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a-00102

                 Dr. Robert RUTLEDGE
  Title of Paper: 6436 CONSECUTIVE MINI-GASTRIC
             BYPASSES: 16 YEARS LATER
          Nationality: United States of America
                    Position: Director
                  Department: Surgery
Organization: Center For Laparoscopic Obesity Surgery
                  Tel: +1-702 714 0011
                  E-mail: drr@clos.net
6436 CONSECUTIVE
   MINI-GASTRIC BYPASSES:
       16 YEARS LATER

            Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
 Obesity Surgery, United States of America
MINI-GASTRIC BYPASS
• Mini-Gastric Bypass
  1997 – 2012 ; >6,000 pts,
  15 yr Data; Multiple Centers,
  R.C.Trials (Lee)
• Vertical Gastric Tube
  (Collis Gastroplasty)
• Gastric Bypass
  (Billroth II Gastro-jejunostomy)
Introduction
• Presented at the First International
  Consensus Conference on the
• Mini-Bypass /
• One Anastomosis
  Bypass
• (MGB)
• Paris Oct 2012.
Introduction
• In spite of initial skepticism;
• There is growing evidence that
  MGB is a
• Safe and effective procedure with
• Many of the features of an ideal bariatric
  surgery.
Methods:


• Review of 6,436 MGBs 1997 to 2013

• First International Consensus
  Conference on the Mini-Bypass /
  One Anastomosis Bypass,
  Paris 2012 October 18-19.
Results

• Mean preop weight (+/- Standard Deviation)
  was 151 +/- 31 kg, BMI 46 +/- 7. &
• 79% were female. Mean operative time was
  43 + 11 minutes and median length of stay
  was 1 day.
• Three deaths occurred within 30 days of
  surgery, (0.05%).
• None in the last 10 years.
Results
• Early complications occurred in 4.9%.
• 44 (0.7%) patients had anastomotic leaks.
• Three (0.05%) patients presented with
  dypepsia/bile reflux not responsive to
  medical therapy and were successfully
  treated by Braun side-to-side jejuno-
  jejunostomy
• Gastritis/dyspepsia/marginal ulcer was the
  most serious long term complication;
  routinely treated medically (4.9%).
Results
• Excessive weight loss occurred in 1% of
  patients; treated by take down of the bypass.
• Mean % excess weight loss (EWL) of 78%.
• 10 year weight regain 4.9%.
• >50% EWL was achieved for 95% of patients
  at 18 months and for 92% at 60 months.
• 6% of patient had inadequate weight loss or
  significant weight regain were treated by
  revision, (addition of ~2 meters to the
  bypass).
SUCCESS CRITERIA
"IDEAL" WEIGHT LOSS SURGERY
1. Low Risk
2. Major Weight Loss
3. Easily performed
4. Short operative times
5. Outpatient or short hospital stay
6. Minimal Blood Loss
7. No Need for ICU Stay
8. Minimal Pain
9. Very High Patient Satisfaction
10. A Good "Exit Strategy"
SUCCESS CRITERIA
"IDEAL" WEIGHT LOSS SURGERY
11. Change Behavior & Preferences; Marked Decrease in Hunger
   and Increased Satiety
12. Minimal Retching and Vomiting
13. Few adhesions or hernias
14. Minimal impact on Heart and Lung Function
15. Low Failure Rate
16. Low Cost
17. Short Recovery Time
18. Rapid Return to Work
19. Low Risk of Pulmonary Embolus
20. Durable weight loss
SUCCESS CRITERIA
"IDEAL" WEIGHT LOSS SURGERY
21. Low Risk of Ulcer
22. Fat Malabsorption; low cholesterol & CV risk
23. No Plastic Foreign Body
24. Easily Verifiable Results; > 10 years of Results
25. Low Risk of Bowel Obstruction
26. Based upon sound surgical principles
27. Independent confirmation of results
28. Healthy life after surgery
29. Supported by LEVEL I Evidence; RCT (Controlled Prospective
   Randomized Trial)
30. Block “Sweet Eater” Failures
Selected Bariatric Procedures

• RNY


• Band


• Sleeve


• MGB
MINI-GASTRIC BYPASS
BASED SOUND SURGICAL PRACTICE

• Billroth II Performed
  over 100 years
• 16,000 Billroth II’s
  USA in 2007
• Operation of choice:
  Trauma, Ulcers, Cancer
  Stomach etc.
Conclusions:
• This study confirms reports presented first
  over 10 years ago and now supported by
  dozens of other surgeons from 29
  countries from around the world,
• MGB is an short, simple, effective, low-
  risk, and durable bariatric procedure.
• In addition, it can be easily
  revised, converted, or reversed.

