Understanding Weight Loss After Bariatric SurgeryUnderstanding the Bilio-Pancreatic Limb Length
Statistics, Random Distribution and Too Little or Too Much of a Good Thing
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
The Mystery of Bile or No Bile:“Elementary My Dear Watson!”
Why the two opposite studies of the MGB
1. Minimal Bile Reflux
2. Common Bile Reflux
Answer: 1. Skill and knowledge of the Surgeons & 2. Propper care and education of post op patients
Conclusion: Don't Do the MGB! If You Don't Know What You are Doing
Rx Lifestyle & Diet Plan
Simple Diet & Lifestyle Changes: Rx gut microbiome: Plain Yogurt / Curd / Fermented Dairy:1-2 tsps 3-6 x / Day.
Stop smoking, NSAIDs, Iron, “Supplements”, Vitamins & Medications
Before Meals, Stay upright after eating, Small meals, Limit fatty foods,
Avoid problem (junk) foods: soda, candy, fried foods, caffeinated and carbonated drinks, chocolate, citrus juices, vinegar dressings & mint, etc.
Limit or avoid alcohol, Eat slowly, small amounts, chew thoroughly and rest between bites,
Keep head up for 30-90 minutes post meals, relax for 30-90 minutes after meals.
PREVENTIONandTreatment of Sleeve Gastrectomy Leaks
Dr Rutledge
Where does it occur?
ONE PLACE!
This is “Tiger Country” – remember that!
Managing ComplicationsFIRST Prevent Complications
Managing LeaksFirst Prevent Leaks!!
Examples of ComplacencySleeve Gastrectomy Leak
“Sleeve Gastrectomy & Risk of Leak: Systematic Analysis of 4,888 Patients”
“Risk of leak is low at 2.4%"
Surg Endosc. 2012 Jun;26(6):1509-15. Epub 2011 Dec 17. Aurora AR, Khaitan L, Saber AA. Department of Surgery, University Hospitals Case Medical Center, Cleveland, Ohio
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
MGB is Great Look at the Data
MGB widespread persistent Confusion
Fear of Malnutrition
Need MGB Standardization Education Recognition of MGB Surgeons of Excellence
Mini-Gastric Bypass Done Right: A Description of the Surgical TechniqueDr. Robert Rutledge
Mini-Gastric Bypass Done Right:
A Description of the Surgical Technique
Authors: Dr.Rutledge, Dr.K.S.Kular and Dr.Manchanda.
This chapter discusses the technique of Mini-Gastric Bypass (MGB). The title of the chapter is Mini-Gastric Bypass Done Right.The surgical technique is selected to indicate our opinion that many surgeons and physicians have been and remain confused about the performance of the MGB as created and taught be Dr Rutledge.
Explicitly, the Mini-Gastric Bypass(MGB) which will be discussed in this article is NOT a so called Single Anastomosis Bypass, its not the Omega Loop Bypass nor the SAGB nor the SADI and especially it is definitely not the Old Mason Loop Gastric Bypass. These misnomers and other surgeon and patient misunderstandings and confusion has led to problems with this otherwise it is a simple procedure.
The Mini-Gastric Bypass is reported and described as a simple technique yet as the following examples will show it can be both tragic and occasionally deadly when used by surgeons with inadequate understanding of the procedure and its technique.
The Mini-Gastric Bypass is an analogue of two routine straightforward general surgical principles, the Collis Gastroplasty and the Antrectomy and Billroth II. Although the foundational principles of the MGB are relatively simple and straightforward it has been shown that many surgeons are confused about the details of the procedure, leading in some cases to tragic and deadly results in the wrong hands.
Kular To Tailor or Not to TailorMost Important to UNDERSTAND: BP Limb Length...Dr. Robert Rutledge
To Tailor or Not to TailorMost Important to UNDERSTAND: BP Limb Length and Outcomes
1. BP Limb Length “Roughly” Predicts Wt Loss (Rutledge)
2. Simple: More BP Limb => More Weight Loss
3. More Weight Loss => Increase Risk of Excessive Weight Loss (i.e. BPD SADI etc...)
4. MGB gives Choice (Patient & Surgeon)
5. OK, Don't Tailor => Less Wt Loss & Lower Risk Malnutrition
6. In Skilled Hands: Excellent Wt Loss & Low Risk of Excessive Wt Loss MGB in others => Can be Dangerous & Deadly
7. Surgeon MUST understand Easy Rapid Rx excessive Wt Loss
8. NEED: Standardization, Education & Recognition
Safe and Effective Treatment of Obesity & Diabetes:Failure of the Band, Sleeve & RNYvsSuccess of the Mini-Gastric Bypass
Medical News: Bypass Surgery for Diabetes w Nonmorbid Obesity? Marlene Busko: Jun 04, 2013
BUT: Not metioned in the abstract:
22 serious complications in 60 RNY patients (36%);
2 most serious complications Anastomotic leaks (3.3%)
1 patient suffered anoxic brain injury.
