First International ConsensusConference on the Mini-Bypass / One        Anastomosis Bypass     Paris 2012 October 18-19   ...
Failure. Power.    &Success!
Failure of Sleeve & Band.Power of Mini-Gastric Bypass.               &   Successful Treatment of     Obesity & Diabetes!
Expert Judgment ofWeight Loss Surgery    Procedures
The Need for a Multidisciplinary Team• Psychiatrist and Psychologist• Nutritionist and Dietitian• Physical therapist and P...
Multidisciplinary Team• For Cholecystectomy?• Why no Multidisciplinary Team for  Gallbladder Surgery?• Support Group?• Pre...
No Multidisciplinary Team for     Cholecystectomy          Because     Cholecystectomy    Cures the Disease             of...
Multidisciplinary Team• A poor form of weight loss surgery• Will require a really good  Multidisciplinary Team• A poor ope...
Multidisciplinary Team’s      Abuse of the Failed Patient• A further comment:• What will the Multidisciplinary Team  say a...
What do the Experts Say?
Survey Results• As part of a Pre-Conference survey for the• MGB/OAB Consensus Conference• Asked Expert Surgeons to Judge 4...
12. Your Opinion about the LAP BAND• LAP BAND is good, short simple  surgery, maybe the best form of  WLS, I use it often ...
13. Your Opinion about the SLEEVE• SLEEVE is Good, short simple  surgery, maybe the best form of  WLS, I use it often 32.1...
14. Your Opinion about the RNY• RNY is Good, maybe the best form of  WLS, I use it often 42.9%• RNY is OK it is an accepta...
15. Your Opinion about the Mini-  Bypass / One Anastomosis Bypass• MGB is good, short simple surgery,  maybe the best form...
These results are shown      graphically
MGB: Fewest Negative Judgments• 46.4% said the Band was a bad operation• 14.3%, 7.1% and 3.6% said the Sleeve, the RNY and...
MGB: Most Often Judged Best• These experts judged the MGB most often  to be a "good, short simple surgery,  maybe the best...
Frequency of Negative Judgment
Frequency of Choice as"Best" form of Surgery
Judgment of the Band
Judgment of the Sleeve
Judgment of the RNY
Judgment of the MGB/OABHighest Good / Lowest Bad
Success: Mini-Gastric Bypass Simplicity, Power & Safety
Failed Sleeve to RNY; Sept 2012                      Less 24 months!•   Failed Sleeve:•   Weight loss•   Diabetes Rx•   SE...
Band, Sleeve vs   the Neuro-Humoral Drive to Eat• Restrictive Procedures• MAKE SWEET EATERS:• Mechanical Block of  Normal ...
Band & Sleeve     Block Normal Healthy Foods• Weight Loss =>• Increased Hunger• Decreased Satiety• Healthy Foods Blocked• ...
Band & Sleeve;Block Intake Normal Healthy FoodSleeve            Band
Restrictive Procedures   • Successfully Block    Normal Healthy Diet           But• They DO NOT BLOCK ...
Pathologic Dietary Choices             Calories:     Ice Cream 200g/540 cal,    2 Milky-way Bars, 1,000 cal      2 L Bottl...
Diet InducedIncreased Hunger
Summary• Most Diets & Restrictive  Procedures Will Fail• Attempts to Override  Neuro-Humoral Hunger System  Routinly Fails...
SOLUTION?
Diet InducedIncreased Hunger
Mini-Gastric Bypass  The Mongoose!
Mini-Gastric Bypass• Blocks  Neuro-Humoral  Hunger System• Short, Simple,  Durable, 30 minute  Surgery that:• Decreases Hu...
Mini-Gastric Bypass Decreases Hunger           Survey 2,783 Pts
What Do the Experts Say?  Survey of 102 surgeons answered detailed                survey online.Surgeons from 6 Continents...
IFSO Varianational Committee Survey  Over 100 Surgeons from Around the World:
MGB Best Rx Diabetes
Both Kular and Rutledge, Op Time < 40 min
Risk ofEsophagealCancer?
30% Reflux & Esophageal    Cancer?
LeaksSurg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33.      Laparoscopic sleeve gastrectomy:
Band/Sleeve            Road to Failure           Initial Weight Loss           Return of HungerEat Normal Foods         Ea...
