Course OutlineUnderstanding the Mini-Gastric BypassMGB Bronze Certification Course1. Standardization 2. Education3. Recognition

1. Before I Begin
May I Humbly
Thank You
for this Kind Invitation
Special Thanks to You
My Brothers & Colleagues

2. Before We Begin:
I Commit Myself to You &
We All Commit Ourselves to the Wellbeing of Our
Patients, Families & County's Health
Now & Hearafter I am Forever Your Humble Servant
Please Ask Anything from Me
I will Do My Best to Serve You & Your Patients Both Now in
the Course & in the Future

3. Finally I Come Before You Today
as No Great Teacher/Surgeon
But as Battered & Bruised Brother Warrior
I am NOT a Great Surgeon,
I am an Old Surgeon,
I am Here to Tell You of My Many Mistakes &
Errors & Help You Avoid Them
Any Wisdom I Have is From 40 Years in the Field
with You My Dear Brothers

4. Why Are We Here?
The MGB is NOT Just a
Single Anastomosis Bypass!

5. What's wrong with the the Sleeve,
The Sleeve is Good, Good Enough
Why are we here?
I. Why do we need the MGB?
Answer: MGB more powerful, Lower risk,
Revision of Failed Sleeve, (Sleeve = Lap Band) more...
BUT MOST Important: Diabetes
II. If You DO need/want the MGB,
Its simple and nothing special nothing to it?
Answer: Wrong, MGB => Deadly in unskilled hands (Examples?)
MGB => Not Hard to Learn, BUT you must LEARN IT!

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

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

8. Expert MGB Surgerons Invited to Join the
Board of Governors of the MGB Review Corp
I invite you to join the Board of Governors of the MGB Review Corporation
For Excellence in the MGB!
1. Complete the MGB Review Corporation Information Form
https://www.surveymonkey.com/r/MRCReviewCorp
2.Join the Facebook Page & Group: MGBReviewCorp
https://www.Facebook.com/MGBReviewCorp/
https://www.Facebook.com/groups/MGBReviewCorp
Please join us to initiate your participation in the group process
Email, Call or Message for more information or to give advice & your opinions:
​Email: DrR@clos.net, Facebook: DrRRutledge
Facebook Messenger: @DrRRutledge,
What's App: Dr Rutledge

9. The Mini-Gastric Bypass Course
• Simple Powerful & Easily Performed
• Dangerous in the Hands of Surgeons
who do not make the effort to
understand the basics of the operation
• NEED:
Standardization, Education & Recognition

10. Course Goals
MGB Review Corp
• *Improved Patient Care*
• Standardization, Education &
Certification, Recognition & Marketing
• MGB Review (Excellence) Corporation
• International MGB Excellence Corp
• MGB Review Corp.com

11. Full 1 day MGB course
Outline

12. 8:00 am to 8.30 am; Session 1
Introduction,
Welcome and Goals for the Meeting;
1. MGB/ OAGB Guidelines => Consensus paper
&
2. Discussion Creation Institution of IMEC (
International MGB Excellence Certification
Corporation

13. 8.30 am to 9:00 am, Session 2
MGB BII Rx Diabetes,
MGB, BII and Diabetes,
Ideal Surgery,
MGB=Routine General Surgery,
B2 and Gastric Cancer,
MGB- Billroth II

14. 10:00 am to 10:30 am; Session 3
10:30 am to 11:00 am; Break
MGB PreOp,
Selection Criteria,
Pre-Op Instructions,
PreOp Evaluation,
Sample H&P

15. 11:00 am to 11:30 am; Session 4;
Surgical Technique,
Gastric Pouch,
Begin at or beyond the Crow's Foot,
Loose Pouch,
Avoid the EG junction,
MGB Good Rx for Hiatal Hernia

16. 11:30 am to 12:30 am; Session 5
12:30 pm to 1:30 pm; Lunch
Surgical Technique:
Bilio- Pancreatic Bypass,
Bilio- Pancreatic Limb Length,
Gastro-jejunostomy,
Gastro- jejunostomy Closure