RNY pts more likely to have Complications
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hos...Dr. Robert Rutledge
Five Year Outcome Sleeve Gastrectomy Mini-Gastric Bypass From a Community Hospital in Punjab, India
Dr K S Kular
Kular Medical Education & Research Society
Kular Group of Institutes
drkskular@gmail.com
www.kularhospital.com
Sleeve
MGB
Kular Hospital
Sleeve v MGB (Hint: MGB Better)
Weight Loss Raw Data, Weight Loss Excluding SG Revisions v Age Wt matched MGBs, Resolution of Co-Morbidities, Patient Satisfaction, Dyspepsia/Bile Reflux
Conclusions
MGB is Great Look at the Data
MGB widespread persistent Confusion
Fear of Malnutrition
Need MGB Standardization Education Recognition of MGB Surgeons of Excellence
Mini-Gastric Bypass Done Right: A Description of the Surgical TechniqueDr. Robert Rutledge
Mini-Gastric Bypass Done Right:
A Description of the Surgical Technique
Authors: Dr.Rutledge, Dr.K.S.Kular and Dr.Manchanda.
This chapter discusses the technique of Mini-Gastric Bypass (MGB). The title of the chapter is Mini-Gastric Bypass Done Right.The surgical technique is selected to indicate our opinion that many surgeons and physicians have been and remain confused about the performance of the MGB as created and taught be Dr Rutledge.
Explicitly, the Mini-Gastric Bypass(MGB) which will be discussed in this article is NOT a so called Single Anastomosis Bypass, its not the Omega Loop Bypass nor the SAGB nor the SADI and especially it is definitely not the Old Mason Loop Gastric Bypass. These misnomers and other surgeon and patient misunderstandings and confusion has led to problems with this otherwise it is a simple procedure.
The Mini-Gastric Bypass is reported and described as a simple technique yet as the following examples will show it can be both tragic and occasionally deadly when used by surgeons with inadequate understanding of the procedure and its technique.
The Mini-Gastric Bypass is an analogue of two routine straightforward general surgical principles, the Collis Gastroplasty and the Antrectomy and Billroth II. Although the foundational principles of the MGB are relatively simple and straightforward it has been shown that many surgeons are confused about the details of the procedure, leading in some cases to tragic and deadly results in the wrong hands.
Kular To Tailor or Not to TailorMost Important to UNDERSTAND: BP Limb Length...Dr. Robert Rutledge
To Tailor or Not to TailorMost Important to UNDERSTAND: BP Limb Length and Outcomes
1. BP Limb Length “Roughly” Predicts Wt Loss (Rutledge)
2. Simple: More BP Limb => More Weight Loss
3. More Weight Loss => Increase Risk of Excessive Weight Loss (i.e. BPD SADI etc...)
4. MGB gives Choice (Patient & Surgeon)
5. OK, Don't Tailor => Less Wt Loss & Lower Risk Malnutrition
6. In Skilled Hands: Excellent Wt Loss & Low Risk of Excessive Wt Loss MGB in others => Can be Dangerous & Deadly
7. Surgeon MUST understand Easy Rapid Rx excessive Wt Loss
8. NEED: Standardization, Education & Recognition
MGB Need for Standardization, Education & Recognition
DrR Rutledge MGB MRC Course Schedule Day One Introduction
1
9-9:50
Introduction
Welcome Goals
Welcome MGB Review Corporation Bronze Certification Course
Outline of Introduction
I. One Sentence Overview: Obesity & diabetes Growing Epidemic
II. Present forms of “Gold Standard” forms of Bariatric Surgery FAR from Perfect/adequate Solutions
III. Sleeve/RNY/Band/Distal Bypasses (BPD, SADI etc) All with Minor, Moderate, Serious & Deadly Complications
IV. MGB “Uniformly & Repeatedly, Around the World In Studies by “Experts”…
The MGB is Equal to or Better than Other Comparable forms of Bariatric Surgery”
V. But!
Despite numerous articles by MGB Experts showing Excellent Results
Growing Number of Articles of Non-Expert MGB Surgeons with Serious & Deadly Complications.
VI. Goals of the MGB Review Corporation
Rally MGB Experts (Collecting Expert MGB Surgeons to Leadership and Recognition)
Collaborate of Standardizing the MGB (Rutledge Technique)
Educate Interested/New MGB Surgeons (Bronze Certification) Course + Successful Completion of 300 question Exam (or Board of Governors Membership Approval)
Document Surgical Technique (Silver Certification) video Review of MGB Case Performance 5 + Cases
Document Excellence in Outcomes (Gold Certification) 20+ Consecutive Case Review with Contact Info and Permission
Recognition as a Leader to Teach MGB (Platinum/Diamond Certification)
VI. Goal Improved Patient Care and Recognition of MGB Surgeons of Excellence
MGB vs Sleeve, Meta-analysis
MGB BII Rx Diabetes
Sleeve/RNY/Band/Dbs (Distal Bypasses, BPD, SADI etc.)
