Dr r mini gastric bypass complications-2


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Dr r mini gastric bypass complications-2

  1. 1. Mini-Gastric Bypass: Much More Effective & Fewer Short & Long Term Complications Robert Rutledge
  2. 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. 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. 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. 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. 6. Complications: 5% • Most Frequent Complaint/Complication • Similar to reports from RNY • Dyspepsia/Ulcer/Gastritis • Anemia in 5%,
  7. 7. Complications: 2% • Gas • Cramps • Nausea • Vomiting 2%,
  8. 8. Complications: 1% • Diarrhea • Leak • Dehydration • Regained Weight • Hernia • Minor Bleeding 1%,
  9. 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. 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. 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. 12. Bariatric Surgeons Fear the Billroth II Studies show surgeons who fear the Billroth II are usually poorly Informed about Gastric cancer
  13. 13. What should MGB Surgeons and Patients Know About The Billroth II and the Risk of Gastric Cancer?
  14. 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. 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. 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. 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. 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. 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