Selection of the “Best” Bariatric surgery Procedure<br />The Mini-Gastric Bypass<br />
Dr Rutledge: Training & Background<br /><ul><li>Undergrad/Medical School; Teacher Dr. Lester Dragstedt Pioneer / Inventor ...
2 Years Cardiac Surgery National Institutes of Health National Heart Lung Blood Institute
20 years University of NC; Professor of Surgery, Associate Chief of Staff, Director of Section Medical Informatics, Direct...
Author of 93 papers and articles</li></li></ul><li>Dr Rutledge: Training & Background<br /><ul><li>Specialty: Trauma, Crit...
Experience: Trauma Surgery, Director NC Trauma Registry
Peptic Ulcer Surgery; Vagotomy & Pyloroplasty; Antrectomy & Billroth II
Bariatric Surgery 33 years: Open RNY & Vertical Banded Gastroplasty
1997 one first surgeons laparoscopic RNY
Mini-Gastric Bypass; 14 years, over 6,000 cases</li></li></ul><li>CONSIDERING THE MGB?MGB IS A SUPERB SURGERY BUT…WARNING:...
OFFER A SAFE & SUCCESSFUL MGB PROGRAM<br /><ul><li>Call / Email: Anytime question or advice on any clinical, technical or ...
USA 001-702-714-0011 DrR@clos.net
Personal Visit: Dr. Rutledge Visiting Professor: France, Turkey, Austria & India, Upcoming visits Greece, Istanbul, United...
Please Use the Knowledge of Others Before You Start;Experience; over 14 years, over 6,000 patients
USA 001-702-714-0011 DrR@clos.net</li></li></ul><li>UPCOMING “HANDS ON” MGB IN INDIA“TRICKS AND TRAPS” TRAINING PROGRAM<br...
Hands On Surgery (with approval)	Scrub in on cases	Assist and 	Participate in MGB Surgery
This Fall and Next Year
Bija India, Dr Rutledge & Dr Kular
USA 001-702-714-0011 DrR@clos.net</li></li></ul><li>SURGERYHISTORY OF  POOR DECISIONSJOSEPH LISTER: AMERICAN  SURGEONS DEL...
REPTILIAN BRAINPOOR DECISION MAKING<br /><ul><li>Lister published antisepsis paper:
1867</li></ul>Dr. Gross; Gross Clinic 1875<br />
Definition of the Problem<br /><ul><li>Obesity Epidemic
History of Failure of Bariatric Surgical Procedures
Selecting the “Ideal / BEST” Bariatric Surgical Procedure</li></li></ul><li>Problem Definition:Bariatric Surgery: A HISTOR...
The Gastric Sleeve:Not as Bad as the BandNot as Dangerous as the RNY<br />
SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY<br />1.  Low Risk<br />2. Major Weight Loss<br />3. Easily performed<br />4. S...
SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY<br />11. Change Behavior & Preferences;  Marked Decrease in Hunger and Increas...
SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY<br />21. Low Risk of Ulcer<br />22. Fat Malabsorption; low cholesterol & CV ri...
Selected Bariatric Procedures<br /><ul><li>RNY
Band
Sleeve
MGB</li></li></ul><li>MINI-GASTRIC BYPASS	<br /><ul><li>The  Mini-Gastric Bypass1997 – 2011 ; >6,000 pts,10 yr Data; Multi...
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Choice weightlosssurgery 2

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Choice weightlosssurgery 2

  1. 1. Selection of the “Best” Bariatric surgery Procedure<br />The Mini-Gastric Bypass<br />
  2. 2.