Sleeve: Devastating Leak, Irreversible, => Failure, Weight Regain, GERD, Barrett’s & Esophageal Cancer
Popularity rise similar to the VBG and Lap Band
RNY: Complexity, Difficult to Revise, Failure, Bowel Obstruction, Late Severe Dangerous Hypoglycemia
Distal Bypasses; Malnutrition etc
Kular Sleeve vs Mini-Gastric Bypass
IN EVERY STUDY, by every measure, the Mini-Gastric Bypass is equal to or better than every other form of bariatric surgery
The Mini-Gastric BypassDr Rutledge, DrR@CLOS.netFour Stories for Four Radical Ideas
20 minutes, 4 topics
5 minutes each
1. (Mis)Understanding the MGB Mechanism of action
2. MGB Paradox (Good MGB/Bad MGB)
3. MGB: BP Limb Length
4. MGB-OT to the new MGB2i
The Billroth II is a good safe operation
Routinely used daily by General, Trauma and Cancer Surgeons Around the world
Studies show surgeons who are more fearful of Billroth II and cancer are the least knowledgeable about the scientific data on the Billroth II and Gastric Cancer
Prediction of Weight Loss Following The Mini-Gastric Bypass: Multivariate Regression Modeling
Robert Rutledge, K Kular, N. Manchanda CLOS Center For Laparoscopic Obesity Surgery, MGB Review Corp
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Pulmonary Thromboembolism - etilogy, types, medical- Surgical and nursing man...VarunMahajani
Disruption of blood supply to lung alveoli due to blockage of one or more pulmonary blood vessels is called as Pulmonary thromboembolism. In this presentation we will discuss its causes, types and its management in depth.
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
1. First: Patients Do Not Experience
MEAN Weight Loss!
• Many surgeons use the MEAN (Average)
to Judge the result
(i.e. Mean %Excess Weight Loss)
• While the MEAN is useful...
• It is like
looking at only one end of the Elephant
• And Sometimes it is the WRONG End
2. Understanding Weight Loss After
Bariatric Surgery
Understanding the
Bilio-Pancreatic Limb Length
Statistics, Random Distribution and
Too Little or Too Much of a Good
Thing
3. To Tailor or Not to Tailor
Most Important to UNDERSTAND: BP Limb Length and Outcomes
1. BP Limb Length “Roughly” Predicts Wt Loss (Rutledge)
2. Simple: More BP Limb => More Weight Loss
3. More Weight Loss =>
Increase Risk of Excessive Weight Loss (i.e. BPD SADI etc...)
4. MGB gives Choice (Patient & Surgeon)
5. OK, Don't Tailor => Less Wt Loss & Lower Risk Malnutrition
6. In Skilled Hands: Excellent Wt Loss & Low Risk of Excessive Wt Loss
MGB in others => Can be Dangerous & Deadly
7. Surgeon MUST understand Easy Rapid Rx excessive Wt Loss
8. NEED: Standardization, Education & Recognition
4. Topics & Objectives
1. MGB is an Excellent Procedure: Look at the Data
2. MGB: Widespread, Persistent Confusion (examples)
i.e. BP Limb Length Does Not Predict Weight Loss (Wrong)
i.e. Fear of MGB Malnutrition (MGB rates similar to RNY)
i.e. Mismanagement of MGB Malnutrition
(Don't Do Weight Loss Surgery for Malnurition)
3. Need MGB Standardization, Education, Recognition of
MGB Surgeons of Excellence
5. Confusion By Surgeons
Who Do Not Understand the MGB
?? MGB Best Bariatric Surgery ??
In Hundreds of Articles of MGB
In Every Study, By Every Measure
the MGB is Equal to or
(More Often) Better Than
Any Comparable Bariatric Surgery
(Including Randomized Controlled
Prospective Trials)
6. Understanding the Obvious
• First: If you do not understand an operation (MGB)
• Do Not Use the Operation!!
• In Short: This Presentation in Summary:
1. Widespread and Persistent Misunderstanding of MGB
2. Often Leading to Complications and Even Death
3. Needed: * Standardization of MGB, ** Education and
*** Recognition of Knowledgeable and Skilled Surgeons
7. Needed: Standardization of MGB
and Recognition of Surgeons
Knowledgeable and Skilled in its
use
* Standardize, ** Educate, *** Recognize
The Best in MGB
Please Join The Board of Governors!
MGBReviewCorp.com
8. Expert MGB Surgerons Invitated to Join the
Board of Governors of the MGB Review Corp
I invite you to join the Board of Governors of the MGB Review Corporation
For Excellence in the MGB!
1. Complete the MGB Review Corporation Information Form
https://www.surveymonkey.com/r/MRCReviewCorp
2.Join the Facebook Page and Group: MGBReviewCorp
https://www.Facebook.com/MGBReviewCorp/
https://www.Facebook.com/groups/MGBReviewCorp
Please join us to initiate your participation in the group process
Email, Call or Message for more information or to give advice and your opinions:
Email: DrR@clos.net, Facebook: DrRRutledge
Facebook Messenger: @DrRRutledge,
Phone: 702-483-7133 or 702-714-0011 or What's App: Dr Rutledge
9. Confusion By Surgeons Who Do Not
Understand the MGB
How Often
Have Surgeons
And
Continue to Be Wrong
About the Mini-Gastric Bypass?
10. Confusion By Surgeons Who Do Not
Understand the MGB
Some Examples of MGB Confusion
1. The Pouch is Too Big & Pts Will Not Loose Weight
2. Short Gastric Pouch (MGB = Old Mason Loop)
3. Dissection EG Junction and crural Repair
4. MGB with a “Ring”
5. Irrational Fear of Bile Reflux
6. Confused About Risk Gastric Cancer
7. Fear of Malnutrition
8. Management of MGB Complications
And More...
