Question:
Anyone familar with difference in the way RNY is done now vs. 2002?

I am seeking info on if anyone has looked at having a revision of thier RNY to the way some surgeon's are now doing the surgery. In 2002 thier was not a link between the old stomach wich contains the acids and misc. to allow for absorbtion of vitamins and iron. Barix in MI now makes a link from the old stomach to the upper part of the intestines to allow those acids to help prevent the iron deficencies and calcium problems. I currently have to have iron infusions every 4-6 months despite vitamins and am suffering from osteopenia. Any information available?    — rgreathouse (posted on February 6, 2010)

February 6, 2010
Not sure if this is related, but when my RNY was done in 2002, my stomach was not transected meaning that the lower portion of the stomach was not cut from the new pouch. The staple line was made separating the two, but no "transection" was made. Because of that, the staple line has come un-done and food is now passing into the lower section of my stomach basically bypassing my bypass. I am currently seeking a revision to fix this and have the transection made. When the stomach is cut, scar tissue grows over the staple line making it much more difficult for the staple line to come un-done and that's why they don't do non-transected RNYs anymore. This is probably only one of the differences between the 2002 and 2010 RNYs. Either way, with the supplements I take, I have had little if any problems with vitamin and/or mineral deficiencies.
   — StillTammy

February 6, 2010
I've never heard of the RNY being performed the way you described. If they didn't remove your remnant stomach and pyloric valve where would the stomach acids go that it still produces? I don't think you can live that way; seems you would back up and/or be very sick unless it was removed or allowed to drain. It's my understanding the "Y" part of the RNY surgery is where the old stomach, pyloric valve & duodenum section is reconnected further down the intestinal track to allow the stomach acids produced in the lower half of the old stomach to drain into. You are still bypassed meaning the new pouch has a shorter, straight length of instestine brought up to it. You still have to take supplements as the bypassed portion is the section that absorbs the majority of the vitamins & minerals. The connection between the old stomach simply allows the acids to drain into the intestinal track and help facilitate the breakdown of foods/supplements which "enhances" absorption but does not increase the absorbable portion. Hope that makes sense. Perhaps you have a distal RNY type of gastric bypass. That is where they bypassed more of the intestinal track. With a distal or ERNY (extended RNY), there is need for more aggressive supplementation because there is even less absorbing intestine left. The most common RNY done today is the proximal, or "short" bypass. We still have to be diligent and take our supplements though. Forgetting a day here and a day there eventually adds up and will lead to deficiencies, including the need for iron infusions. It is difficult to get back to normal once you've developed a deficiency but hang in there and do exactly what your specialists are telling you. Make sure too that once you get back to oral supplementation that you are following the recommended regimen on iron and calcium. There are specific times and combinations of taking these supplements because of the counter-actions of ingesting them together, etc. Vitamin C and carbonyl iron should be taken together, on an empty stomach no less than 2 hrs from other supplements; C enhances the absorption of the iron. Amount of iron varies, you need more if you're menstruating, particularly if you have heavy periods. Calcium citrate instead of carbonate forms; 1,500-2,000 mg per day, taken with vit D and dosing should be at least 2 hrs apart and best if taken with food. It's mind boggling at first but once you establish a schedule it becomes routine. I wish you the very best and hope your deficiency situation is resolved soon. For more answers about vitamins, check out this fellow OH member's blog: http://wlsvitagarten.com/
   — Arkin10

February 7, 2010
I was revised from a VBG to a proximal RNY 5/2000 so I am almost 10 years out from the RNY. My surgery was performed exactly the way that the poster above me, Pat, described. My pouch was also transected because already back then so many people were starting to have problems with the staple line disrupting. I remember reading all of the posts on this very board about that prior to my revision to RNY. I made sure that I was transected but needn't have worried, my surgeon refused to do it any other way. I am reading your description of the RNY and it doesn't sound like anything I have read about in my time here. I hope someone comes along that can better address your question.
   — Kellye C.

February 10, 2010
I had a proximal. however now there is a link between the old stomach to the level needed for iron/calcium absorption to prevent the problems post op 7yrs ago. I't is not like they call you and tell you about it. I learned this through my sister doing a new orientation for WLS.
   — rgreathouse

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