Failure of Sleeve & Band.
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First International Consensus Conference on the Mini-Bypass /
One Anastomosis Bypass
Paris 2012 October 18-19
Email [email protected]
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Failure.Power.
&Success!
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Failure of Sleeve & Band.Power of Mini-Gastric Bypass.
&Successful Treatment of
Obesity & Diabetes!
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Expert Judgment of Weight Loss Surgery
Procedures
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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?
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Multidisciplinary Team
• For Cholecystectomy?• Why no Multidisciplinary Team for
Gallbladder Surgery?• Support Group?• Pre Op Liquid Diet• Psychiatric counseling?• Dietician?• No. • Why?
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No Multidisciplinary Team for
Cholecystectomy
Because
Cholecystectomy
Cures the Disease
of
Cholelithiasis
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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…
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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)
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What do the Experts Say?
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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
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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%
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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%
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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%
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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%
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These results are shown graphically
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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.
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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.
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Frequency of Negative Judgment
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Frequency of Choice as "Best" form of Surgery
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Judgment of the Band
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Judgment of the Sleeve
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Judgment of the RNY
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Judgment of the MGB/OABHighest Good / Lowest Bad
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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 (%
)
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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, [email protected].
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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)
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Band & SleeveBlock Normal Healthy Foods
• Weight Loss =>• Increased Hunger • Decreased Satiety• Healthy Foods Blocked • Drive to Eat UP• What Happens?
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Band & Sleeve; Block Intake Normal Healthy Food
Sleeve Band
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Restrictive Procedures
•Successfully Block Normal Healthy Diet
But•They DO NOT BLOCK ...
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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
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Diet Induced Increased Hunger
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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!
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SOLUTION?
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Diet Induced Increased Hunger
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Mini-Gastric BypassThe Mongoose!
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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?
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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
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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.
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IFSO Varianational Committee Survey
Over 100 Surgeons from Around the World:
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MGB Best Rx Diabetes
0%
20%
40%
60%
80%
100%
Band Sleeve RNY MGB
Diabetes Resolved (%)
36%
59%
64%
86%
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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
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0%
5%
10%
15%
20%
25%
30%
35%
Band Sleeve RNY MGB
Dyspepsia %
31%
22%
5%
6%
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0%
5%
10%
15%
20%
Band Sleeve RNY MGB
Pre op GE Reflux rate (%)
10%
11%
17%
19%
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0%
5%
10%
15%
20%
25%
30%
Band Sleeve RNY MGB
Postop GE Reflux rate (%)
24%
27%
6%
4%
Risk of Esophageal Cancer?
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0%
10%
20%
30%
40%
50%
60%
70%
80%
Band Sleeve RNY MGB
Excess Weight Loss (%)
42%
60%
62%
78%
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0%
5%
10%
15%
20%
25%
30%
35%
Band Sleeve RNY MGB
Weight Loss "Failure" (%)
34%
15%
12%
5%
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0%
20%
40%
60%
80%
100%
Band Sleeve RNY MGB
Lost More than 50% of EW
39%
79%
81%
95%
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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%
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0.0%
0.5%
1.0%
1.5%
2.0%
Band Sleeve RNY MGB
Ulcers %
0.9%
0.3%
1.9%
1.8%
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0%
10%
20%
30%
40%
50%
60%
70%
80%
90%
Band Sleeve RNY MGB
Short simple operation
82%
70%
0%
69%
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0%
20%
40%
60%
80%
100%
Band Sleeve RNY MGB
Routinely get get major weight loss
13%
65%
87%
95%
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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?
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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:
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Band/SleeveRoad to Failure
Initial Weight Loss
Return of Hunger
Eat Normal Foods
ObstructionAcid Reflux/Cancer
Eat Liquid Calories
Weight Regain
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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
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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