This paper argues that a multidisciplinary team is not necessary for bariatric surgery, specifically mini-gastric bypass surgery. The author studied results from over 7,000 patients who underwent mini-gastric bypass without a multidisciplinary team. The results were excellent, with over 80% of patients losing over 50% of their excess weight and a failure rate of only 1.7%. The author concludes that the critical factor for successful outcomes is performing an excellent, low-risk surgical procedure, not use of a multidisciplinary team. He compares it to cholecystectomy for gallbladder disease, where a team is also not necessary because the operation cures the underlying problem.

1. a-00112
Dr. Robert RUTLEDGE
Title of Paper: BLAMING THE VICTIM; NEED FOR A
MULTIDISCIPLINARY TEAM FOR BARIATRIC SURGERY, MINI-
GASTRIC BYPASS
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. BLAMING THE VICTIM;
NO NEED FOR A
MULTIDISCIPLINARY TEAM FOR
BARIATRIC SURGERY, MINI-
GASTRIC BYPASS
Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
Obesity Surgery, United States of America

3. Gallbladder Disease
• Gall stones Cholecystitis
• Cholecystectomy
• Cure
• No need for
Multidisciplinary Team
• No need for psychologist,
dietitian, physical therapist,
support group, multiple follow
ups etc….

4. Introduction
• The results of numerous bariatric procedures is
marked by failure.
• Patients' weight regain or
Failure to lose weight is often attributed to
Patients' failures,
• “A good operation sabotaged by a poor patient”
• Many Believe that these failures can be
ameliorated by non-surgical support by the use
of Multi-Disciplinary Team (MDT).

5. Introduction
• The hypothesis of this study was that the
critical success factor for weight loss
following bariatric surgery is the operative
procedure and
• NOT patient motivation, education or use
of a multidisciplinary team (MDT).

6. Corollaries
• Corollaries to the Primary hypothesis:
• The WORSE the Bariatric Procedure;
• The MORE Need for a Multi-Disciplinary
Team
• Combination of an POOR procedure with
• Excellent multidisciplinary team will still
• Lead to POOR patient outcomes

7. Methods:
• Four surgeons offering the Mini-Gastric
Bypass WITHOUT an MDT were queried
as part of the
• First International Consensus
Conference on the Mini-Bypass / One
Anastomosis Bypass, Paris 2012
October 18-19.
• Patient results were assessed in these
7150 patients treated without MDT.

8. Results
• The results in patients with no MDT
were excellent.
• Lost More than 50% of EW (%) in 83%.
• Weight Loss "Failure" (%) 1.7%
• Excess Weight Loss (%) was 79%.
• Mean length of follow up was 5.4 years.

9. Results
• The rate of long term revision was
2.6%.
• Bowel obstruction rate was 0.3%.
• Postop GE Reflux rate (%) 5.8%,
• Marginal Ulcer rate was 2.4%.

10. Conclusions:
• The critical factor in excellent outcomes
following bariatric surgery is likely
• NOT the presence or absence of patient
motivation or a Multidisciplinary Team.
• The critical success factor in the outcome
of the surgical treatment of obesity and
metabolic diseases is
• An excellent, effective, low risk operative
procedure.

11. MDT and Cholecystectomy
• No MDT is Needed post
Cholecystectomy
• Why?
• Because the Operation Cures the
Disease

12. For Discussion
• Imagine:
• Excellent Bariatric Procedure with
• Complete/Near Complete Resolution of
• Obesity and Associated Co-Morbities