The document summarizes the results of a study on 6436 consecutive mini-gastric bypass procedures performed over 16 years. Key results include a mean excess weight loss of 78% at 10 years post-surgery. Complications were low, with an 0.05% mortality rate and 4.9% early complication rate. The conclusion is that the mini-gastric bypass is an effective, low-risk, and durable bariatric procedure.

1. a-00102
Dr. Robert RUTLEDGE
Title of Paper: 6436 CONSECUTIVE MINI-GASTRIC
BYPASSES: 16 YEARS LATER
Nationality: United States of America
Position: Director
Department: Surgery
Organization: Center For Laparoscopic Obesity Surgery
Tel: +1-702 714 0011
E-mail: drr@clos.net

2. 6436 CONSECUTIVE
MINI-GASTRIC BYPASSES:
16 YEARS LATER
Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
Obesity Surgery, United States of America

3. MINI-GASTRIC BYPASS
• Mini-Gastric Bypass
1997 – 2012 ; >6,000 pts,
15 yr Data; Multiple Centers,
R.C.Trials (Lee)
• Vertical Gastric Tube
(Collis Gastroplasty)
• Gastric Bypass
(Billroth II Gastro-jejunostomy)

4. Introduction
• Presented at the First International
Consensus Conference on the
• Mini-Bypass /
• One Anastomosis
Bypass
• (MGB)
• Paris Oct 2012.

5. Introduction
• In spite of initial skepticism;
• There is growing evidence that
MGB is a
• Safe and effective procedure with
• Many of the features of an ideal bariatric
surgery.

6. Methods:
• Review of 6,436 MGBs 1997 to 2013
• First International Consensus
Conference on the Mini-Bypass /
One Anastomosis Bypass,
Paris 2012 October 18-19.

7. Results
• Mean preop weight (+/- Standard Deviation)
was 151 +/- 31 kg, BMI 46 +/- 7. &
• 79% were female. Mean operative time was
43 + 11 minutes and median length of stay
was 1 day.
• Three deaths occurred within 30 days of
surgery, (0.05%).
• None in the last 10 years.

8. Results
• Early complications occurred in 4.9%.
• 44 (0.7%) patients had anastomotic leaks.
• Three (0.05%) patients presented with
dypepsia/bile reflux not responsive to
medical therapy and were successfully
treated by Braun side-to-side jejuno-
jejunostomy
• Gastritis/dyspepsia/marginal ulcer was the
most serious long term complication;
routinely treated medically (4.9%).

9. Results
• Excessive weight loss occurred in 1% of
patients; treated by take down of the bypass.
• Mean % excess weight loss (EWL) of 78%.
• 10 year weight regain 4.9%.
• >50% EWL was achieved for 95% of patients
at 18 months and for 92% at 60 months.
• 6% of patient had inadequate weight loss or
significant weight regain were treated by
revision, (addition of ~2 meters to the
bypass).

10. SUCCESS CRITERIA
"IDEAL" WEIGHT LOSS SURGERY
1. Low Risk
2. Major Weight Loss
3. Easily performed
4. Short operative times
5. Outpatient or short hospital stay
6. Minimal Blood Loss
7. No Need for ICU Stay
8. Minimal Pain
9. Very High Patient Satisfaction
10. A Good "Exit Strategy"

11. SUCCESS CRITERIA
"IDEAL" WEIGHT LOSS SURGERY
11. Change Behavior & Preferences; Marked Decrease in Hunger
and Increased Satiety
12. Minimal Retching and Vomiting
13. Few adhesions or hernias
14. Minimal impact on Heart and Lung Function
15. Low Failure Rate
16. Low Cost
17. Short Recovery Time
18. Rapid Return to Work
19. Low Risk of Pulmonary Embolus
20. Durable weight loss

12. SUCCESS CRITERIA
"IDEAL" WEIGHT LOSS SURGERY
21. Low Risk of Ulcer
22. Fat Malabsorption; low cholesterol & CV risk
23. No Plastic Foreign Body
24. Easily Verifiable Results; > 10 years of Results
25. Low Risk of Bowel Obstruction
26. Based upon sound surgical principles
27. Independent confirmation of results
28. Healthy life after surgery
29. Supported by LEVEL I Evidence; RCT (Controlled Prospective
Randomized Trial)
30. Block “Sweet Eater” Failures

13. Selected Bariatric Procedures
• RNY
• Band
• Sleeve
• MGB

14. MINI-GASTRIC BYPASS
BASED SOUND SURGICAL PRACTICE
• Billroth II Performed
over 100 years
• 16,000 Billroth II’s
USA in 2007
• Operation of choice:
Trauma, Ulcers, Cancer
Stomach etc.

15. Conclusions:
• This study confirms reports presented first
over 10 years ago and now supported by
dozens of other surgeons from 29
countries from around the world,
• MGB is an short, simple, effective, low-
risk, and durable bariatric procedure.
• In addition, it can be easily
revised, converted, or reversed.