is (I could have this wrong), I though with a bypass, they sleeve your stomach and then they connect the bottom of your stomach to some part of your small intestine.

So now you have the corkscrew sleeve.  How will the food get through to the bypassed part of your intestines if if can't get there now? Will they be sleeving or taking out more of your stomach?

I must be confused about how bypasses work!

Good Luck!  Hope the more questions your surgeon answers for you, help you to make a decision.

Well, I think I'm starting to come to terms with the necessity of the surgery. Now I've settled down a bit I can think more clearly and realise I need more information about specifics...little things like where he operates and how much it costs....I wonder where my head was the other day?

Shrinking Violet wrote:

Interesting summary of a research article printed in the Journal of American Medical Association 2012.

These results indicate that BMI is a significant predictor of mortality within 30 days of surgery, even after adjusting for the contribution to mortality risk made by type of surgery and for a specific patient's overall expected risk of death. Patients with a BMI of less than 23.1 demonstrated a significant increased risk of death, with 40% higher odds than the risk of death among patients in the middle range for BMI (26.3 to <29.7). Interestingly, almost 40% of the patients in the study population would be classified as obese using standard thresholds for grouping BMI values. Patients with a BMI of 29.7 or greater had lower odds of death compared with patients in the middle range, but these differences were not statistically significant.

Well, ferk!
Apart from that, I don't know what to say :(

Shrinking Violet wrote:

Thanks everyone. I'll admit to a bit of panic.

Sweetie, you are entitled to "a bit of a panic".
I'd be in more than 'a bit of a panic'!

And unfortunately, it really appears that logically you don't have a choice.
A ghastly decision to have to make.
Currently your intake is insufficient to keep you nourished.
Therefore, the only way to remedy this is having the RNY.
But then you have the fear of the it potentially all going horribly wrong - a real fear based on what is happened in the past.

The second surgeon you saw seems as good as you are going to get.
"He is known as serious and cautious with few post operative complications. I preferred him to the first surgeon because he listened, informed, let me ask questions, made me feel comfortable and understood I needed time to make a decision."


I am pleased that you are seeing a psychologist, and hope that your GP is good.
Have you family around you?  Are they supportive?  I bet they are worried stupid about you.

Interesting summary of a research article printed in the Journal of American Medical Association 2012.

These results indicate that BMI is a significant predictor of mortality within 30 days of surgery, even after adjusting for the contribution to mortality risk made by type of surgery and for a specific patient's overall expected risk of death. Patients with a BMI of less than 23.1 demonstrated a significant increased risk of death, with 40% higher odds than the risk of death among patients in the middle range for BMI (26.3 to <29.7). Interestingly, almost 40% of the patients in the study population would be classified as obese using standard thresholds for grouping BMI values. Patients with a BMI of 29.7 or greater had lower odds of death compared with patients in the middle range, but these differences were not statistically significant.

Thanks everyone. I'll admit to a bit of panic.

This surgeon was the second one to tell me I needed a RNY. I was also told by the gastroenterologist who did my last gastroscopy that my only option was surgery because my stomach was too deformed to be fixed. Neither of the surgeons I saw were the surgeon who did my sleeve surgery. I wouldn't go back to see him if you paid me. He has never acknowledged I have a complication and yet....here I am facing an open RNY. I saw my contrast films for the first time yesterday and even I could see the problem at first glance....it didn't take an Einstein to see the angulation and corkscrew. I didn't see the scans that show the regurgitation of stomach contents back to my mouth though....they were taken in hospital.

I know, logically, that I don't have a choice but I have serious medical problems and this makes my surgery potentially life threatening. I have had problems with medical professionals in the past including misdiagnosis etc which almost cost me my life and I'm having psychology sessions to build trust but I'm not there yet.

If I have this surgery it will not only be a big physical challenge but a huge psychological challenge. If I go ahead it will be a leap of faith.