  3. 3. Dr Rutledge: Training & Background<br /><ul><li>Undergrad/Medical School; Teacher Dr. Lester Dragstedt Pioneer / Inventor of the Highly Controversial Vagotomy and Pyloroplasty
  4. 4. 2 Years Cardiac Surgery National Institutes of Health National Heart Lung Blood Institute
  5. 5. 20 years University of NC; Professor of Surgery, Associate Chief of Staff, Director of Section Medical Informatics, Director North Carolina Trauma Registry
  6. 6. Author of 93 papers and articles</li></li></ul><li>Dr Rutledge: Training & Background<br /><ul><li>Specialty: Trauma, Critical Care, Medical Informatics and Bariatric Surgery (1978-1998 20 years University NC)
  7. 7. Experience: Trauma Surgery, Director NC Trauma Registry
  8. 8. Peptic Ulcer Surgery; Vagotomy & Pyloroplasty; Antrectomy & Billroth II
  9. 9. Bariatric Surgery 33 years: Open RNY & Vertical Banded Gastroplasty
  10. 10. 1997 one first surgeons laparoscopic RNY
  11. 11. Mini-Gastric Bypass; 14 years, over 6,000 cases</li></li></ul><li>CONSIDERING THE MGB?MGB IS A SUPERB SURGERY BUT…WARNING: “THERE ARE “TRICKS AND TRAPS”<br />Dr. Rutledge<br />USA 001-702-714-0011 DrR@clos.net<br />
  12. 12. OFFER A SAFE & SUCCESSFUL MGB PROGRAM<br /><ul><li>Call / Email: Anytime question or advice on any clinical, technical or patient MGB question
  13. 13. USA 001-702-714-0011 DrR@clos.net
  14. 14. Personal Visit: Dr. Rutledge Visiting Professor: France, Turkey, Austria & India, Upcoming visits Greece, Istanbul, United KingdomCzech Republic, Italy, Germany, UAE, Pakistan,
  15. 15. Please Use the Knowledge of Others Before You Start;Experience; over 14 years, over 6,000 patients
  16. 16. USA 001-702-714-0011 DrR@clos.net</li></li></ul><li>UPCOMING “HANDS ON” MGB IN INDIA“TRICKS AND TRAPS” TRAINING PROGRAM<br /><ul><li>Didactic Sessions Talk with the Leading World Experts
  17. 17. Hands On Surgery (with approval) Scrub in on cases Assist and Participate in MGB Surgery
  18. 18. This Fall and Next Year
  19. 19. Bija India, Dr Rutledge & Dr Kular
  20. 20. USA 001-702-714-0011 DrR@clos.net</li></li></ul><li>SURGERYHISTORY OF POOR DECISIONSJOSEPH LISTER: AMERICAN SURGEONS DELAYED ADOPTION OF ANTISEPSIS 10 YEARS<br />
  21. 21. REPTILIAN BRAINPOOR DECISION MAKING<br /><ul><li>Lister published antisepsis paper:
  22. 22. 1867</li></ul>Dr. Gross; Gross Clinic 1875<br />
  23. 23. Definition of the Problem<br /><ul><li>Obesity Epidemic
  24. 24. History of Failure of Bariatric Surgical Procedures
  25. 25. Selecting the “Ideal / BEST” Bariatric Surgical Procedure</li></li></ul><li>Problem Definition:Bariatric Surgery: A HISTORY OF FAILURE<br />
  26. 26. The Gastric Sleeve:Not as Bad as the BandNot as Dangerous as the RNY<br />
  27. 27. SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY<br />1.  Low Risk<br />2. Major Weight Loss<br />3. Easily performed<br />4. Short operative times<br />5. Outpatient or short hospital stay<br />6. Minimal Blood Loss<br />7. No Need for ICU Stay<br />8. Minimal Pain<br />9. Very High Patient Satisfaction<br />10. A Good "Exit Strategy" <br />
  28. 28. SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY<br />11. Change Behavior & Preferences; Marked Decrease in Hunger and Increased Satiety<br />12. Minimal Retching and Vomiting <br />13. Few adhesions or hernias<br />14. Minimal impact on Heart and Lung Function<br />15. Low Failure Rate<br />16. Low Cost<br />17. Short Recovery Time<br />18. Rapid Return to Work<br />19. Low Risk of Pulmonary Embolus<br />20. Durable weight loss<br />
  29. 29. SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY<br />21. Low Risk of Ulcer<br />22. Fat Malabsorption; low cholesterol & CV risk <br />23. No Plastic Foreign Body <br />24. Easily Verifiable Results; > 10 years of Results<br />25. Low Risk of Bowel Obstruction<br />26. Based upon sound surgical principles <br />27. Independent confirmation of results<br />28. Healthy life after surgery<br />29. Supported by LEVEL I Evidence; RCT (Controlled Prospective Randomized Trial)<br />30. Block “Sweet Eater” Failures<br />
  30. 30. Selected Bariatric Procedures<br /><ul><li>RNY
  31. 31. Band
  32. 32. Sleeve
  33. 33. MGB</li></li></ul><li>MINI-GASTRIC BYPASS <br /><ul><li>The Mini-Gastric Bypass1997 – 2011 ; >6,000 pts,10 yr Data; Multiple Centers,R.C.Trials
  34. 34. Vertical Gastric Tube(Collis Gastroplasty)
