UPDATED Preliminary Program: MGB-OA Consensus Conference

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UPDATED Preliminary Program:  
MGB-OA Consensus Conference
*** Optional ***  Added Saturday LIVE Surgery
UPDATED Preliminary Program (Shortened link = http://wp.me/s2Dmx-mccp2 )

** Oct 18: Thursday morning : PUBLISHED DATA ON MGB

–      ***Hand out Voting Questionnaire for Consensus Voting***

–      Pr. JM Chevallier Charge to the Meeting; Listen, Learn, Discuss, Vote, Plan
Time: 8 min
Objectives:
1. Why Are We Here: MGB Excellent Therapy – Not Widely Recognized
2. Report of MGB Series: Is MGB Excellent/Best Practice Treatment for Obesity/Metabolic Disease
3. Technical Details of Best Performance of MGB
4. Plan for Adoption and Improvement of MGB around the World

Questions and Answers and Votes from Floor
Time: 8 min
1. Why is MGB not used by everyone
2. What are the Results of MGB
3. What are the Technical Details (Critical Success Factors of the MGB)
4. What Should Be the Next Steps in Adoption of MGB

–      Intro Safwan A Taha; Bariatric Surgery, Where are We Now and Where are We Going
Time: 8 Min
1. 2 min JIB, VBG, RNY, Band, Sleeve, Plication
2. 2 min History of Failure
3. 2 Min Rise of the MGB
4. 2 Min The Future

–      Kamal Mahawar & Dr P Lointer, MGB: Review of Literature on MGB
Time: 8 min
Objectives:
1. Literature Results Non-MGB
2. Review of MGB Series
3. Conclusion of Literature Review
4. Recommendations Based Upon Literature Review

Questions and Answers and Votes from Floor
Time: 8 min
1. Results of Non-MGB Bariatric Surgery is Not Ideal
2. Ideal Bariatric Surgery
3. Results of MGB
4. Recommendations based upon Literature review of MGB

–      Special Guest Presentations:
Dr. Narwaria  Former President Obesity Surg Soc India
My Journey to the MGB / MGB-In India
Time 8 min
1. Who Am I: Successful International leader in Bariatric Surgery
2. Initial Skepticism of MGB
3. Initial Results with MGB
4. Insights into the Mind of an MGB Skeptic

–      Pr. JM Chevallier President Obesity Surg Soc France:
What I know about MGB: 7 years experience
Time 8 min
1. Who Am I: Successful International leader in Bariatric Surgery
2. Initial Skepticism of MGB
3. Initial Results with MGB
4. Insights into the Mind of an MGB Skeptic

Questions and Answers and Votes from Floor
Time: 8 min
1. Why Should Presently Successful Bariatric Surgeons Choose MGB
2. Skepticism of MGB
3. Results of MGB
4. Response to MGB Skeptics

–     Michal Cierny          The Czech Experience (Ulcer & MGB)
Time: 8 min
1. Ulcer after MGB vs RNY
2. PreOp and Post Op Management Prevention
3. Treatment of Gastritis / Ulcer
4. No NSAIDs, Rx H.Pylori, Anti-Acids (PPI’s, H2 Blockers), Bismuth subsalicylate, Yogurt, No Smoking!!, Soda, Coffee, Etoh, Green Tea, Meat, Hand washing, Careful food prep, Safe water source

–     R Weiner :       MGB Results in Germany
Time 8 min
1. Bile Reflux Ulcer after MGB vs RNY
2. PreOp and Post Op Management / Prevention
3. Treatment of Gastritis / Ulcer
4. No NSAIDs, Rx H.Pylori, Anti-Acids (PPI’s, H2 Blockers), Bismuth subsalicylate, Yogurt, No Smoking!!, Soda, Coffee, Etoh, Green Tea, Meat, Hand washing, Careful food prep, Safe water source, *** Endoscopy ***, *** Surgery Revision ***

–      R Rutledge : Rational Choices in Bariatrics, Fear of Gastric Cancer/Marginal Ulcer
Time: 8 min
1. Performance Assessment Tool (What are the criteria of ideal weight loss / metabolic surgery, MGB Nearest to Ideal
2. Confused Surgeons; It is not the Bile that is feared but the Consequences (Cancer, Gastritis, Ulcer)
3. Fear Gastric Cancer
I. Unfounded
II. Fear Held by those with the LEAST Knowledge
4 Ulcer MGB = RNY

Questions and Answers and Votes from Floor
Time: 8 min
1. Ulcers / Gastritis in MGB
2. Ulcers / Gastritis Prevention
3. Ulcers / Gastritis Treatment
4. Surgery for Ulcers / Gastritis

–     Manuel Garcia Caballero:    One Anastomosis Gastric Bypass, Critical Advantages
Time 8 min
1. Bile Reflux After Billroth II
2. Caballero/Carbajo Anti-Reflux Stitch
3. 11 yr Results with OAB
4. Fear Bile Reflux => Do OAB

