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Irrational Fear of Gastric Cancer: CHOOSING THE BEST WEIGHT LOSS SURGERY R Rutledge MD,  The Centers for Laparoscopic Obesity Surgery www.CLOS.net Email: DrR@clos.net
 
Dr Rutledge: Training & Background ,[object Object],[object Object],[object Object],[object Object]
Dr Rutledge: Training & Background ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Dr. Rutledge USA 001-702-714-0011 DrR@clos.net CONSIDERING THE MGB? MGB IS A  SUPERB  SURGERY BUT… WARNING:  “ THERE ARE “TRICKS AND TRAPS ”
OFFER A  SAFE  &  SUCCESSFUL  MGB PROGRAM ,[object Object],[object Object],[object Object],[object Object],[object Object]
UPCOMING “HANDS ON” MGB IN INDIA “TRICKS AND TRAPS” TRAINING PROGRAM ,[object Object],[object Object],[object Object],[object Object],[object Object]
Human Decision Making is Flawed Need for Decision Making Support ,[object Object],[object Object],[object Object],[object Object]
HUMAN DECISION MAKING ERRORS Recent Research in Psychology and Neurobiology Shows that: The Human Brain is a Notoriously  Bad  Decision Maker
Human Decision Making Errors Very Common ,[object Object],[object Object],[object Object]
Irrational Illogical Thinking  Decision-Making Errors ,[object Object],[object Object],[object Object]
PRIMITIVE  RESPONSE SYSTEMS MODIFY RISK ASSESSMENT
THE REPTILIAN BRAIN: EMOTION & DECISION MAKING ,[object Object],[object Object],[object Object],[object Object]
IRRATIONAL ILLOGICAL THINKING  CONFIRMATION BIAS ,[object Object],[object Object],[object Object],[object Object]
REPTILIAN BRAIN  POOR DECISIONS FEAR LEADS TO JUDGMENT ERRORS  ,[object Object],[object Object],[object Object],[object Object],[object Object]
SURGERY HISTORY OF  POOR DECISIONS JOSEPH LISTER:  AMERICAN  SURGEONS  DELAYED ADOPTION  OF ANTISEPSIS 10 YEARS
REPTILIAN BRAIN POOR DECISION MAKING ,[object Object],[object Object],Dr. Gross; Gross Clinic  1875
HUMAN DECISION MAKING  ERRORS : EXPECTED , NOT RARE ,[object Object],[object Object],[object Object],[object Object]
THE PROBLEM ,[object Object],[object Object],[object Object]
Problem Definition: Bariatric Surgery:  A HISTORY OF FAILURE Procedure Assessment Jejuno-ileal Bypass  (Failure) Vertical Banded Gastroplasty  (Failure) Lap Band  (Fail?) RNY Bypass  (Fail?) BPD/DS  (Fail?) Sleeve: 5% Leak, 60-80% GE Reflux, Irreversible, Weight regain (Fail?)
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"  SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY
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
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
ALTERNATIVES ,[object Object],[object Object],[object Object],[object Object]
MINI-GASTRIC BYPASS ,[object Object],[object Object],[object Object]
MINI-GASTRIC BYPASS BASED SOUND SURGICAL PRACTICE  ,[object Object],[object Object],[object Object]
C: Consequences /  Results  / Outcomes RNY Band SG MGB 1. Low Risk - + - + 2. Major Weight Loss + - - ++ 3. Easily performed - - + + + 4. Short operative times - + + + 5. Short hospital stay - - + + + 6. Minimal Blood Loss - + + + 7. No Need for ICU Stay - + + + 8. Minimal Pain - + + + 9. High Patient Satisfaction - - - + 10. A Good "Exit Strategy"  - - - + - - +
C: Consequences /  Results  / Outcomes RNY Band Sleeve MGB 11. Decrease Hunger + - + + 12. Min Vomiting  + + + + 13. No Internal hernias - + + + 14. Min Heart/Lung  - + + + 15. Low Failure Rate - - - + 16. Low Cost - - - + 17. Short Recovery - + + + 18. Return to Work - + + + 19. Low Risk of PE - + + + 20. Durable Weight Loss - - - +
