12 December 2007


I came across a post on OH about a study on weight loss and the length of the bypassed bowel in Duodenal Switch patients. Here is the abstract and I've highlighted an interesting part:
BACKGROUND: It is commonly believed that weight loss after biliopancreatic diversion/duodenal switch is inversely related to the length of the alimentary limb and the common channel. However, the effect of the biliopancreatic limb length (BPL) on weight loss has received little attention. METHODS: A total of 1001 patients after biliopancreatic diversion/duodenal switch (209 men and 792 women, mean age 42 +/- 10 yr, mean body mass index [BMI] 52 +/- 9 kg/m(2)) were divided into 2 groups according to the ratio of the BPL to the total small bowel length (SBL): a BPL <=45% of the SBL versus a BPL >45% of the SBL. The nutritional parameters and percentage of excess weight loss were compared between the 2 groups. RESULTS: In patients with a BMI of <=60 kg/m(2), the percentage of excess weight loss at 1 year postoperatively was 66.8% for those with a BPL <=45% of the SBL and 69.3% for those with a BPL >45% of the SBL (P = NS). At 2 years, the corresponding percentages were 73.7% and 79.5% (P = NS) and, at 3 years, were 73.4% and 75.2% (P = NS). In patients with a BMI >60 kg/m(2), the corresponding percentages of excess weight loss was 56.8% versus 61.4% (P = .07) at 1 year, 62.2% versus 77.5% (P = .04) at 2 years, and 59.8% versus 77.5% at 3 years (P = .05). CONCLUSION: The results of our study have shown that amount of weight lost after biliopancreatic diversion/duodenal switch is directly related to the proportion of small bowel bypassed in patients with a BMI >60 kg/m(2). Also, the effect increased with the duration of follow-up. In less heavy patients, the BPL/SBL ratio had a minimal effect on long-term weight loss and a more pronounced effect on nutritional parameters.

This is interesting because it appears as though the amount of your small bowel that is bypassed can be an indicator of success for patients with starting BMI's over 60. Turns out it's not all about how long your common channel is. I ran over to the Lab Rat Data to crunch my own numbers and have determined that Dr. Marchesini bypassed around 67% of my small bowel so that bodes well for me. I was also encouraged to see that on average those with a BMI over 60 had lost 60% EWL after the first year, I think I lost around 62%. It took me awhile to accept that I wouldn't be one of those DSers who loses all their weight in their first year, it'll take me 2+ years to get it done, I did start at over 515 lbs after all.

I also did some research on diuretic withdrawal, for lack of a better term, and it seems like I am looking at 2-3 weeks before my body gets back to normal. I checked my overly elaborate (anal) weight tracking chart and it seems I'd been taking them for around 3 1/2 months. Sucks, but I am determined to get through it without going crazy. So far I've "gained" around 15-16 lbs in water weight, I don't know how much real weight I've lost, I gotta believe without all the excess water, I've lost a few lbs. Well, I've been drinking water like crazy, over a gallon a day which isn't as fun nor as hard as it sounds. I also read that I need to cut back on my salt intake. I definitely did not do that yesterday, so starting today, I am going to keep it as low as possible. Anyway, information is power so I'm just going to keep moving forward.



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