1. Mini-Gastric Bypass:
Much More Effective &
Fewer Short & Long Term
Complications
Robert Rutledge

2. BACKGROUND:
• The Mini-Gastric Bypass (MGB) is
increasingly being adopted in
countries around the world
• (England, France, Spain, Turkey,
Lebanon, India, Italy, Taiwan,
Germany, Greece etc.)

3. OBJECTIVE:
• The purpose of this study is to
report on the
world's largest experience with
the MGB,
the complications that can be
expected following the MGB and
provide
advice on management.

4. METHODS:
• Complications, management
and outcomes for 4,584
• Patients followed for up to 15
years were analyzed as part of
a prospective data collection
system.

5. RESULTS:
• As reported by others the
Excess weight loss excellent (82%).
• Lifetime risk of any Complaint or
Complication
• 31.6% of patients reported some
complaint or complication
• Minor in 22.7%,
• Moderate in 3.7%,
• Severe -> Hospitalization in 5.2%

6. Complications: 5%
• Most Frequent
Complaint/Complication
• Similar to reports from RNY
• Dyspepsia/Ulcer/Gastritis
• Anemia in 5%,

7. Complications: 2%
• Gas
• Cramps
• Nausea
• Vomiting 2%,

8. Complications: 1%
• Diarrhea
• Leak
• Dehydration
• Regained Weight
• Hernia
• Minor Bleeding 1%,

9. Complaint/Complications: <1%
•
•
•
•
Renal Stones
Gall Bladder Removal
Stricture
Minor EatingComplaints
• Malnutrition
• Re-Exploration
• Poor Wt Loss
•
•
•
•
•
•
•
•
Low Ca.
Pneumonia-Minor
Perforated Ulcer
Hypoglycemia
Thiamine Deficiency
Potassium Deficiency
Revision
Gout <1%.

10. Discussion
• The complications of the Mini-Gastric Bypass are very
similar to those reported with the RNY
• The MGB is a simple and successful procedure
• The most common complications are Ulcer/Gastritis and
Iron Deficiency Anemia.
Both are easily prevented or treated medically.
• The many complications and risks require doctors and
patients to maintain constant vigilance after surgery.

11. Fear of Gastric Cancer After
Billroth II/Mini-Gastric Bypass
is Minimal;
Less than the Risk of Cancer
from a Single CT Scan.

12. Bariatric Surgeons
Fear the Billroth II
Studies show surgeons who fear
the Billroth II are usually poorly
Informed about Gastric cancer

13. What should MGB Surgeons
and Patients Know About
The Billroth II and the Risk of
Gastric Cancer?

14. Widespread Continous Use of Billroth II
by Informed General Surgeons
• The Billroth II has been performed continuously
for over 100 years
• Continues to be used in laparoscopic gastric
cases from Korea and China sites of high risk of
gastric cancer.
• 16,000 Billroth II’s were performed in the USA in
2007.
• The BII is still the operation of choice for many
cases in Trauma, Ulcers, Cancer Stomach etc.

15. MGB Data
• Since the first The Mini-Gastric Bypass in
1997
• over 12,000 MGBs have been performed.
• There is now 10-15 year Data; reports
from Multiple Centers, positive results
from Randomized Controlled Trials.
• NONE have shown concerning findings of
Bile Reflux/Gastric Cancer in any series.

16. Critics of the MGB raise Fears of
Gastric Cancer Bile Reflux Gastritis;
‘Surgeons Fears are because they
Have Forgotten Their General Surgery”
“UNINFORMED (Bariatric) SURGEONS
FEAR BILLROTH II”
“EDUCATED (General) SURGEONS
ROUTINELY USE BILLROTH II”

17. Understanding Fears of
Cancer and the Billroth II
• 1. Basic Cancer Biology
GCa Declining Rapidly
Lifetime risk GCa (HPylori -) pts 0.3%
CTScan => Increase Cancer 0.2%
• 2. Gastric Cancer Causes/Prevention
Caused by Environmental Factors/Easily
Prevented;
Diet, Lifestyle changes & Rx H. Pylori
• 3. Many Large Studies: Show No Increased Risk
of GCa after BII

18. Understanding Fears of
Cancer and the Billroth II
• 4. Some studies: DO Show slight Increased Risk 20 – 30
years (RR 1.5)
• But: Billroth II performed to Rx Ulcer;
Ulcer/Gastric Ca both related to H. Pylori infection.
• Even the worst case the risk of Gastric cancer after BII is
much less than the risk of cancer after ONE CT SCAN!
• 5. Endoscopic screening of Billroth II is Not
Recommended. Why? Extremely Low Risk!
• 6. Well informed General, Trauma and Oncologic
surgeons Routinely use the Billroth II (Thousands of
publications) 2007 16,000 BII procedures performed in
USA.

19. Fear of Cancer in Mice
• Some surgeons have quoted
• Mouse studies increased risk
of cancer in BII in mice
• Cell phones and Caramel
coloring in Coca Cola cause
cancer in mice