C: Consequences /  Results  / Outcomes RNY Band SG  MGB 21. Low Risk of Ulcer - + + - 22. Malabsorption of fat + - - + 23. No Foreign Body + - + + 24. Verifiable Results - - - ++ 25. Bowel Obstruction - - + + ++ 26. Sound Surgical  + - + + 27. Independent confirm - - - ++ 28. Healthy life  - - - ++ 29. RCT; LEVEL I Evidence - - - ++ 30. Block Sweet Eater + - - ++
[object Object],[object Object]
STATISTICAL ILLITERACY; "MANY DOCTORS MISUNDERSTAND MEDICAL LITERATURE" ,[object Object],[object Object],[object Object],[object Object]
GASTRIC CANCER  RAPIDLY DECLINING ,[object Object],[object Object],[object Object]
BARIATRIC SURGEONS  FEAR  BILLROTH II; CANCER SURGEONS  CHOOSE  BILLROTH II ,[object Object],[object Object],[object Object],[object Object]
BARIATRIC SURGEONS  FEAR  BILLROTH II WHAT IS MAGNITUDE OF THE PROBLEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BARIATRIC SURGEONS  FEAR  BILLROTH II MAGNITUDE OF THE PROBLEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BARIATRIC SURGEONS  FEAR  BILLROTH II MAGNITUDE OF THE PROBLEM ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
ULCERS INCREASE RISK CANCER ,[object Object],[object Object],[object Object],[object Object],[object Object]
ULCERS INCREASE RISK CANCER ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
BARIATRIC SURGEONS  FEAR  BILLROTH II GASTROENTEROLOGISTS   IGNORE  BILLROTH II ,[object Object],[object Object],[object Object],[object Object],[object Object]
RISK OF GASTRIC CANCER AFTER  BILLROTH II IS LOW ,[object Object],[object Object],[object Object],[object Object],[object Object]
 
WHAT CAUSES GASTRIC CANCER? ITS NOT BILLROTH II ,[object Object],[object Object],[object Object],[object Object],[object Object]
DIET AND CANCER PREVENTION ,[object Object],[object Object],[object Object],[object Object],[object Object]
CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT?  A  OR  B A B
CANCER QUIZ:  MORE DEADLY  Hot Dog  or Mini-Gastric Bypass A ,[object Object],[object Object],[object Object]
UNINFORMED  FEAR  BILLROTH II EDUCATED  USE  BILLROTH II ,[object Object],[object Object]
UNINFORMED  FEAR  BILLROTH II EDUCATED  USE  BILLROTH II ,[object Object],[object Object],[object Object]
UNINFORMED  FEAR  BILLROTH II EDUCATED  USE  BILLROTH II ,[object Object],[object Object],[object Object]
UNINFORMED  FEAR  BILLROTH II EDUCATED  USE  BILLROTH II ,[object Object],[object Object],[object Object]
[object Object],[object Object]
Rational Data Analysis vs. Irrational FEAR Gastric Cancer ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
FEAR OF GASTRIC CANCER ,[object Object],[object Object],[object Object]
FEAR OF GASTRIC CANCER A Billroth II Probably Makes No Difference
FEAR OF GASTRIC CANCER A Billroth II Probably Makes No Difference
C: Consequences /  Results  / Outcomes RNY Band SG MGB 1. Low Risk - + - + 2. Major Weight Loss + - - ++ 3. Easily performed - - + + + 4. Short operative times - + + + 5. Short hospital stay - - + + + 6. Minimal Blood Loss - + + + 7. No Need for ICU Stay - + + + 8. Minimal Pain - + + + 9. High Patient Satisfaction - - - + 10. A Good "Exit Strategy"  - - - + - - +
C: Consequences /  Results  / Outcomes RNY Band Sleeve MGB 11. Decrease Hunger + - + + 12. Min Vomiting  + + + + 13. No Internal hernias - + + + 14. Min Heart/Lung  - + + + 15. Low Failure Rate - - - + 16. Low Cost - - - + 17. Short Recovery - + + + 18. Return to Work - + + + 19. Low Risk of PE - + + + 20. Durable Weight Loss - - - +