11. Bowel Bypass Limb Length &
Weight Loss
• Recently the confusion about
Bowel Bypass Limb Length and
Weight Loss
• Many Studies of RNY => No advantage of BP Limb
length Re: Weight Loss
• Surgeon Advocate MGB 150 cm bypass only.
Why?
150 cm => Less Malnutrition (Correct)
150 cm => Equal Weight Loss (Wrong)
12. Summary (In Short)
1. BP Limb/Weight Loss, 2. Malnutrition & MGB, 3. Rx Excessive Wt Loss
1. BP Limb and Weight Loss
(Hint: Longer Bypass = More Weight Loss)
2. Malnutrition and MGB
(Hint: Uncommon and Easily Managed and
MGB Unique: Surgeon/Patient can choose
More Power or Lower Risk of Excess Wt Loss)
3. Management of Excess Weight Loss after MGB
(Hint: Easy, immediate 30-60 minute revision
NOT RNY!)
13. To Tailor or Not to Tailor
Most Important to UNDERSTAND: BP Limb Length and Outcomes
1. BP Limb Length “Roughly” Predicts Wt Loss (Rutledge)
2. Simple: More BP Limb => More Weight Loss
3. More Weight Loss =>
Increase Risk of Excessive Weight Loss (i.e. BPD SADI etc...)
4. MGB gives Choice (Patient & Surgeon)
5. OK, Don't Tailor => Less Wt Loss & Lower Risk Malnutrition
6. In Skilled Hands: Excellent Wt Loss & Low Risk of Excessive Wt Loss
MGB in others => Can be Dangerous & Deadly
7. Surgeon MUST understand Easy Rapid Rx excessive Wt Loss
8. NEED: Standardization, Education & Recognition
14. 1. BP Limb and Weight Loss
(Hint: Longer Bypass =
More Weight Loss)
15. Dr Rutledge's Study
BP Limb Length & Weight Loss
4,000+ patients
Longer bypass => More Weight Loss
19. BP Limb & Weight Loss: Conclusions
• Largest reported study of bypass length and weight loss after gastric bypass.
• Prior negative studies with small sample sizes may have suffered from a Type II
error.
• (Small sample => No Diff)
• Preop weight & limb length significantly associated w weight loss
• Every additional foot of bowel bypassed is associated with a
mean increase in the expected one year weight loss.
20.
21. Dr Rutledge's Study
BP Limb Length & Weight Loss
Very Simple Conclusions
1. Longer bypass = More Weight Loss
2. Longer bypass = More Power (Mean XsWL)
3. More Power => Increased Risk of Excess Weight Loss (Small)
22. 2. Malnutrition and MGB
(Hint: Uncommon and Easily Managed
and
MGB Unique: Surgeon/Patient can
Choose
More Power or Lower Risk of
Excess Wt Loss)
23. Confusion By Surgeons Who Do Not
Understand the MGB
Fear of Malnutrition
Management of MGB
Complications
Focus
24. Recently Surgeons Have
“Discovered” Malnutrition after the MGB!
1. Impact of biliopancreatic limb length on severe
protein‒calorie malnutrition requiring revision Mahawar K
J Minim Access Surg. 2017
2. Severe fatal protein malnutrition after mini-gastric bypass
surgery: Case report Motamedi M., Int J Surg Case Rep.
2017
3. Laparoscopic reversal of mini-gastric bypass to original
anatomy for severe postoperative malnutrition. Genser L
Langenbecks Arch Surg. 2017
4. Laparoscopic conversion mini-gastric bypass to proximal
RnY for malnutrition: case report Rosenthal R Surg Obes
Relat Dis. 2009
25. Recently Surgeons Have
“Discovered” Fear Malnutrition after the MGB!
1. Shows Evidence of Deep Misunderstanding of:
2. Of the MGB (Uncommon & Easily Managed)
3. Of the RNY (Has Similar Risk of Malnutrition)
4. Of the SADI BPD etc (MUCH Worse malnutrition)
5. But MOST Important;
Misunderstanding of Simple Statistics
(Mean & Std. Deviation, Simple)
26. Fear of Malnutrition in the MGB
One Example:
• 12 pts TPN nutrition
• 7 "one-anastomosis gastric bypass" (OAGB)
or "mini gastric bypass,"
“This case series suggests that OAGB
could over expose subjects to severe
nutrition complications”
JPEN J Parenter Enteral Nutr. 2017 Need for Intensive Nutrition Care
After Bariatric Surgery. Bétry C
28. Evidence of Deep Misunderstanding of the MGB
•What Do large Scale Series of MGB Report?