17. 1:30 pm to 2;30 PM; Session 6
Post Op,
Post Op Orders,
Discharge Instructions,
MGB Diet,
Supplements,
Follow Up, Follow Up Blood Tests

18. 2:30 to 3:30 pm; Session 7
3:30 to 4:00 pm; Break
Dx Leak Protocol,
Rx Leak Protocol,
MGB Years Later

19. 4:30 to 5:00 pm; Session 8
1. Late Rx and Dx,
Deficiencies & Excess Wt. Loss,
Fainting/Salt, Bile, Gastritis, Ulcer, Estrogen
and Depression, Osteoporosis, Anemia
2. Consensus Paper and
Guidelines/Standardization

20. Summary of Topics to Be Discussed & Course Overview: Day 1
• 8:00am - 8:10am Registration
• 8:20am-9:00am Inauguration & Welcome
Address PreTest
• 9:00am-9:50am Introduction:
Need: Standardization/Education/Recognition
• *9:50am-10:40 (003) MGB Background;
MGB = Routine Surgery, MGB vs Sleeve, MGB
Billroth II Rx Diabetes,
• Break 10 min
• *10:50am-11:40am (004) MGB Videos
MGB - Billroth II, B2 & Gastric Cancer,
MGB Guidelines
• *11:40am-12:30pm (005) MGB PreOp, Selection
Criteria, **Rutledge MGB Technique
• 12:30pm-1:20pm (006) Gastric Pouch, Hiatal
Hernia
• 1:20pm-2:30pm Break & Lunch
• *2:30pm - 3:20pm (007)Bilio-Pancreatic Limb Length,
Gastro-Jejunostomy, Gastro-Jejunostomy Closure
• *3:20pm - 4: 10pm (008) MGB Diet ,
Supplements Follow Up Blood Tests
• * 4:10pm to 5:00pm (009) DxRx Leak Protocol,
MGB Years Later, Deficiencies & Excess Wt. Loss
• * 5:00pm to 5:50pm (010) Bile Reflux, Gastritis, Ulcer,
Fainting/Salt, Estrogen & Depression
• 5:50pm to 6:30pm Discussion, Questions

21. Summary of Topics to Be Discussed &
Course Overview: Day 1 Morning
• 8:00am - 8:10am Registration
• 8:20am-9:00am Inauguration & Welcome Address PreTest
• 9:00am-9:50am 0x01 Introduction: Need: Standardization/Education/Recognition
• 9:50am-10:40am (0x02) MGB Background; MGB = Routine Surgery,
B2 & Gastric Cancer, MGB vs Sleeve, MGB Billroth II Rx Diabetes
• Break 10 min
• 10:50am-11:40am (004 0x03) MGB Videos, MGB - Billroth II, MGB Guidelines
• 11:40am-12:30pm (005 0x04) MGB PreOp, Selection Criteria,
Rutledge MGB Technique
• 12:30pm-1:20pm (006 0x05) Gastric Pouch, Hiatal Hernia

22. Summary of Topics to Be Discussed &
Course Overview: Day 1 Afternoon
• 1:20pm-2:30pm Break & Lunch
• 2:30pm-3:20pm (007 0x06) Bilio-Pancreatic Limb Length, Gastro-Jejunostomy,
Gastro-Jejunostomy Closure
• 3:20pm-4:10pm (008 0x07) MGB Diet , Supplements, Follow Up Blood Tests
• 4:10pm-5:00pm (009 0x08) DxRx Leak Protocol
• 5:00pm to 5:50pm (0x09) MGB Prevent Rx Excess Wt. Loss
5:50pm to 6:30pm Discussion, Questions
• 6:30pm to 7:00pm