C: Consequences /  Results  / Outcomes RNY Band SG  MGB 21. Low Risk of Ulcer - + + - 22. Malabsorption of fat + - - + 23. No Foreign Body + - + + 24. Verifiable Results - - - ++ 25. Bowel Obstruction - - + + ++ 26. Sound Surgical  + - + + 27. Independent confirm - - - ++ 28. Healthy life  - - - ++ 29. RCT; LEVEL I Evidence - - - ++ 30. Block Sweet Eater + - - ++
CONCLUSIONS:  Rational Choice: Mini-Gastric Bypass ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
WHY CRITICS ONLY CARE FOR MGB? ,[object Object],[object Object],[object Object]
WHY CRITICS ONLY CARE FOR MGB? ,[object Object],[object Object],[object Object]
WHY CRITICS ONLY CARE FOR MGB? ,[object Object],[object Object],[object Object],[object Object]
WHY CRITICS ONLY CARE FOR MGB? ,[object Object],[object Object],[object Object],[object Object],[object Object]
CRITICS OF THE  MINI-GASTRIC BYPASS SHOULD BE EMBARRASSED
Dr Rutledge;   USA 001-702-714-0011 DrR@clos.net ARE YOU CONSIDERING THE MGB? WARNING:  THERE ARE “TRICKS AND TRAPS”
OFFER A SAFE AND SUCCESSFUL  MGB PROGRAM ,[object Object],[object Object],[object Object],[object Object],[object Object]
UPCOMING “HANDS ON” MGB IN INDIA “TRICKS AND TRAPS” TRAINING PROGRAM ,[object Object],[object Object],[object Object],[object Object],[object Object]
THE TIDE BEGINS TO TURN TO THE MINI-GASTRIC BYPASS ,[object Object],[object Object],[object Object],[object Object]
A CLARION CALL FOR BETTER BARIATRIC SURGERY ,[object Object],[object Object],[object Object],[object Object],[object Object]
MGB, 9 YEARS LATER!  OUT PERFORMS RNY ,[object Object],[object Object],[object Object],[object Object]
SURVEY: MGB OUT-PERFORMS  BAND & RNY ,[object Object],[object Object]
EXAMPLE  FEAR & DECISION MAKING SBO VS. GASTRIC CANCER ,[object Object],[object Object],[object Object]
11+ RNY STUDIES INTERNAL HERNIA BOWEL OBSTRUCTION ,[object Object],[object Object],[object Object],[object Object]
DEATH  AFTER  SMALL BOWEL OBSTRUCTION ,[object Object],[object Object],[object Object],[object Object]
FEAR AND DECISION MAKING SBO VS. GASTRIC CANCER ,[object Object],[object Object],[object Object]
FEAR AND DECISION MAKING SBO VS. GASTRIC CANCER ,[object Object]
FEAR? SBO VS. GASTRIC CANCER ,[object Object],[object Object]
FEAR? SBO VS. GASTRIC CANCER ,[object Object],[object Object],[object Object]
FEAR? SBO VS. GASTRIC CANCER ,[object Object],[object Object],[object Object],[object Object]
FEAR? SBO VS. GASTRIC CANCER ,[object Object],[object Object],[object Object],[object Object],[object Object]
WHICH DO YOU  FEAR? SBO VS. GASTRIC CANCER ,[object Object],[object Object],[object Object],[object Object]
FEAR AND DECISION MAKING SBO VS. GASTRIC CANCER ,[object Object],[object Object],[object Object]
FOLLOW UP EFFECT ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]

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Mgb fear-no-gastric-cancer

  • 1. Irrational Fear of Gastric Cancer: CHOOSING THE BEST WEIGHT LOSS SURGERY R Rutledge MD, The Centers for Laparoscopic Obesity Surgery www.CLOS.net Email: DrR@clos.net
  • 2.  
  • 3.
  • 4.
  • 5. Dr. Rutledge USA 001-702-714-0011 DrR@clos.net CONSIDERING THE MGB? MGB IS A SUPERB SURGERY BUT… WARNING: “ THERE ARE “TRICKS AND TRAPS ”
  • 6.
  • 7.
  • 8.
  • 9. HUMAN DECISION MAKING ERRORS Recent Research in Psychology and Neurobiology Shows that: The Human Brain is a Notoriously Bad Decision Maker
  • 10.
  • 11.
  • 12. PRIMITIVE RESPONSE SYSTEMS MODIFY RISK ASSESSMENT
  • 13.
  • 14.
  • 15.