Two Examples
•All Large Scale MGB Series are the Same:
•Malnutrition after MGB:
Risk LOW & Treatment Easy **
• (** If Surgeon Knows What to Do **)
29. Malnutrition Post MGB
Deep Misunderstanding of MGB
• Obes Surg. 2016
Laparoscopic Conversion of (Mini) Gastric Bypass
Complications
• 49 Conversions of 2,382 Cases
= 2%
• 58% Conversions for Malnutrition
= 1% MGB => Revision for Malnutrition
30. Malnutrition Post MGB
Deep Misunderstanding of MGB
• Surg Obes Relat Dis. 2015
Mini-gastric bypass: long-term results,
Chevallier J M
• Malnutrition Required Revision
= 1.6%
31. Fear of Malnutrition?
MGB Malnutrition Rate: 4 / 1,000 MGBs
• MGB Malnutrition requiring revision
• Total survey data
• 101 Surgeons (Many NOT Doing Standard MGB)
• 36,952 Patients
• *Malnutrition Rate 0.4%* (138 pts)
• Severe protein‒calorie malnutrition requiring revisional surgery
after one anastomosis (mini) gastric bypass, Mahawar J Minim
Access Surg. 2017
32. Fear of Malnutrition?
MGB Malnutrition Rate: 4 / 1,000 MGBs
• MGB Malnutrition requiring revision
• 101 Surgeons (Many NOT Doing Standard
MGB),
36,952 Patients, *Malnutrition Rate 0.4%* (138 pts)
• 5-10 Times LOWER Than RNY, 50-100 Times Lower than SADI
• Mahwar 2017
34. RNY vs MGB
Risk of Malnutrition
Evidence of Deep Misunderstanding of
the RNY, Malnutrition, Revision Data
RNY has Malnutrition/Revision Rates
Roughly Equal to MGB
35. Pubmed Searches:
A Simple Test
• PUBMED:
Search “roux-en-y gastric bypass”
=> 11,834 Articles
•Search “Roux-en-y gastric bypass”
+ “Malnutrition”
=> 481 articles
4% of All RNY Articles are on Malnutrition
36. Pubmed Searches:
A Simple Test
•Search “roux-en-y gastric bypass”
=> 11,834 Articles
•Search “Roux-en-y gastric bypass”
+ “Deficiency”
=> 514 articles
4% of All RNY Articles are on Deficiency
37. RNY Malnutrition
Sample Articles (There are > 400 More...)
1. Revisional surgery for severe protein-calorie malnutrition after Roux-en-Y gastric
bypass: Ceneviva R, Surg Obes Relat Dis. 2016
2. Endoscopic reversal of gastric bypass for severe malnutrition after Roux-en-Y
gastric bypass surgery. Ngamruengphong S, Gastrointest Endosc. 2015
3. Risk of Malnutrition, Trace Metal, and Vitamin Deficiency Post Roux-en-Y Gastric
Bypass, Billeter A, Obes Surg. 2015
4. Malnutrition-induced myopathy following Roux-en-Y gastric bypass. Hsia A, Muscle
Nerve. 2001
+ 400 more...
38. RNY Malnutrition
Requiring “Feeding Tube”
• 3,487 pts
•
139 (3.9%) required a *Feeding Tube*
• Refractory malnutrition was the indication after RnY bypass
• Department of Surgery, University of Virginia Health System,
Charlottesville, Virginia
• Surg Obes Relat Dis. 2016 Feeding tube placement for
malnutrition, Charles EJ
39. Malnutrition and RNY
Reversal of Roux-en-Y
• 2017 IFSO President Himpens
• RNY side effects => reversal
•Dumping, hypoglycemia, Malnutrition, severe
diarrhea and excessive nausea and vomiting
• Obes Surg. 2017 Medium-Term Outcomes after Reversal of
Roux-en-Y Gastric Bypass. Arman G, Himpens J
40. Roux-en-Y gastric bypass reversal:
A Systematic Review
• 35 articles
• Malnutrition was the most common
indication for reversal
• Followed by severe dumping syndrome
(9.4%), postprandial hypoglycemia (8.5%),
and excessive weight loss (8.5%)
• Surg Obes Relat Dis. 2016 Roux-en-Y gastric bypass reversal,
Shoar S
41. RNY Most Common Indication for TPN
J Parenter Enteral Nutr. 2017
• 54 pts (6.3%) had TPN post bariatric surgery.
• The most common procedure was
• Roux-en-Y gastric bypass (72%),
• Malnutrition the most common indication (57%).
• Weight at TPN 72 kg
• JPEN J Parenter Enteral Nutr. 2017 Home Parenteral
Nutrition in Bariatric Surgery- Malnutrition. Mundi M
42. Study Sleeve and RNY
Same Decrease in PreAlbumin
• Continuous decrease in prealbumin
•Mild protein depletion
38% of RNY
52% of Sleeve
• “RNY & Sleeve comparable effects in risk of
micro-nutrient and protein deficiencies”
• Obes Surg. 2016 Micro-nutrient and Protein Deficiencies After Gastric
Bypass and Sleeve Gastrectomy
43. Excessive Weight Loss Following Roux-en-Y
Obes Surg. 2016 Management of Excessive Weight Loss Following Roux-
en-Y
• RNY Pts successfully reversed to
normal anatomy after evaluation,
management, and treatment by
multidisciplinary team.
• Lowest BMI (kg/m(2)) was 14.2
• Obes Surg. 2016 Management of Excessive Weight Loss
Following Roux-en-Y Akusoba
44. SADI
Obes Surg. 2017 SADI: A Systematic
Review
1/3
One out of 3 found to have
Malnutrition
45. SADI
A Systematic Review of Efficacy and Safety
• 12 studies including 581 SADI
• %EWL
70% @ 1 year
85% @ 2 years
• Malnutrition in up to
* 34% * of patients
• Obes Surg. 2017 Single Anastomosis Duodeno-Ileal Switch
(SADI): A Systematic Review of Efficacy and Safety.
