a-00102

Dr. Robert RUTLEDGETitle of Paper: 6436 CONSECUTIVE MINI-GASTRIC

BYPASSES: 16 YEARS LATERNationality: United States of America

Position: DirectorDepartment: Surgery

Organization: Center For Laparoscopic Obesity SurgeryTel: +1-702 714 0011E-mail: drr@clos.net

6436 CONSECUTIVE MINI-GASTRIC BYPASSES:

16 YEARS LATER

Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America

MINI-GASTRIC BYPASS

• Mini-Gastric Bypass1997 – 2012 ; >6,000 pts, 15 yr Data; Multiple Centers, R.C.Trials (Lee)

• Vertical Gastric Tube(Collis Gastroplasty)

• Gastric Bypass(Billroth II Gastro-jejunostomy)

Introduction

• Presented at the First International Consensus Conference on the

• Mini-Bypass / • One Anastomosis

Bypass • (MGB) • Paris Oct 2012.

Introduction

• In spite of initial skepticism; • There is growing evidence that

MGB is a • Safe and effective procedure with • Many of the features of an ideal bariatric

surgery.

Methods:

• Review of 6,436 MGBs 1997 to 2013

• First International Consensus Conference on the Mini-Bypass / One Anastomosis Bypass, Paris 2012 October 18-19.

Results

• Mean preop weight (+/- Standard Deviation) was 151 +/- 31 kg, BMI 46 +/- 7. &

• 79% were female. Mean operative time was 43 + 11 minutes and median length of stay was 1 day.

• Three deaths occurred within 30 days of surgery, (0.05%).

• None in the last 10 years.

Results

• Early complications occurred in 4.9%. • 44 (0.7%) patients had anastomotic leaks. • Three (0.05%) patients presented with

dypepsia/bile reflux not responsive to medical therapy and were successfully treated by Braun side-to-side jejuno-jejunostomy

• Gastritis/dyspepsia/marginal ulcer was the most serious long term complication; routinely treated medically (4.9%).

Results

• Excessive weight loss occurred in 1% of patients; treated by take down of the bypass.

• Mean % excess weight loss (EWL) of 78%. • 10 year weight regain 4.9%. • >50% EWL was achieved for 95% of patients

at 18 months and for 92% at 60 months. • 6% of patient had inadequate weight loss or

significant weight regain were treated by revision, (addition of ~2 meters to the bypass).

1. Low Risk2. Major Weight Loss3. Easily performed4. Short operative times5. Outpatient or short hospital stay6. Minimal Blood Loss7. No Need for ICU Stay8. Minimal Pain9. Very High Patient Satisfaction10. A Good "Exit Strategy"

SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY

SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY11. Change Behavior & Preferences; Marked Decrease in Hunger

and Increased Satiety12. Minimal Retching and Vomiting 13. Few adhesions or hernias14. Minimal impact on Heart and Lung Function15. Low Failure Rate16. Low Cost17. Short Recovery Time18. Rapid Return to Work19. Low Risk of Pulmonary Embolus20. Durable weight loss

SUCCESS CRITERIA"IDEAL" WEIGHT LOSS SURGERY

21. Low Risk of Ulcer22. Fat Malabsorption; low cholesterol & CV risk 23. No Plastic Foreign Body 24. Easily Verifiable Results; > 10 years of Results25. Low Risk of Bowel Obstruction26. Based upon sound surgical principles 27. Independent confirmation of results28. Healthy life after surgery29. Supported by LEVEL I Evidence; RCT (Controlled Prospective

Randomized Trial)30. Block “Sweet Eater” Failures

Selected Bariatric Procedures

• RNY

• Band

• Sleeve

• MGB

MINI-GASTRIC BYPASSBASED SOUND SURGICAL PRACTICE

• Billroth II Performed over 100 years

• 16,000 Billroth II’sUSA in 2007

• Operation of choice: Trauma, Ulcers, Cancer Stomach etc.

Conclusions:

• This study confirms reports presented first over 10 years ago and now supported by dozens of other surgeons from 29 countries from around the world,

• MGB is an short, simple, effective, low-risk, and durable bariatric procedure.

• In addition, it can be easily revised, converted, or reversed.