Hi!

Has anyone heard of Malabsorption Gastric Bypass? So i was supposed to have the Duodenal Switch surgery but when my Surgeon went in yesterday my stomach was incased in scar tissue from previous surgeries so he didn't reduce my stomach he said he disconnected and then reconnected the bottom part of my stomach so i wouldn't absorb as many calories. He said it would have been very dangerous, risk of piercing stuff and would have also needed to do open surgery if he was to remove the scar tissue..

Has anyone heard of this or had it happen to you?

I feel devastation.

All gastric bypass surgeries are malabsorptive. I'm not sure if yours is different from a standard bypass, You can be successful with any weight loss surgery. It's more about brain than stomach. Good luck and don't let the switch put you in a negative frame of mind. Your doctor had to do the best he could for you given the circumstances he found. Best wishes!

Malabsorption is part of any bypass procedure. I had the bypass and have been very successful, 124 lbs gone

I know that initial thoughts must be disappointing that you did not get what you expected. However most people do very well with a bypass. Try to stay positive and see how it goes. Like with any wls you will lose the weight if you follow your plan.

Yep roux en y bypass very common very good results

You may find after healing you can eat larger portions than regular surgery folks, if he didn't reduce the size of your stomach. My surgeon had to leave a bigger pouch because of scar tissue from my lapband so I have to be careful with portion control so I'm not taking in too many calories, but the malabsortive part has really worked for me. It's trained me (despite my stupidity) to avoid sugary carbs and too much fat because it feels so unpleasant to indulge too much. I'm at the point where the thought of eating regular icecream is unpleasant so I don't even miss it.

So you can definitely work with the tool you have!!

It sounds like he did the gastric bypass part of the duodenal switch and not the sleeve part. Like people have said, you will do great with gastric bypass.

I had the sleeve done and have lost almost 7e pounds. My Dr wanted me to do the DS, however for now, I chose to do only the sleeve part. Good luck! Let us know how you do.

Did he just not do any stomach reduction at all, or did he make a pouch type structure like a traditional RNY gastric bypass?

If he made a pouch, even a larger one, and connected it well downstream to provide DS-like malabsorption, that would be what is known as a distal RNY, which is rarely done, but is a cousin to the traditional RNY which is primarily a restrictive procedure with a minimal amount of malabsorption added.

Another possibility is that he did a DS type of intestinal routing but with a large stomach pouch similar to an RNY, and this would be a Scopinaro procedure, which was a precursor to the standard or traditional BPD DS and was rarely done in the US.

Another possibility from your description is something like the old jejunolileal bypass which was a purely malabsorptive procedure done in the 60's and 70's that kept the stomach intact along with the duodenum and some portion of the small intestine but bypassed the majority of it, reconnecting things down near the colon. It was abandoned owing to a lot of complications though he may have done some less malabsorbing variation. It was mostly replaced with the now traditional RNY gastric bypass.

I'm sorry that you didn't get what you were expecting, but you should be able to make this work. It is important, however, that you get a clear understanding of what exactly he did (get a copy of the surgical report for your records) so that you, and any doctor who may need to work on you in the future for whatever reason, has a good understanding of how your insides now work.

@RickM Thank you for this information! He did not touch my stomach and what he described sounds exactly like the Distal RNY.

This is great information so now i don't feel as down.

Thank you again!

In your shoes, what I would really want to know is just how malabsorptive he made it, as that influences both how you supplement in the future, and how you need to eat to lose the weight, as both will likely be somewhat different than with the mainstream procedures like the RNY or DS.

The old purely malabsorptive procedures like the JIB worked fairly well, but had a lot of nutritional complications which is why they were abandoned. The RNY went the other way being primarily restrictive and works well with only moderate nutritional consequences from its mild malabsorption, but weight maintenance is only so-so. The BPD/DS hits something of a sweet spot in being moderately malabsorptive with a similar level of nutritional quirks and a more moderate restriction. The old Scopinaro was more malabsorptive and had more problems than the typical DS (that usually had about a 50cm common channel, compared to 100+ for the BPD/DS).

One of the general rules-of-thumb that we discussed in the DS world is that with the DS, the sleeve (restriction) gets the weight off, while the switch (the malabsorption) keeps it off.

The implication of all of this (from an amateur/non doctor perspective) is that if there is enough malabsorption to effectively take the weight off by itself (a la the old JIB or Scopinaro) then there can be excessive nutritional problems, or if the malabsorption is moderate enough to not cause significant nutritional problems, the weight loss may be marginal. I would assume (hope) that this is the case with what your surgeon did, and that you will have to work harder at the loss part of the equation, but will have typical DS/distal RNY nutritional quirks to work around. This is something that you really need to understand in working with your surgeon in the coming follow up visits.

Good luck!

@RickMI have an appointment with my Surgeon on 8/2 so I'm planning on asking all these questions. You have been extremely informative. Thank you so much!!