47. Simple Statistics Suggest Risk of
Malnutrition
• RNY/MGB/BPD,SADI
• Est. Mean %XsWtLoss = 72/78/82% (Roughly)
• Standard Deviation: 23/23/24%
• If we assume 120% Excess Weight Loss is
indicative of Malnutrition
• Mean + S.D. => Easy EXPECTED Malnutrition
• Expected Rate from Simple Statistics
for Band/Sleeve/RNY/MGB/BPB,SADI
48. RNY: Risk of Malnutrition/Excess Weight
Loss
1. RNY Mean Excess Wt Loss: = 72% **
(Powerful)
2. Standard Deviation (S.D.) =
23%
3. Malnutrition/eXcessWL (MXWL) = Loss
of 120% XBL
4. RNY: Risk Malnutrition/eXcess WL
(MXWL) =
1.8% (Moderate Risk)
49. MGB (2M bypass): Risk of
Malnutrition/Excess Weight Loss
1. MGB (2M bypass) Mean Excess Wt
Loss: = 78% **
(More Powerful Surgery)
2. Standard Deviation (S.D.) =
24%
3. Malnutrition/eXcessWL (MXWL) = Loss
of 120% XBL
4. MGB (2M bypass): Risk
Malnutrition/eXcess WL (MXWL) = 3%
(Higher Risk)
5. BUT MGB Can Be Tailored!
50. BPD/SADI etc: Risk of Malnutrition/Excess
Weight Loss
1. BPD/SADI etc Mean Excess Wt Loss:
= 82% ** (Very Powerful)
2. Standard Deviation (S.D.) =
24%
3. Malnutrition/eXcessWL (MXWL) =
Loss of 120% XBL
4. BPD/SADI etc: Risk
Malnutrition/eXcess WL (MXWL) =
**6% (Highest Risk)
51. MGB: Unique
Offers the Surgeons Choice:
Choose More Power or Safety
The Surgeon, Family and Patient
Can choose an operation that
matches their situation
52. Simple Example of Expert Use of MGB
BP Limb Titration
•Power: BP Limb Length 200cm =
Excess Weight Loss ~ 1/100 patients
•Conservative: BP Limb Length 150cm =
Excess Weight Loss ~ 1/1,000 patients
•How to Use this Knowledge...
53. Simple Example of Expert Use of MGB
BP Limb Titration
• Patient: 50 y.o diabetic, Glucose 400mg, 400 units
Insulin, Blind in one eye losing site in the other.
Gangrene in two toes, s/p MI time 2, CVA and
recent TIA... Physician predict risk of impending
death!
• Discuss options with the Pt & Family
• Might Choose Greater Power:
BP Limb Length 200cm =
Risk Excess Weight Loss ~ 1/100 patients
54. Simple Example of Expert Use of MGB
BP Limb Titration
• Patient: Young Female BMI 40 possible poor
follow up otherwise good health. + Vegetarian
• Discuss options with the Pt & Family
• Might Choose Conservative:
BP Limb Length 150cm =
Excess Weight Loss ~ 1/1,000 patients
55. •MGB Uniquely Qualified to Allow Patient and
Surgeon to Address Power & Surgery Risk
Modulating Risk of Malnutrition/Excess Weight
Loss
Study Demonstrates Power and Risk of
Malnutrition/Excess Weight Loss
MGB Allows patient and surgeon to titrate
operative choices based upon preferences and
secondarily to easily address post op excess
weight loss or malnutrition
56. MGB Titrate Operative Choices
(1.5 vs 2.0 BP Limb)
• Similar this survey MGB surgeons have reported
on rates of Post Op Malnutrition and excess weight
loss requiring re-operation:
• Results: Risk of Malnutrition/Excess Weight Loss
• MGB BP Limb of 2 meters eXcess WL
requiring revision surgery 1%
• MGB BP Limb of 1.5 meters eXcess WL
requiring revision surgery 0.1%
57. MGB: Patient and Surgeon Choice
MGB with BP Limb of 2 meters for
Maximal weight Loss and approximately
1-3% risk of excess weight loss
Or
MGB with BP Limb of 1.5 meters for Less
weight Loss and approximately 0.1% risk
of excess weight loss
58. Choosing Weight Loss Surgery (RNY) for
Malnutrition/Excess Weight Loss after MGB
17 patients underwent OLGB (MGB) conversion to
RYGB
Almost Half, 41%, developed major Complications
“The conversion of MGB to RNY is associated with
high morbidity”
Opinion: Do not Do Weight Loss Surgery for
Malnutrition/Deficiency After MGB
Surg Obes Relat Dis. 2017 Roux-en-Y gastric bypass for the treatment of severe complications after
omega-loop gastric bypass Poghosyan
59. Management of MGB
Excess Weight Loss
• Immediate Assess Nutritional Status/Resuscitation +
Early Surgical Revision (Do Not Delay)
• Classify Malnutrition/Deficiencies:
90% Severe/Sick:
Rx: Divide GJ + Gastro-gastrostomy (Op Time 30-60 min)
10% Mild:
Rx: Divide GJ + Shorten Bypass (Op Time 30-60 min)
• (Warning: Not RNY! Don't Do Weight Loss Surgery for
Excess Weight Loss/Malnutrition)
60. A More Detailed Explanation
Simple Statistics
Expected Weight Loss
vs
Risk Malnutrition
61. First: Patients Do Not Experience
MEAN Weight Loss!