  35. 35. Gastric Bypass(Billroth II Gastro-jejunostomy)</li></li></ul><li>MINI-GASTRIC BYPASSBASED SOUND SURGICAL PRACTICE <br /><ul><li>Billroth II Performed over 100 years
  36. 36. 16,000 Billroth II’sUSA in 2007
  37. 37. Operation of choice: Trauma, Ulcers, Cancer Stomach etc.</li></li></ul><li>Criteria for Success; Ideal Weight Loss Surgery<br />
  38. 38. Criteria for Success; Ideal Weight Loss Surgery<br />
  39. 39. Criteria for Success<br />
  40. 40. Marginal Ulcer after Gastric Bypass; RNY & MGB<br />Marginal Ulcers after Roux-en-Y Gastric Bypass: Pain for the Patient…Pain for the Surgeon<br />January 2010<br />by Camellia Racu, <br />Bariatric Times. <br />2010;7(1):23–25<br />
  41. 41. Marginal Ulcer after Gastric Bypass; RNY & MGB<br />
  42. 42. Marginal Ulcer after Gastric Bypass; RNY & MGB<br />Marginal ulcers RNYranging from 0.6 to 16%<br />True incidence is very likely much higher<br />Csendesprospective study routine postoperative endoscopic evaluation<br />28% of marginal ulcers were asymptomatic<br />Gastric Bypass (RNY & MGB)HIGH incidence of Marginal Ulcer<br />BILE MAKES NO DIFFERENCE!!!<br />
  43. 43. Incidence of perforated gastrojejunal anastomotic ulcers after RNY<br />April 2002 to April 2010, 1213 patients underwent laparoscopic RYGB<br />Operative mortality was .15%<br />10 perforated GJA ulcers (.82%) at a mean of 13.5 (6-19) months<br />Morbidity and mortality rate was 30% and 10%<br />Perforated GJA ulcers can develop in 1 of 120 Roux en Y Gastric Bypasses & DEADLY<br />
  44. 44. Marginal Ulcers: Achilles Heel of Gastric Bypass<br />Management<br />1. Warn Patients & Surgeon “Be Vigilant”<br />2. Aggressive anti-H. Pylori Rx<br />3. Aggressive use of Antacids<br />4. Strict Avoidance of Ulcerogenic Agents(NSAIDS, Etoh, Smoking, Coffee, Soda, Nitrates)<br />5. Encourage: Probiotics, Yogurt, Fruits Vegetables<br />BILE MAKES NO DIFFERENCE!!!<br />
  45. 45. CONCLUSIONS: Best Choice: Mini-Gastric Bypass<br /><ul><li>Choice of Obesity Surgery
  46. 46. Objectives “Ideal” Weight Loss Surgery
  47. 47. RNY, Band, Sleeve, MGB
  48. 48. MGB Best meets all objectives/success criteria
  49. 49. Beware of Marginal Ulcer
  50. 50. Rational Decision Making: Best Choice; Mini-Gastric Bypass</li></li></ul><li>WHY CRITICS ONLY CARE FOR MGB?<br /><ul><li>Why do Critics only care about the Mini-Gastric Bypass?
  51. 51. 100,000’s of people already have and are living with and are getting the Billroth II every day
  52. 52. Why haven’t concerned bariatric surgeons stepped forward to stop all general, trauma and oncologic surgeons from performing this Billroth II surgery?</li></li></ul><li>WHY CRITICS ONLY CARE FOR MGB?<br /><ul><li>Why do Critics only care about the Mini-Gastric Bypass?
  53. 53. Why haven’t concerned bariatric surgeons stepped forward to start a fund to help suffering Billroth II patients get needed conversions of their surgery to Roux-en-Y?
  54. 54. Why don’t they write letters to the editor calling for the Billroth II to be declared a operation non-grata?</li></li></ul><li>WHY CRITICS ONLY CARE FOR MGB?<br /><ul><li>Why do Critics only care about the Mini-Gastric Bypass?
  55. 55. Why haven’t concerned bariatric surgeons stepped forward to national funding for lifetime endoscopic screening of Billroth II patients to find dreaded gastric cancers?
  56. 56. It seems odd doesn’t it?
  57. 57. There is a simple reason</li></li></ul><li>WHY CRITICS ONLY CARE FOR MGB?<br /><ul><li>There is a simple reason
  58. 58. The critics of the MGB do not do those things because they are ridiculous
  59. 59. Such actions are Not supported by the data
  60. 60. The Billroth II and the MGB are both good operations
  61. 61. Published data Does Not support the critics misreading of the medical literature</li></li></ul><li>CRITICS OF THE MINI-GASTRIC BYPASSSHOULD BE EMBARRASSED<br />
  62. 62. Rational Data Analysis vs.Irrational FEAR Gastric Cancer<br /><ul><li>1. Gastric Cancer Declining Rapidly
  63. 63. 2. GC Environmental Causes; Easily Prevented
  64. 64. 3. Some studies show Small Increased RiskProbably from Ulcers / H. Pylori
  65. 65. 4. Many large studies: NO increased risk
  66. 66. 5. Endoscopic Screening: Not Recommended
  67. 67. 6. General, Trauma & Oncologic Surgeons Use Billroth II</li>

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