GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY

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GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY
1. Bariatric surgery history is replete with failed Primary Gastric Procedures for obesity,
2. Physiologically it is easy to see how an excess of 2, 000 calories a day can be ingested as liquid/soft calories (Coke and Cake) thus “Beating” the operations’ “gastric restriction” Band/Sleeve.
3. Studies in Gastric Cancer patients show that Combined Gastro-Intestinal Procedures outperform Primary Gastric Procedures
4. Primary Gastric Procedures can be predicted to fail even following initial success (see Lap Band(r))

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GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY

  1. 1. a-00119 Dr. Robert RUTLEDGE Title of Paper: GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY 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. 2. GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY Robert RUTLEDGE1 1Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America
  3. 3. Introduction • The history of bariatric surgery is filled with failed • Primary Gastric Procedures (PGP) • (e.g. jaw wring, horizontal gastroplasty, silicone ring and vertical banded gastroplasty, LAP BAND, Sleeve etc.)
  4. 4. Methods: • Review of published studies of gastric cancer patients treated with either • 1. Primary Gastric Procedure (PGP) or • 2. Combined Gastro-Intestinal Procedure (CGIP) on weight loss and diabetes.
  5. 5. Results PGP vs CGIP: • • • • • 403 gastric cancer patients with DM. PGP vs. CGIP Reduction in BMI 7.6 vs. 11.4 (5) Diabetes Improve/Resolve: CGIP 37% vs. CGIP 52% • (Outcome after gastrectomy in gastric cancer patients ..., Kim et.al., Korea, World J Gastro 2012, Jan.)
  6. 6. Resolution of Diabetes • 71% CGIP resolution improvement • (Zervos “Amelioration of insulin requirement in patients undergoing duodenal bypass for reasons other than obesity...” J Am Coll Surg. 2010 May)
  7. 7. Results: PGP vs. CGIP • 75 Gastric Cancer Patients 1996-2009 • Improvement in DM status was • 7.5 times higher in CGIP than in PGP patients • (Kang "Influence of gastrectomy for stomach cancer on type 2 diabetes mellitus..." J Korean Surg Soc 2012 Jun.)
  8. 8. Results PGP vs. CGIP • 229 Gastric Cancer Patients, • the DM remission or improvement rate was higher in the CGIP than PGP group • (67% vs. 49%, P=0.02) • (Lee, “Comparative study of diabetes mellitus resolution according to reconstruction type after gastrectomy”, Obes Surg. 2012 Aug).
  9. 9. Conclusions: • 1. Bariatric surgery history is replete with failed Primary Gastric Procedures for obesity, • 2. Physiologically it is easy to see how an excess of 2, 000 calories a day can be ingested as liquid/soft calories (Coke and Cake) thus “Beating” the operations’ “gastric restriction” Band/Sleeve.
  10. 10. Conclusions: • 3. Studies in Gastric Cancer patients show that Combined Gastro-Intestinal Procedures outperform Primary Gastric Procedures • 4. Primary Gastric Procedures can be predicted to fail even following initial success (see Lap Band(r))
  11. 11. Conclusions • 5, Operations designed to treat obesity need long term treatment success should have a Combined Gastro-Intestinal Component.

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