• Many surgeons use the MEAN (Average)
to Judge the result
(i.e. Mean %Excess Weight Loss)
• While the MEAN is useful...
• It is like
looking at only one end of the Elephant
• And Sometimes it is the WRONG End
63. Weight and Metabolic Outcomes 12
Years after *RNY* Gastric Bypass
• The mean unadjusted change from
baseline in body weight in the surgery
group was −46.8 kg
• (95% confidence interval, −48.0 to −45.5)
• 5% of RNY Pts lose > 100 lbs
• NEJM 2017
65. Understanding Weight Loss
• It is Not Enough to Know the MEAN
weight loss
• You must understand the
SCATTER
• The Standard Deviation (Std. Dev., S.D.)
66. Understanding Weight Loss
1. First Simple Things
2. Then We'll Study Statistics
3. In Short:
Fear of Malnutrition
is Simple Lack of Basic Knowledge
68. Dr Rutledge's Study
BP Limb Length & Weight Loss
• 4,000+ Patient Study
• 1. Longer bypass = More Weight Loss
• 2. Longer bypass = More Power (MeanXsWL)
• 3. More Power = Increased Risk of Excess Weight Loss
• 4. MGB is Unique “Tailored Operation”
69. Dr Rutledge's Study
BP Limb Length & Weight Loss
• 4,000+ patients
• 1. Shorter bypass = Less Weight Loss
• 2. Shorter bypass = Less Power (Mean XsWL)
• 3. Less Power = Decreased Risk of Excess Weight
Loss
• 4. MGB is Unique “Tailored Operation”
70. Conclusions
• More Bypass = More Weight Loss /
Increased Risk of Excess Weight Loss
• MGB is UNIQUE;
Surgeon, patient, family => Tailored Surgery
• Measuring the common channel / entire bowel
= NO improvement in Accuracy (Std.Dev.)
72. The Goal of Weight Loss Surgery:
Weight Loss, Of Course
But Not Too Much and
Not Too Little
73. Bariatric Weight Loss Surgery
• A History of Failure
• Jejuno-ileal Bypass
• Horizontal Gastroplasty
• Vertical Banded Gastroplasty
• Lap Band
• ? Sleeve/RNY/BPD etc.?
74. Judgment of Success or Failure
•Many Factors might be used to judge
the success or failure of Weight Loss
Surgery
75. Weight Loss
Because of Convenience and
Publications
For this presentation I will use:
% Excess Weight Loss (Imperfect)
76. Data Collection
Review of published series
Survey of participating Surgeons
For the purpose of this study Data
Collection
Operation Type, %Excess weight loss
(Mean and Standard Deviation)
78. Explanation: Mean
Mean = Power/Effectiveness of a Group
of results calculated average of the
measurements:
a calculated "central" value of a set of
numbers.
To calculate: Just add up all the
Measurements, then divide by how many
Measurements there are.
79. Explanation: Standard Deviation
Standard deviation is a number used to tell how
measurements for a group are spread out from
the average (mean), or expected value.
A small standard deviation means that most of
the Measurements are very close to the average
(accurate)
A high standard deviation means that the
Measurements are spread out (inaccurate)
80. “Normal Distribution”
A normal distribution, a
bell curve
Blue = Accurate Small SD
Red = Inaccurate Large
SD
All normal distributions
look like a symmetric,
bell-shaped curve
81. Bell Shaped Curve Normal Distribution
• Red Powerful
Mean = 2.0
• Blue Weak
Mean = 0.4
• Red Accurate
SD = 0.5
• Blue Inaccurate
SD = 1.0
85. Survey/Review Percent XsWtLoss
Mean = Power, SD = Accuracy
Mean S.D.
Band 45% + 23%
Sleeve 58% + 24%
RNY 72% + 23%
MGB 78% + 22% Unique
BPD/SADI82% + 24%
MGB Can be Made
More or Less
Powerful based
upon Surgeon,
Patient and Family
preference by
modifying BP Limb
Length
86. Percent XsWtLoss, SD = Accuracy
All Roughly the same!
Mean S.D.
Band 45% + 23%
Sleeve 58% + 24%
RNY 72% + 23%
MGB 78% + 22%
BPD/SADI 82% + 24%
What Does this Mean?