23. Summary of Topics to Be Discussed &
Course Overview: Day 2
• 8:00am to 12:20pm
Live MGB Cases (Primary & Revisions)
• Break 10 Min
• 12:30pm-1:20pm (0x10) Post Op MGB,
Bile & MGB, Marginal Ulcer & Gastritis,
Estrogen, Pregnancy, Infertility, Fainting
etc.
• 1:20pm to 2:10pm Lunch
• 2:10pm to 3:00pm (0x11) Prevention,
Dx/Rx Deficiencies, Osteoporosis,
Anemia,
Liver Disease
• 3:00pm-3:30 (0x12) MGB Revision Surgery
• Break 10 Min
• 3:30pm-4:30pm (0x13) MGB v Sleeve
• 4:30pm-5:00pm (0x14) MGB Anesthesia
• 5:00pm-5:30pm (0x15) Metabolic Surgery,
Future: MGB Diabetes
• 5:30pm-6:00pm Discussion Questions
• 6:00pm to 7:00pm Chief Guest Address,
Group Photograph &
Certificate Distribution

24. End?
We Will Do Anything You Wish!
Have you ever been to a surgical meeting where
the whole day is long boring talks with too
many slides with small print in the dark and you
can barely stay awake?

25. Misunderstanding the MGB
What are we Doing Here?
1. History of mgb with technical differences (RnY, OAGB, SADI) illustrated
2. video of a routine perfect mgb (to keep audience awake)
3. concepts of limb lengths with comparison with other bypasses
4. Evidence base: weight loss comparison with other procedures
5. Evidence base: complications including malnutrition with other procedures
6. How to manage complications with videos.
7. Videos of what not to do in MGB (to keep audience awake)
8. GERD and bile reflux: why? evidence? comparison with other procedures
9. perioperative care
10. Revisions with videos: need for revisions

26. 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

27. Topics to Be Discussed
• Live Surgery
• MGB Diet
• Supplements
• Follow Up Blood Tests
• Dx-Rx Leak Protocol
• MGB Years Later
• Deficiencies & Excess Wt. Loss
• Fainting/Salt
• Bile Reflux, Gastritis, Ulcer
• Estrogen & Depression
• Osteoporosis
• Anemia
• Marginal Ulcer/Gastritis
• Discussion Questions

28. MGB Course Critical Knowledge Factors:
Overview
• Introduction Goals & Course Structure
• MGB vs Sleeve, Meta-analysis; Why Consider the MGB, MGB vs Sleeve Data
• MGB BII Rx Diabetes; Brief Review Diabetes & MGB as Best Rx
• Ideal Surgery; What factors make surgery the best/Ideal?
• MGB-Routine Surgery; MGB Background, MGB Nothing more than General
Surgery
• B2 & Gastric Cancer; Fear & Confusion, Explained
• MGB Videos the MGB in slow Video Review & questions
• MGB-Billroth II; General Surgery Knowledge Reviewed
• MGB Guidelines; Standardization vs SAGB, Omega Loop etc...

29. MGB Course Critical Knowledge Factors:
Overview
• MGB PreOp
• Selection Criteria
• Rutledge MGB Technique
• Gastric Pouch
• Hiatal Hernia; Discussion of the MGB & GERD & bile fears
• Bilio-Pancreatic Limb Length, Detailed understanding of confused topic
• Gastro-Jejunostomy; Very misunderstood
• Gastro-Jejunostomy Closure; Reminders of general surgery
• Post Op; What to do, what to expect

30. MGB Course Critical Knowledge Factors:
Overview
• MGB Diet; What to expect & what to eat & when
• Supplements Vitamins vs Diet, Calcium, Iron etc.
• Follow Up Blood Tests, Deficiencies
• Dx-Rx Leak Protocol; What to look for, What to Do
• MGB Years Later; 15-20 years later with Dr Rutledge's
patients
• Deficiencies & Excess Wt. Loss; Management & implications
for surgery

31. MGB Course Critical Knowledge Factors:
Overview
• Fainting/Salt
• Bile Reflux, Gastritis, Ulcer
• Estrogen & Depression
• Osteoporosis
• Anemia
• Marginal Ulcer/Gastritis
• Discussion Questions

32. Conclusion: Goals & Purpose
*Improved Patient Care*
Standardization, Education &
Certification, Recognition &
Marketing
MGB Review (Excellence) Corporation
MGB Review Corp.com