First International Consensus Conference on the Mini-Bypass /

One Anastomosis Bypass

Paris 2012 October 18-19

Email DrR@CLOS.Net

Failure.Power.

&Success!

Failure of Sleeve & Band.Power of Mini-Gastric Bypass.

&Successful Treatment of

Obesity & Diabetes!

Expert Judgment of Weight Loss Surgery

Procedures

The Need for a Multidisciplinary Team

• Psychiatrist and Psychologist• Nutritionist and Dietitian• Physical therapist and Physical Trainer• Support Group• Support Group Leader• Anesthesiologist• Generalist and Endocrinologist and

Gastroenterologist• And More?

Multidisciplinary Team

• For Cholecystectomy?• Why no Multidisciplinary Team for

Gallbladder Surgery?• Support Group?• Pre Op Liquid Diet• Psychiatric counseling?• Dietician?• No. • Why?

No Multidisciplinary Team for

Cholecystectomy

Because

Cholecystectomy

Cures the Disease

of

Cholelithiasis

Multidisciplinary Team

• A poor form of weight loss surgery• Will require a really good

Multidisciplinary Team• A poor operation that fails to

successfully treat obesity and diabetes

• Patient will NEED a support group• And a Psychologist and a Grief

councilor and more…

Multidisciplinary Team’sAbuse of the Failed Patient

• A further comment:• What will the Multidisciplinary Team

say and feel about their patient failures

• The failed patient is a judgment against the Multidisciplinary Team and their program

• Often the Team (Surgeon) will Blame the Victim (Failed Patient)

What do the Experts Say?

Survey Results

• As part of a Pre-Conference survey for the

• MGB/OAB Consensus Conference

• Asked Expert Surgeons to Judge 4 weight

loss procedures.

• This is a report Expert Judgment of the

Band, the Sleeve, RNY and the MGB

12. Your Opinion about the LAP BAND

• LAP BAND is good, short simple surgery, maybe the best form of WLS, I use it often 7.1%

• LAP BAND is OK it is an acceptable alternative and I use it sometimes 46.4%

• LAP BAND is a Bad operation and should not be used 46.4%

13. Your Opinion about the SLEEVE

• SLEEVE is Good, short simple surgery, maybe the best form of WLS, I use it often 32.1%

• SLEEVE is OK it is an acceptable alternative and I use it sometimes 53.6%

• SLEEVE is a Bad operation and should not be used 14.3%

14. Your Opinion about the RNY

• RNY is Good, maybe the best form of WLS, I use it often 42.9%

• RNY is OK it is an acceptable alternative and I use it sometimes 50.0%

• RNY is a Bad operation and should not be used 7.1%

15. Your Opinion about the Mini-Bypass / One Anastomosis Bypass

• MGB is good, short simple surgery, maybe the best form of WLS, I use it often 67.9%

• MGB is OK it is an acceptable alternative and I use it sometimes 28.6%

• MGB is a Bad operation and should not be used 3.6%

These results are shown graphically

MGB: Fewest Negative Judgments

• 46.4% said the Band was a bad operation

• 14.3%, 7.1% and 3.6% said the Sleeve,

the RNY and the MGB were bad operations

and should not be done.

• By this measure experts judged the band

the least favorable operation and the MGB

the best choice.

MGB: Most Often Judged Best

• These experts judged the MGB most often to be a "good, short simple surgery, maybe the best form of WLS, I use it often" in 67.9% of cases as compared to

• 7.1%, 32.1% and 42.9% for the band, the sleeve and the RNY respectively.

• In these expert's opinion the MGB is by far the best judged form of weight loss surgery.

Frequency of Negative Judgment

Frequency of Choice as "Best" form of Surgery

Judgment of the Band

Judgment of the Sleeve

Judgment of the RNY

Judgment of the MGB/OABHighest Good / Lowest Bad

Success: Mini-Gastric Bypass Simplicity, Power & Safety

0

1

2

3

4

5

6

7

8

PreOp Post Op

MGB Effect on Hunger Levels

7.4

3.7

Per

cen

t (%

)

Failed Sleeve to RNY; Sept 2012Less 24 months!

• Failed Sleeve:• Weight loss• Diabetes Rx• SEVERE Reflux symptoms.

• Time to Failure less than 24 months.

• 30% for "Severe Reflux"!!!!

• Indications and Mid-Term Results of Conversion from Sleeve Gastrectomy to Roux-en-Y Gastric Bypass. Authors Gautier T, et al. Obes Surg. 2012 Sep 23. Département de Chirurgie Digestive, Caen University Hospital, Caen Cedex, France, gautier.tho@gmail.com.

Band, Sleeve vsthe Neuro-Humoral Drive to Eat

• Restrictive Procedures • MAKE SWEET EATERS: • Mechanical Block of

Normal Healthy Foods • Weight Loss: Honeymoon 2 years• Then Failure Weight Regain • GE Reflux

(Risk of Esophageal Cancer)

Band & SleeveBlock Normal Healthy Foods

• Weight Loss =>• Increased Hunger • Decreased Satiety• Healthy Foods Blocked • Drive to Eat UP• What Happens?