It means all forms of Bariatric
Surgery vary in POWER
(Band<Sleeve<RNY<MGB<BPD-SADI)
But
All are roughly
Equally Inaccurate
87. Explanation of Weight and Malnutrition
1.Power of Bariatric Surgery = Mean
Excess Wt Loss
2. Accuracy = Std.Dev., “Spread” of the
Patients Weight Loss around the mean
88. Explanation of Weight and Malnutrition
1. To Explain malnutrition and Excess
Weight Loss
2. For this study
3. Define Malnutrition/eXcess WL (MXWL)
=
Loss of 120% of Excess Body Weight
(XsBW)
89. Calculating Risk of Malnutrition/Excess Weight
Loss
1. Power of Bariatric Surgery = Mean Excess Wt
Loss
2. Accuracy = Std.Dev., “Spread” of the Patients
Weight Loss around the mean
3. If we define Malnutrition/eXcess WL (MXWL) =
Loss of 120% of Excess Body Weight (XBW)
4.Then we can calculate risk of Malnutrition/eXcess
WL (MXWL) for each bariatric operation
90. Example: SADI
High Power (Mean)
+ 25% Standard Deviation
=>
Increased Risk Malnutrition
Simple:
More Powerful Surgery
=>
More Risk of Malnutrition
92. Lap Band:
**VERY LOW** Risk of Malnutrition
1. Lap Band Mean Excess Wt
Loss: = 45% ** (WEAK)
2. Standard Deviation (S.D.) =
23% (Usual)
3. Malnutrition/eXcessWL
(MXWL) = Loss of 120%
XBL
4. Band: Risk
Malnutrition/eXcess WL
(MXWL) = 0.06% Very Low!
93. Sleeve:
Risk of Malnutrition
1. Sleeve Mean Excess Wt
Loss: = 58% ** (Power
Moderate)
2. Standard Deviation (S.D.) =
24%
3. Malnutrition/eXcessWL
(MXWL) = Loss of 120%
XBL
4. Sleeve: Risk
Malnutrition/eXcess WL
(MXWL) = 0.5% (Low Risk)
94. RNY: Risk of Malnutrition/Excess Weight
Loss
1. RNY Mean Excess Wt Loss:
= 72% ** (Powerful)
2. Standard Deviation (S.D.) =
23%
3. Malnutrition/eXcessWL
(MXWL) = Loss of 120% XBL
4. RNY: Risk
Malnutrition/eXcess WL
(MXWL) =
1.8% (Moderate Risk)
95. MGB (2M bypass): Risk of
Malnutrition/Excess Weight Loss
1. MGB (2M bypass) Mean
Excess Wt Loss: = 78% **
(More Powerful Surgery)
2. Standard Deviation (S.D.) =
24%
3. Malnutrition/eXcessWL
(MXWL) = Loss of 120% XBL
4. MGB (2M bypass): Risk
Malnutrition/eXcess WL
(MXWL) = 3% (Higher Risk)
5. BUT MGB Can Be Tailored!
96. BPD/SADI etc: Risk of Malnutrition/Excess
Weight Loss
1. BPD/SADI etc Mean Excess
Wt Loss: = 82% ** (Very
Powerful)
2. Standard Deviation (S.D.) =
24%
3. Malnutrition/eXcessWL
(MXWL) = Loss of 120% XBL
4. BPD/SADI etc: Risk
Malnutrition/eXcess WL
(MXWL) = **6% (Highest Risk)
97. Calculating Risk of Malnutrition/Excess Weight
Loss
•Op Est. Risk Xs Wt Loss
Band 0.06%
Sleeve 0.5%
RNY 1.8%
MGB (2M bypass) 3%
BPD/SADI 6%
Two Important Points to Note:
1.MGB with 2 meter (6 foot
Bypass)
2.BPD/SADI etc
NO More Accurate
than other operations that
DO NOT MEASURE THE
COMMON CHANNEL
98. Calculating Risk of Malnutrition/Excess Weight
Loss
1. The Power (Mean XWL)
varies by procedure
(B<S<R<M<Bpd)
Std.Dev. stays roughly the
same
(B=S=R=M=Bpd)
2. Greater power => INCREASED
Risk Malnutrition/Excess
Weight Loss
(B 0.06%<S 0.5%<R 1.8%<M 3%<Bpd
6%)
Two Important Points to Note:
1.MGB with 2 meter
(6 foot Bypass)
2.BPD/SADI etc
NO More Accurate
than other operations that
DO NOT MEASURE THE
COMMON CHANNEL
99. ASSOCIATION OF BYPASS LIMB
LENGTH AND ONE YEAR WEIGHT
LOSS IN 4,114 MINI-GASTRIC
BYPASS PATIENTS
Dr Rutledge, Know this Since 2011
Poster Number: P.185,
Your Presentation takes place: Date: 01.09.2011,
Session: P8 / GASTRIC BYPASS / 16.00-17.00
100. BP Limb & Weight Loss: Results
• Weight loss following MGB followed a
logarithmic decline though the end of the first
year and then leveled off.
• Bypass limb length varied from
0.5 - 3 meters.
• Weight loss Increases as
Bypass limb length Increase
101. BP Limb & Weight Loss: Results
• A multivariate regression model using bypass
length and Preop weight improved the predictive
value of the model,
• Wt Loss = 13.04 + Bypass*6.98 +
Pre Op Wt * 0.25
• (Fig. 2, p<0.0001, r2= 0.38)
103. Myth of the Common Channel
Measuring the Common Channel will
improve the outcomes (accuracy of weight
loss) following bariatric surgery
1.No supporting evidence
2.This study shows procedures/surgeons
using the common channel DO NOT
improve weight loss accuracy
104. Conclusions
1. Bariatric Operation based on published reports
and survey data are more or less powerful
Band < Sleeve < RNY < MGB < = BPD/SADI etc
2. All Bariatric Procedures studied are roughly
equally accurate/inaccurate
3. Measuring the Common Channel as part of
bypass operation does NOT appear to improve or
affect Accuracy of Bariatric Procedures