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Apc a-00102-6436 mg bs

  • 1. a-00102 Dr. Robert RUTLEDGE Title of Paper: 6436 CONSECUTIVE MINI-GASTRIC BYPASSES: 16 YEARS LATER Nationality: United States of America Position: Director Department: Surgery Organization: Center For Laparoscopic Obesity Surgery Tel: +1-702 714 0011 E-mail: drr@clos.net
  • 2. 6436 CONSECUTIVE MINI-GASTRIC BYPASSES: 16 YEARS LATER Robert RUTLEDGE1 1Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America
  • 3. MINI-GASTRIC BYPASS • Mini-Gastric Bypass 1997 – 2012 ; >6,000 pts, 15 yr Data; Multiple Centers, R.C.Trials (Lee) • Vertical Gastric Tube (Collis Gastroplasty) • Gastric Bypass (Billroth II Gastro-jejunostomy)
  • 4. Introduction • Presented at the First International Consensus Conference on the • Mini-Bypass / • One Anastomosis Bypass • (MGB) • Paris Oct 2012.
  • 5. Introduction • In spite of initial skepticism; • There is growing evidence that MGB is a • Safe and effective procedure with • Many of the features of an ideal bariatric surgery.
  • 6. Methods: • Review of 6,436 MGBs 1997 to 2013 • First International Consensus Conference on the Mini-Bypass / One Anastomosis Bypass, Paris 2012 October 18-19.
  • 7. Results • Mean preop weight (+/- Standard Deviation) was 151 +/- 31 kg, BMI 46 +/- 7. & • 79% were female. Mean operative time was 43 + 11 minutes and median length of stay was 1 day. • Three deaths occurred within 30 days of surgery, (0.05%). • None in the last 10 years.
  • 8. Results • Early complications occurred in 4.9%. • 44 (0.7%) patients had anastomotic leaks. • Three (0.05%) patients presented with dypepsia/bile reflux not responsive to medical therapy and were successfully treated by Braun side-to-side jejuno- jejunostomy • Gastritis/dyspepsia/marginal ulcer was the most serious long term complication; routinely treated medically (4.9%).
  • 9. Results • Excessive weight loss occurred in 1% of patients; treated by take down of the bypass. • Mean % excess weight loss (EWL) of 78%. • 10 year weight regain 4.9%. • >50% EWL was achieved for 95% of patients at 18 months and for 92% at 60 months. • 6% of patient had inadequate weight loss or significant weight regain were treated by revision, (addition of ~2 meters to the bypass).
  • 10. SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY 1. Low Risk 2. Major Weight Loss 3. Easily performed 4. Short operative times 5. Outpatient or short hospital stay 6. Minimal Blood Loss 7. No Need for ICU Stay 8. Minimal Pain 9. Very High Patient Satisfaction 10. A Good "Exit Strategy"
  • 11. SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY 11. Change Behavior & Preferences; Marked Decrease in Hunger and Increased Satiety 12. Minimal Retching and Vomiting 13. Few adhesions or hernias 14. Minimal impact on Heart and Lung Function 15. Low Failure Rate 16. Low Cost 17. Short Recovery Time 18. Rapid Return to Work 19. Low Risk of Pulmonary Embolus 20. Durable weight loss
  • 12. SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY 21. Low Risk of Ulcer 22. Fat Malabsorption; low cholesterol & CV risk 23. No Plastic Foreign Body 24. Easily Verifiable Results; > 10 years of Results 25. Low Risk of Bowel Obstruction 26. Based upon sound surgical principles 27. Independent confirmation of results 28. Healthy life after surgery 29. Supported by LEVEL I Evidence; RCT (Controlled Prospective Randomized Trial) 30. Block “Sweet Eater” Failures
  • 13. Selected Bariatric Procedures • RNY • Band • Sleeve • MGB
  • 14. MINI-GASTRIC BYPASS BASED SOUND SURGICAL PRACTICE • Billroth II Performed over 100 years • 16,000 Billroth II’s USA in 2007 • Operation of choice: Trauma, Ulcers, Cancer Stomach etc.
  • 15. Conclusions: • This study confirms reports presented first over 10 years ago and now supported by dozens of other surgeons from 29 countries from around the world, • MGB is an short, simple, effective, low- risk, and durable bariatric procedure. • In addition, it can be easily revised, converted, or reversed.