Band & Sleeve; Block Intake Normal Healthy Food

Sleeve Band

Restrictive Procedures

•Successfully Block Normal Healthy Diet

But•They DO NOT BLOCK ...

Pathologic Dietary Choices

Calories: Ice Cream 200g/540 cal,

2 Milky-way Bars, 1,000 cal2 L Bottle Coke 830 cal

Total: 2,370 cal

Diet Induced Increased Hunger

Summary

• Most Diets & Restrictive Procedures Will Fail

• Attempts to Override Neuro-Humoral Hunger System Routinly Fails

• RPs Force Patients into Pathological Dietary Choices

•MAKE SWEET EATERS!

SOLUTION?

Diet Induced Increased Hunger

Mini-Gastric BypassThe Mongoose!

Mini-Gastric Bypass

• BlocksNeuro-Humoral Hunger System

• Short, Simple, Durable, 30 minute Surgery that:

• Decreases Hunger &Increases Satiety

The MongooseHe is a Little Bit Ugly, No?

0

2

4

6

8

10

Pre Op Post Op

Reported Hunger Levels

7.4

3.7

Mini-Gastric Bypass Decreases Hunger Survey 2,783 Pts

What Do the Experts Say?

Survey of 102 surgeons answered detailed survey online.

Surgeons from 6 Continents and 23 countries. The group reported on a

past year's experience with over 39,000 cases, Very experienced surgeons.

IFSO Varianational Committee Survey

Over 100 Surgeons from Around the World:

MGB Best Rx Diabetes

0%

20%

40%

60%

80%

100%

Band Sleeve RNY MGB

Diabetes Resolved (%)

36%

59%

64%

86%

Both Kular and Rutledge, Op Time < 40 min

0

20

40

60

80

100

120

Band Sleeve RNY MGB

Op Time

42

60

110

68

0%

5%

10%

15%

20%

25%

30%

35%

Band Sleeve RNY MGB

Dyspepsia %

31%

22%

5%

6%

0%

5%

10%

15%

20%

Band Sleeve RNY MGB

Pre op GE Reflux rate (%)

10%

11%

17%

19%

0%

5%

10%

15%

20%

25%

30%

Band Sleeve RNY MGB

Postop GE Reflux rate (%)

24%

27%

6%

4%

Risk of Esophageal Cancer?

0%

10%

20%

30%

40%

50%

60%

70%

80%

Band Sleeve RNY MGB

Excess Weight Loss (%)

42%

60%

62%

78%

0%

5%

10%

15%

20%

25%

30%

35%

Band Sleeve RNY MGB

Weight Loss "Failure" (%)

34%

15%

12%

5%

0%

20%

40%

60%

80%

100%

Band Sleeve RNY MGB

Lost More than 50% of EW

39%

79%

81%

95%

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

3.0%

Band Sleeve RNY MGB

Bowel Obstruction (%)

0.4%

0.0%

2.5%

0.1%

0.0%

0.5%

1.0%

1.5%

2.0%

Band Sleeve RNY MGB

Ulcers %

0.9%

0.3%

1.9%

1.8%

0%

10%

20%

30%

40%

50%

60%

70%

80%

90%

Band Sleeve RNY MGB

Short simple operation

82%

70%

0%

69%

0%

20%

40%

60%

80%

100%

Band Sleeve RNY MGB

Routinely get get major weight loss

13%

65%

87%

95%

0%

10%

20%

30%

40%

50%

60%

70%

80%

Band Sleeve RNY MGB

Rarely suffer from long term complications

4%

52%

39%

70%30% Reflux &Esophageal

Cancer?

0.0%

0.5%

1.0%

1.5%

2.0%

2.5%

Band Sleeve RNY MGB

Published Leak Rates

0.1%

2.0%

1.0%

0.5%

Leaks

Surg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33.Laparoscopic sleeve gastrectomy:

Band/SleeveRoad to Failure

Initial Weight Loss

Return of Hunger

Eat Normal Foods

ObstructionAcid Reflux/Cancer

Eat Liquid Calories

Weight Regain

In Summary

• Restrictive Procedures Fail• In as Little as 2 Years• Restrictive Procedures Push Patients

towards Liquid Calories • (Can a Sleeve stop Coke!)(Can a Sleeve stop Coke!)• Weight Regain is Common• Acid Reflux 30%+

• Acid Reflux = Esophageal Cancer

The Mini-Gastric Bypass Excellent Operation with Results Reported on Thousands of Patients Over the Past 10-15

years

• Survey Shows:• Short, Simple, Effective, Durable,• 30 min Operation with 1 day

Hospital Stay• Lower Leak rate than Sleeve or

RNY• Best Weight Loss• Easily Reversible, Revisable