In Summary• Restrictive Procedures Fail• In as Little as 2 Years• Restrictive Procedures Push Patients  towards Liquid Cal...
The Mini-Gastric Bypass  Excellent Operation with Results Reported onThousands of Patients Over the Past 10-15 years  • Su...
Failure of Sleeve & Band.
Failure of Sleeve & Band.
Failure of Sleeve & Band.
Failure of Sleeve & Band.
Failure of Sleeve & Band.
Failure of Sleeve & Band.
Failure of Sleeve & Band.
Failure of Sleeve & Band.
Failure of Sleeve & Band.
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Failure of Sleeve & Band. Power of Mini-Gastric Bypass. & Successful Treatment of Obesity & Diabetes!

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Failure of Sleeve & Band.

  1. 1. First International ConsensusConference on the Mini-Bypass / One Anastomosis Bypass Paris 2012 October 18-19 Email DrR@CLOS.Net
  2. 2. Failure. Power. &Success!
  3. 3. Failure of Sleeve & Band.Power of Mini-Gastric Bypass. & Successful Treatment of Obesity & Diabetes!
  4. 4. Expert Judgment ofWeight Loss Surgery Procedures
  5. 5. The Need for a Multidisciplinary Team• Psychiatrist and Psychologist• Nutritionist and Dietitian• Physical therapist and Physical Trainer• Support Group• Support Group Leader• Anesthesiologist• Generalist and Endocrinologist and Gastroenterologist• And More?
  6. 6. Multidisciplinary Team• For Cholecystectomy?• Why no Multidisciplinary Team for Gallbladder Surgery?• Support Group?• Pre Op Liquid Diet• Psychiatric counseling?• Dietician?• No.• Why?
  7. 7. No Multidisciplinary Team for Cholecystectomy Because Cholecystectomy Cures the Disease of Cholelithiasis
  8. 8. Multidisciplinary Team• A poor form of weight loss surgery• Will require a really good Multidisciplinary Team• A poor operation that fails to successfully treat obesity and diabetes• Patient will NEED a support group• And a Psychologist and a Grief councilor and more…
  9. 9. Multidisciplinary Team’s Abuse of the Failed Patient• A further comment:• What will the Multidisciplinary Team say and feel about their patient failures• The failed patient is a judgment against the Multidisciplinary Team and their program• Often the Team (Surgeon) will Blame the Victim (Failed Patient)
  10. 10. What do the Experts Say?
  11. 11. Survey Results• As part of a Pre-Conference survey for the• MGB/OAB Consensus Conference• Asked Expert Surgeons to Judge 4 weight loss procedures.• This is a report Expert Judgment of the Band, the Sleeve, RNY and the MGB
  12. 12. 12. Your Opinion about the LAP BAND• LAP BAND is good, short simple surgery, maybe the best form of WLS, I use it often 7.1%• LAP BAND is OK it is an acceptable alternative and I use it sometimes 46.4%• LAP BAND is a Bad operation and should not be used 46.4%
  13. 13. 13. Your Opinion about the SLEEVE• SLEEVE is Good, short simple surgery, maybe the best form of WLS, I use it often 32.1%• SLEEVE is OK it is an acceptable alternative and I use it sometimes 53.6%• SLEEVE is a Bad operation and should not be used 14.3%
  14. 14. 14. Your Opinion about the RNY• RNY is Good, maybe the best form of WLS, I use it often 42.9%• RNY is OK it is an acceptable alternative and I use it sometimes 50.0%• RNY is a Bad operation and should not be used 7.1%
  15. 15. 15. Your Opinion about the Mini- Bypass / One Anastomosis Bypass• MGB is good, short simple surgery, maybe the best form of WLS, I use it often 67.9%• MGB is OK it is an acceptable alternative and I use it sometimes 28.6%• MGB is a Bad operation and should not be used 3.6%
  16. 16. These results are shown graphically
  17. 17. MGB: Fewest Negative Judgments• 46.4% said the Band was a bad operation• 14.3%, 7.1% and 3.6% said the Sleeve, the RNY and the MGB were bad operations and should not be done.• By this measure experts judged the band the least favorable operation and the MGB the best choice.
