Why the Band and Sleeve Fail Restrictive Procedures and Sweet and "Liquid Calories"

1. Why the Band and Sleeve Fail
Restrictive Procedures and Sweet and
"Liquid Calories"

2. 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)

3. Band & Sleeve
Block Normal Healthy Foods
Weight Loss =>
Increased Hunger
Decreased Satiety
Healthy Foods Blocked
Drive to Eat UP
What Happens?

4. Band & Sleeve;
Block Intake Normal Healthy Food
Sleeve Band

5. Restrictive Procedures
Successfully Block
Normal Healthy Diet
But
They DO NOT BLOCK ...

6. 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

7. Diet Induced
Increased Hunger

8. Summary
Most Diets &
Restrictive Procedures (Band/Sleeve) Will Fail
Attempts to Override
Neuro-Humoral Hunger System Routinely Fails
R.P.s Force Patients into Pathological Dietary Choices
MAKE SWEET EATERS!

9. Primary Objectives
Obesity and Diabetes are Growing Problems in India
Surgery Can Successfully Treat Obesity and diabetes in
Both the Thin and Obese Diabetic Patient
The Band, the Sleeve and the RNY are failed forms of
Bariatric Surgery
The Mini-Gastric Bypass is Both Very Safe and Very
Effective Over the Short and Long Term

10. SOLUTION?
Diabetes MGB

11. Diet Induced
Increased Hunger

12. Mini-Gastric Bypass
The Mongoose!

13. Mini-Gastric Bypass
Blocks
Neuro-Humoral Hunger
System
Short, Simple, Durable, 30
minute Surgery that:
Decreases Hunger &
Increases Satiety
The Mongoose
He is a Little Bit Ugly, No?

14. Imagine!
A Solution to Diabetes in Italy

15. Dr Rutledge's Results
Mini-Gastric Bypass
In 6,000 patients
Over almost 20 years
<5% complications
Mean 36 minute op time
Median 1 day hospital stay
10-15 year follow up
Controlled prospective trials
Reversible and Revisable <30 minutes

16. Dr Rutledge's Results
Mini-Gastric Bypass
Durable over the long term
High levels of patient satisfaction
General Surgery & Controlled Trial:
MGB Twice as effective as Sleeve Rx Diabetes
Resolution Diabetes 85%+
Decreased Hunger, Chol, BP, cRP,
Enforced Mediterranean Diet

17. One Thousand Consecutive Mini-gastric Bypass:
Short- And Long-term Outcome (Noun)
1,000 patients who underwent MGB
Operative time and length of stay for MGB
89 min
1.8 days
Short-term complications 2.7%
Obes Surg. 2012 May;22(5):697-703. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Noun et al, Department of Digestive
Surgery, Hôtel-Dieu de France Hospital and University Saint Joseph Medical School, Naccache, Achrafieh, BP 166830 Beirut, Lebanon. rnoun@wise.net.lb

18. One Thousand Consecutive Mini-gastric Bypass:
Short- And Long-term Outcome (Noun)
0.5% Leaks
Four (0.4%) patients, severe bile reflux Rx by stapled latero-lateral
jejunojejunostomy (Braun).
Excessive weight loss occurred in four patients easily revised.
Percent excess weight loss (EWL) of 73% occurred at 18 months
Obes Surg. 2012 May;22(5):697-703. One thousand consecutive mini-gastric bypass: short- and long-term outcome. Noun et al, Department of Digestive Surgery, Hôtel-Dieu de France
Hospital and University Saint Joseph Medical School, Naccache, Achrafieh, BP 166830 Beirut, Lebanon. rnoun@wise.net.lb

19. 9 Year MGB Follow Up
Efficacy & Safety
Excess weight loss and mean BMI 5 years after LMGB was 72.1% and 27.1
Of the 1322 patients, 23 (1.7%) reop surgery during a follow-up of 9 years.
The most common cause revision was excess wt loss in 9, followed by inadequate weight
loss in 8, and bile reflux in 3.
No internal hernia or ileus during the follow-up period.
Conclusion: MGB Excellent Durable Long Term Safe (No Hernia/Bowel Obstruction)
Surg Obes Relat Dis. 2011 Jul-Aug;7(4):486-91.Revisional surgery for laparoscopic minigastric bypass. Lee WJ, Department of Surgery, Min-Sheng General Hospital, National Taiwan
University, Taipei, Taiwan. wjlee_obessurg_tw@yahoo.com.tw

20. 2011: Lee et al. MGB vs SLEEVE
12 mos prospective study 60 T2DM patients
Matched for DM duration, type of DM treatment, and
glycemic control
Results
T2DM resolved 47% SG and
93% MGB (p = 0.02)
Weight loss fasting glucose, Hgba1c waist
circumference all Better in MGB worse in SG

21. 2011: Lee et al. MGB vs SLEEVE (Efficacy)
Controlled Prospective Trial: SG is only HALF as effective as MGB in
inducing remission of T2DM
50% 90%

22. Mini-Gastric Bypass Decreases Hunger
Survey 2,783 Pts