Mini-Gastric BypassExcellent Rx GERD Dr. Rutledge (702) 483-7133 Email DrR@clos.net Facebook Messenger @DrRRutledge GERD common serious problem in Bariatric patients Nissen “gold standard” poor results + = simply taking PPI's Dr Rutledge MGB Series:80% success Rx GERD Understand WHY! MGB Good to Excellent Rx GERD

1. https://mgbguidelines.wordpress.com/gastric-pouch-creation/
Mini-Gastric Bypass
Excellent Rx GERD
Dr. Rutledge
(702) 483-7133
Email DrR@clos.net

2. https://mgbguidelines.wordpress.com/gastric-pouch-creation/
•Mini-Gastric Bypass
• Anyone can do a “single
anastomosis gastric bypass”
• That Does Not mean they
can/are doing the true
“Mini-Gastric Bypass” (MGB)
• See the Following Example...

3. GERD
•Rx with Nissen
•Results of Nissen
•GERD in Bariatric Surgery
•Band Sleeve CAUSE GERD
•RNY Rx GERD
•MGB Best Rx GERD
Understanding Why?

4. Systematic review: Laparoscopic fundoplication for
gastroesophageal reflux disease
Laparoscopic fundoplication (LF) for
gastroesophageal reflux disease (GERD).
10 years after LF, 36% reported heartburn &
29% reported regurgitation.
The proportion using PPIs increased, from
9% in year 1 to 18% at 10 years.

5. A randomized controlled trial of
laparoscopic Nissen fundoplication
versus proton pump inhibitors for the
treatment of patients with chronic
gastroesophageal reflux disease
(GERD): 3-year outcomes.
•Surg Endosc. 2011
Aug;25(8):2547-54.

6. RCT; Nissen vs PPIs
•A randomized controlled trial (RCT)
investigated patients with
gastroesophageal reflux disease
(GERD) who were stable and
symptomatically controlled with long-
term medical therapy to compare
ongoing optimized medical therapy
with laparoscopic Nissen
fundoplication (LNF).

7. Nissen vs PPIs: No difference
•GERD Sx or
Acid exposure on 24-h pH
monitoring
•There were six treatment failures
(12%) in the surgical group and
eight treatment failures (16%) in
the medical group by 3 years.

8. RCT: CONCLUSIONS:
For patients whose GERD
symptoms are stable and
controlled with PPI,
continuing medical therapy
and laparoscopic anti-reflux
surgery are equally effective

9. Use of proton pump
inhibitors after anti-reflux
surgery: a nationwide
register-based follow-up
study
•Jan 28, 2014 -
•Lødrup A(1), Pottegård
A(2), Hallas J(2),

10. Denmark Nationwide health
care registry study
•PPI use after Anti-reflux surgery
(ARS) in the general Danish
population using nationwide health
care registries.
•A nationwide retrospective follow-
up study of all patients aged ≥18
and undergoing first-time ARS in
Denmark during 1996–2010

11. Denmark Nationwide health
care registry study
• Female gender, high age,
recent ARS, previous use of
PPI & use of NSAIDs drugs or
antiplatelet therapy
significantly increased the risk
of PPI use (Nissen failure).

12. Long term failure of Nissen
•3465 patients ARS
•5, 10 & 15-year risks of
New PPI Rx =
57%, 72% & *83%*, respectively
•5, 10 & 15-year risks
Long-term PPI use =
30%, 41% and *57%*

13. Nissen Failure
• Conclusions Risk of PPI use after
ARS high!
• More than 50% of patients became
long-term PPI users
• Patients should be made aware
that long-term PPI therapy is often
necessary after Nissen.

14. Majority of Gastro-
Oesophageal Reflux Disease
Patients Continue to Use
Proton Pump Inhibitors After
Anti-reflux Surgery (Nissen)
A Madan et al. Aliment Pharmacol Ther
2006 Mar 01

15. Nissen Failure 80% Rx PPIs
•Nissen fundoplication at our
institution over a period of over
3 years were asked to complete
a questionnaire
•80% patients were still taking
anti-reflux medications
including proton pump
inhibitors

16. Rx GERD with Nissen
Very Questionable Results

17. MGB Rx GERD

18. Survey 3,000 MGB Patients
• 64% of MGB patients taking
antacid medications for GERD
preop (PPIs, H2Blockers or
Antacids)
• Post MGB resolution of GERD
Sx with discontinuation of
medications 81%

19. MGB Rx GERD
Equal to or Better Than
Nissen
• How Does it Work?

20. MGB Rx GERD
Mechanism of Action
1. Reduction of Acid
Production
2. Weight loss
3. Downward traction on the
stomach
4. *Creation of LOW Pressure
System*

21. MGB Rx GERD
Mechanism of Action
1. Reduction of Acid
Production
2. Weight loss
3. Downward traction on the
stomach
4. *Creation of LOW Pressure
System*

22. Conclusions
• GERD common serious problem
in Bariatric patients
• Nissen “gold standard” poor
results + = simply taking PPI's
• Dr Rutledge MGB Series:
80% success Rx GERD
• Understand WHY!
• MGB Good to Excellent Rx GERD