  18. 18. MGB: Most Often Judged Best• These experts judged the MGB most often to be a "good, short simple surgery, maybe the best form of WLS, I use it often" in 67.9% of cases as compared to• 7.1%, 32.1% and 42.9% for the band, the sleeve and the RNY respectively.• In these experts opinion the MGB is by far the best judged form of weight loss surgery.
  19. 19. Frequency of Negative Judgment
  20. 20. Frequency of Choice as"Best" form of Surgery
  21. 21. Judgment of the Band
  22. 22. Judgment of the Sleeve
  23. 23. Judgment of the RNY
  24. 24. Judgment of the MGB/OABHighest Good / Lowest Bad
  25. 25. Success: Mini-Gastric Bypass Simplicity, Power & Safety
  26. 26. Failed Sleeve to RNY; Sept 2012 Less 24 months!• Failed Sleeve:• Weight loss• Diabetes Rx• SEVERE Reflux symptoms.• Time to Failure less than 24 months.• 30% for "Severe Reflux"!!!!• Indications and Mid-Term Results of Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Authors Gautier T, et al. Obes Surg. 2012 Sep 23. Département de Chirurgie Digestive, Caen University Hospital, Caen Cedex, France, gautier.tho@gmail.com.
  27. 27. Band, Sleeve vs the Neuro-Humoral Drive to Eat• Restrictive Procedures• MAKE SWEET EATERS:• Mechanical Block of Normal Healthy Foods• Weight Loss: Honeymoon 2 years• Then Failure Weight Regain• GE Reflux (Risk of Esophageal Cancer)
  28. 28. Band & Sleeve Block Normal Healthy Foods• Weight Loss =>• Increased Hunger• Decreased Satiety• Healthy Foods Blocked• Drive to Eat UP• What Happens?
  29. 29. Band & Sleeve;Block Intake Normal Healthy FoodSleeve Band
  30. 30. Restrictive Procedures • Successfully Block Normal Healthy Diet But• They DO NOT BLOCK ...
  31. 31. Pathologic Dietary Choices Calories: Ice Cream 200g/540 cal, 2 Milky-way Bars, 1,000 cal 2 L Bottle Coke 830 cal Total: 2,370 cal
  32. 32. Diet InducedIncreased Hunger
  33. 33. Summary• Most Diets & Restrictive Procedures Will Fail• Attempts to Override Neuro-Humoral Hunger System Routinly Fails• RPs Force Patients into Pathological Dietary Choices• MAKE SWEET EATERS!
  34. 34. SOLUTION?
  35. 35. Diet InducedIncreased Hunger
  36. 36. Mini-Gastric Bypass The Mongoose!
  37. 37. Mini-Gastric Bypass• Blocks Neuro-Humoral Hunger System• Short, Simple, Durable, 30 minute Surgery that:• Decreases Hunger & The Mongoose He is a Little Bit Ugly, No? Increases Satiety
  38. 38. Mini-Gastric Bypass Decreases Hunger Survey 2,783 Pts
  39. 39. What Do the Experts Say? Survey of 102 surgeons answered detailed survey online.Surgeons from 6 Continents and 23 countries. The group reported on apast years experience with over 39,000 cases, Very experienced surgeons.
  40. 40. IFSO Varianational Committee Survey Over 100 Surgeons from Around the World:
  41. 41. MGB Best Rx Diabetes
  42. 42. Both Kular and Rutledge, Op Time < 40 min
  43. 43. Risk ofEsophagealCancer?
  44. 44. 30% Reflux & Esophageal Cancer?
  45. 45. LeaksSurg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33. Laparoscopic sleeve gastrectomy:
  46. 46. Band/Sleeve Road to Failure Initial Weight Loss Return of HungerEat Normal Foods Eat Liquid Calories Obstruction WeightAcid Reflux/Cancer Regain
  47. 47. In Summary• Restrictive Procedures Fail• In as Little as 2 Years• Restrictive Procedures Push Patients towards Liquid Calories• (Can a Sleeve stop Coke!)• Weight Regain is Common• Acid Reflux 30%+• Acid Reflux = Esophageal Cancer
  48. 48. The Mini-Gastric Bypass Excellent Operation with Results Reported onThousands of Patients Over the Past 10-15 years • Survey Shows: • Short, Simple, Effective, Durable, • 30 min Operation with 1 day Hospital Stay • Lower Leak rate than Sleeve or RNY • Best Weight Loss • Easily Reversible, Revisable

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