I have researched this surgeon. He is known as serious and cautious with few post operative complications. I preferred him to the first surgeon because he listened, informed, let me ask questions, made me feel comfortable and understood I needed time to make a decision. The first surgeon just spoke over me and turned my concerns into some kind of joke, he spoke as if it was all decided and just waiting to book the theatre. He even had the gall to tell me about another patient with a sleeve complication (from another surgeon) who he had to do a RNY on and how she was younger and healthier and weighed more than me but she ended up in ICU and was still there after four weeks and was still very sick! Some story to tell me to make me feel confident! AND....this was from a VERY well known, respected, surgeon with an excellent reputation!

I see the psychologist again on Friday so I'll chat with her about it and I'll see my GP next week, he should have the surgeons letter by then. The decision would be easier if I didn't already have a "terminal" illness. The problem is I've been told I'm dying so often I don't believe it any more. I should have been dead 5 years ago and yet....here I am! Now they've learnt not to give me time frames! I'll probably outlive the doctors at this rate.

Also the rny is a tool, so like sleeve be hard initially but long-term still hard not too gain weight. I found restriction better with sleeve. Did the surgeon do your sleeve and where are you?
 send me a pm if you'd like and we can talk.

Contact Suzy.
also, rny isdone for other reasons besides weight loss, he might be thinking of your long-term health. of he is a good surgeon he would be. can he resleeve? or is the sleeve too much of a mess. I had too have rny after sleeve. different reasons to yoi though.

SV I am thinking since it is normally a procedure used to help people lose weight there won't be anyone here who had it at such a low BMI.

But if it will allow you to actually get some nourishment and be more comfortable than the nasal or stomach tubes then that may give you a better quality of life.
I did a quick Google search and found many complaining they had put weight back on or didn't lose enough so maybe this will actually allow you to eat again and perhaps increase your weight to a healthy range.

I am with Denzel about checking out the surgeon carefully but whatever you do please know that we are here to support you.

Shrinking Violet wrote:

I went to see a surgeon today about re inserting a feeding tube and he is pretty adamant that I need a Roux en Y because my scans etc show a very abnormal sleeve and I can't eat enough to maintain my nutritional status.

He wants to admit me to hospital a week early and feed me through a nose tube first before doing an open surgery due to the high probability of adhesions.

Has any one here had a Roux en Y at a low starting BMI? I'm afraid my weight will just plummet even further. My current BMI is 16.2

I haven't had a good run of luck with surgeons.....I'm not sure what I should do. Logic tells me I have to do something but my gut instinct tells me to run for the hills.

For me, the thing that stands out is "I can't eat enough to maintain my nutritional status" will having the Roux en Y allow you to do this? I know its a more drastic tool for weight loss, but will you be able to eat enough with it, to maintain? If the answer is yes, it has to be better than what you're enduring now? But of course is another drastic procedure that carries its own risks...

And of course, everything denzel said! :)

Geeze girl, you "are between the devil and the deep blue sea"/"Hobson's Choice"/"Sophie's Choice"/"damned if you do and damned if you don't" :(

I guess no-one will be able to give you advice on this, because this is such a rare problem :(
No doubt you've googled it?
How much do you know about this surgeon? and are confident with their surgical and diagnostic skills?

One way to look at the positives of getting it done and the surgery and recovery going well, is that what has happened until now hasn't worked for you (ie your stomach tubes etc - what a f'ing nightmare you have been through).
Now you are seriously underweight.
So, I guess that you really don't have a choice :(

(but just for interest, do your gut instincts usually pan out correctly?)

No matter what, we are here to support you whatever you choose to do.
Big hug x

I went to see a surgeon today about re inserting a feeding tube and he is pretty adamant that I need a Roux en Y because my scans etc show a very abnormal sleeve and I can't eat enough to maintain my nutritional status.

He wants to admit me to hospital a week early and feed me through a nose tube first before doing an open surgery due to the high probability of adhesions.

Has any one here had a Roux en Y at a low starting BMI? I'm afraid my weight will just plummet even further. My current BMI is 16.2

I haven't had a good run of luck with surgeons.....I'm not sure what I should do. Logic tells me I have to do something but my gut instinct tells me to run for the hills.