  • 16. SURGERY HISTORY OF POOR DECISIONS JOSEPH LISTER: AMERICAN SURGEONS DELAYED ADOPTION OF ANTISEPSIS 10 YEARS
  • 17.
  • 18.
  • 19.
  • 20. Problem Definition: Bariatric Surgery: A HISTORY OF FAILURE Procedure Assessment Jejuno-ileal Bypass (Failure) Vertical Banded Gastroplasty (Failure) Lap Band (Fail?) RNY Bypass (Fail?) BPD/DS (Fail?) Sleeve: 5% Leak, 60-80% GE Reflux, Irreversible, Weight regain (Fail?)
  • 21. 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" SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY
  • 22. 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
  • 23. 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
  • 24.
  • 25.
  • 26.
  • 27. C: Consequences / Results / Outcomes RNY Band SG MGB 1. Low Risk - + - + 2. Major Weight Loss + - - ++ 3. Easily performed - - + + + 4. Short operative times - + + + 5. Short hospital stay - - + + + 6. Minimal Blood Loss - + + + 7. No Need for ICU Stay - + + + 8. Minimal Pain - + + + 9. High Patient Satisfaction - - - + 10. A Good "Exit Strategy" - - - + - - +
  • 28. C: Consequences / Results / Outcomes RNY Band Sleeve MGB 11. Decrease Hunger + - + + 12. Min Vomiting + + + + 13. No Internal hernias - + + + 14. Min Heart/Lung - + + + 15. Low Failure Rate - - - + 16. Low Cost - - - + 17. Short Recovery - + + + 18. Return to Work - + + + 19. Low Risk of PE - + + + 20. Durable Weight Loss - - - +
  • 29. C: Consequences / Results / Outcomes RNY Band SG MGB 21. Low Risk of Ulcer - + + - 22. Malabsorption of fat + - - + 23. No Foreign Body + - + + 24. Verifiable Results - - - ++ 25. Bowel Obstruction - - + + ++ 26. Sound Surgical + - + + 27. Independent confirm - - - ++ 28. Healthy life - - - ++ 29. RCT; LEVEL I Evidence - - - ++ 30. Block Sweet Eater + - - ++
  • 30.
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  • 40.
  • 41.  
  • 42.
  • 43.
  • 44. CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B A B
  • 45.
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  • 48.
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  • 50.
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  • 53. FEAR OF GASTRIC CANCER A Billroth II Probably Makes No Difference
  • 54. FEAR OF GASTRIC CANCER A Billroth II Probably Makes No Difference
  • 55. C: Consequences / Results / Outcomes RNY Band SG MGB 1. Low Risk - + - + 2. Major Weight Loss + - - ++ 3. Easily performed - - + + + 4. Short operative times - + + + 5. Short hospital stay - - + + + 6. Minimal Blood Loss - + + + 7. No Need for ICU Stay - + + + 8. Minimal Pain - + + + 9. High Patient Satisfaction - - - + 10. A Good "Exit Strategy" - - - + - - +
  • 56. C: Consequences / Results / Outcomes RNY Band Sleeve MGB 11. Decrease Hunger + - + + 12. Min Vomiting + + + + 13. No Internal hernias - + + + 14. Min Heart/Lung - + + + 15. Low Failure Rate - - - + 16. Low Cost - - - + 17. Short Recovery - + + + 18. Return to Work - + + + 19. Low Risk of PE - + + + 20. Durable Weight Loss - - - +
  • 57. C: Consequences / Results / Outcomes RNY Band SG MGB 21. Low Risk of Ulcer - + + - 22. Malabsorption of fat + - - + 23. No Foreign Body + - + + 24. Verifiable Results - - - ++ 25. Bowel Obstruction - - + + ++ 26. Sound Surgical + - + + 27. Independent confirm - - - ++ 28. Healthy life - - - ++ 29. RCT; LEVEL I Evidence - - - ++ 30. Block Sweet Eater + - - ++
  • 58.
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  • 61.
  • 62.
  • 63. CRITICS OF THE MINI-GASTRIC BYPASS SHOULD BE EMBARRASSED
  • 64. Dr Rutledge; USA 001-702-714-0011 DrR@clos.net ARE YOU CONSIDERING THE MGB? WARNING: THERE ARE “TRICKS AND TRAPS”
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