MGB and Billroth II

1. MGB & Billroth II History

2. I Humbly
Thank You
for Kind Invitation
My Brothers &
Colleagues

3. We Commit to the Wellbeing of Our
Patients, Families & County's Health
I am at Your Service
Please Ask Anything from Me

5. Dr. Rutledge:
“I am No Great Teacher/Surgeon
I am your Brother
I am NOT a Great Surgeon,
I am an Old Surgeon,
My Many Mistakes & Errors &
Help You Avoid Them”

6. MGB Citations / Year
0
10
20
30
40
50
60
2000 2003 2006 2009 2012 2015 2018

7. Why Are We Here?

8. Mini-Gastric Bypass
The Mini-Gastric Bypass is Being Done
Now Let it Be Done Well
Dr Rutledge
Email: DrR@clos.net
Join Us!

9. Now Popular MGB
is Being Done without
Understanding
Leading to Deaths &
Complications

10. • History of DrR & MGB
• MGB = Billroth II, Billroth II is GOOD
• MGB = General Surgery, How to
• The Future of Bariatric (Metabolic) Surgery
• Diabetes in Epidemic
• The Mini-Gastric Bypass can be Tailored;
Useful for all types of patients
Especially “Thin” Diabetics

11. Course Outline
Understanding the
Mini-Gastric Bypass
MGB Bronze Certification Course
1. Standardization
2. Education
3. Recognition

12. Standardization, Education & Recognition
Excellence in Delivering the Mini-Gastric Bypass

13. MGB Growing Fast
Good News / Bad News
Why are we here?
I. Why MGB?
Answer: 1. MGB More Effective & Lower risk,
2. Revision of Failed Sleeve
3. BUT MOST Important: Diabetes
II. If You DO MGB why Learn MGB?
Answer: MGB => Complications / Deadly
in unskilled hands (Examples?)
MGB => Not Hard to Learn,
BUT you must LEARN IT!

14. Email Me:
DrR@Clos.net
Please feel free to contact me at anytime

15. The Mini-Gastric Bypass
• 1. Simple Powerful & Easily Performed
• 2. Dangerous:
Do not understand the operation
• 3. NEED:
Standardization, Education & Recognition

16. Modified Outline MGB Bronze
Certification Course
Day 1
1. History of mgb with technical differences (RnY, OAGB, SADI)
illustrated (Mis)Understanding Billroth II Now & Past Hx
2. video of a routine perfect mgb (to keep audience awake)
3. MGB v Sleeve
4. MGB Technique: Gastric Pouch, EGJ, Hiatal Hernia etc.
5. MGB Technique: concepts of limb lengths with comparison with
other bypasses
6. DxRx Leak Protocol
7. Evidence base: MGB weight loss comparison & outcomes with
other procedures
8. Evidence base: MGB outcomes & complications including
malnutrition with other procedures
Day 2
9. How to manage complications with videos.
10. MGB Anesthesia
11. Videos of what not to do in MGB (to keep audience awake)
12. GERD and bile reflux: why? evidence? comparison with other
procedures
13. Perioperative care: Short Term
14. Pericoperative Mangement: Mid - Late Long Term
Estrogen, Pregnancy, Infertility, Fainting
Prevention, Dx/Rx Deficiencies, Osteoporosis, Anemia,
Liver Disease
15. Revisions with videos: need for revisions
16. Metabolic Surgery, the Future: MGB “Thin” Diabetics

17. History of
MGB & Dr Rutledge

19. • Injury to
Stomach, Pancreas and
Multiple Loops of Small
Bowel
• Rx
Distal Gastrectomy
• Distal Pancreatectomy
• Splenectomy

22. 1997 Next Morning Planned Lap RNY
MGB = Standard General Surgery (Antrectomy & Billroth II)

23. MGB = Billroth II,
Billroth II is GOOD
General Surgeons Know How to Use the
Billroth II
Bariatric Surgeons are Uninformed and Fear
the Billroth II

24. 20 Years FEAR of MGB?
Mason Loop *NOT* MGB

25. Billroth II Loop Antrum: YES, EGJx: NO, NEVER

26. • Well Informed
General
Surgeons
=>
Routinely Use
the Billroth II
• Uninformed
Bariatric
Surgeons
=>
Fear the
Billroth II

27. The Billroth II
is a good safe operation
that makes people
healthier
Studies Show Billroth II
Decreases the Risk of
Stroke, Coronary Heart Disease &
Diabetes and more

28. A Nationwide Population-Based Study
Billroth II Decreased Risk of Stroke
• 6,425 patients Billroth II for Ulcer
• Nationwide Health Database
• Matched with 25,602 Ulcer Pts who did not
receive Billroth II
• Billroth II patients had a lower risk of Stroke!
• Medicine (Baltimore). 2016 Apr;95(16)

29. A Nationwide Population-Based Study
Billroth II Decreased Risk of Coronary Heart Disease.
• BII for Ulcer
•National Health Insurance Database
• Matched with 25,602 Ulcer Pts did not receive
Billroth II
• Billroth II patients 20%+ Decreased Risk of Coronary
Heart Disease
• Obes Surg. 2017 Jun;27(6):1604-1611

30. A Nationwide Population-Based Study
Billroth II Decreased Risk of Diabetes by Almost 50%
• National Health Insurance Database
• Matched with patients did not receive Billroth
II
• Billroth II patients of Diabetes (adjusted hazard
ratio (aHR): 0.56)
• PLoS One. 2016 Nov 28;11(11)