Questions and Answers and Votes from Floor
Time: 8 min
1. Bile Reflux After MGB
2. Anti-Reflux Stitch (OAB)
Sometimes / Always / Never
3. Rate of bile reflux After MGB
4. Management of Bile Reflux After MGB

–      Mario Musella          The Italian Experience; Technical Details of MGB Best Practice
Time: 8 min
1. Caliber & Length of sleeve
2. Length of Bypass
3. Anastomosis (hand-sewn, mechanical, side to side, end to side,linear stapler, circular stapler, Reinforcement of the staple gastric sleeve line, Reinforcement of the gastric remnant staple line, (seam-guard, peri-strip, fibrin glue, other sealant…) Closure of the stapler access (single layer, double layer, mechanical continuous suture, manual continuous suture, mechanical interrupted stitches, manual interrupted stitches…)
4. Only ONE WAY or Multiple Equally Good Ways to Perform MGB

–     C Peraglie
Time: 8 min
1. Caliber & Length of sleeve
2. Length of Bypass
3. Anastomosis (hand-sewn, mechanical, side to side, end to side,linear stapler, circular stapler, Reinforcement of the staple gastric sleeve line, Reinforcement of the gastric remnant staple line, (seam-guard, peri-strip, fibrin glue, other sealant…) Closure of the stapler access (single layer, double layer, mechanical continuous suture, manual continuous suture, mechanical interrupted stitches, manual interrupted stitches…)
4. Only ONE WAY or Multiple Equally Good Ways to Perform MGB

Questions and Answers and Votes from Floor
Time: 8 min
1. MGB; Technical Details; Critical Success Factors
2. MGB-Sleeve
3. MGB Bypass
4. MGB-Gastro-Jejunostomy

–      Rui Ribeiro              Portugal Experience: Technical Details II: MGB Part 1: Gastric Pouch
Time 8 min

1. Surgeon/Patient Position, Ports Position/Placement,

2. Location of pouch initiation, Skeletonization of lesser curve,

3. Creation of the pouch:

Use of the staple gun, Covidien/Ethicon: Pros & Cons,

Location and angle of first staple cartridge

Cartridge selection: White/Blue/Gold/Green,

Delays: Before and During Staple Gun Firing

4. Wisdom of Old Men:

Fear “Thickness”,

Fear The Tube/Bougie/NC tube

Fear the angle of His

–     Jan Apers                Dutch experience with MGB
Time 8 min
1. Dutch Experience with MGB
2. Running the Bowel, Distance of the bypass, Tailoring the length bypass
3. Leaks after MGB
4. Managing Leaks

Directed Discussion:  Agreements and Controversies
–     Panel: Chevalier, Caballero, Tacchino, Kular, Peraglie, Nawaria, Weiner
–     Moderator/Floor Person: Rutledge
–     Recorders: Musella, Van Den Bossche,

** Thursday afternoon : LONG TERM STUDIES AND OTHER TOPICS

–      Sandeep Aggarwal   Role of MGB vs Other Surgery
Time 8 min
1. Band vs MGB
2. BPD vs MGB
3. RNY vs MGB
4. Sleeve vs MGB

– Dr Jean Cady   : MGB as Rescue for Failed Band
Time 8 min
1. Band is Good choice?
2. Failure Rate (Weight Regain, Reflux) and Leak Rate
3. FU Band and MGB, complications and Weight Loss
4. Band vs MGB;  50% vs 90% Success

–      K S Kular:                 MGB vs Sleeve; A comparison and Prediction of the Future
Time 8 min
1. Sleeve is Good choice for Many
2. Failure Rate (Weight Regain, Reflux) and Leak Rate
3. 3 yr FU Sleeve and MGB, Pouch Dilation and Weight Loss
4. Lee; Sleeve vs MGB,  50% vs 90% Success

–     R Tacchino : MGB and BPD; compare and contrast
Time 8 min
1. BPD is Good choice for Many
2. Failure Rate (Weight Regain, Reflux) and Leak Rate
3. 3 yr FU BPD and MGB, Pouch Dilation and Weight Loss
4. BPD, Band, Sleeve, MGB My Advice and Perspective

–     Dr. Atul N.C Peters   MGB compared to RYGB
Time 8 min
1. RNY is Good choice for Many
2. Failure Rate (Weight Regain, Reflux) and Leak Rate
3. FU RNY and MGB, Bowel Obstruction and Weight Regain
4. RNY, BPD, Band, Sleeve, MGB My Advice and Perspective

– Questions and Answers and Votes from Floor
Time: 8 min
1. Long Term Expectations and Predictions of Band, Sleeve, RNY, BPD Outcomes
2. Long Term MGB Outcomes
3. Band, Sleeve, RNY, BPD vs. MGB Recommendations
Always Choose MGB (Rutledge Doctrine)
Always Choose Band, Sleeve, RNY, BPD
Tailored Approach
When to choose Band, Sleeve, RNY, BPD
When to choose MGB
4. BPD vs. MGB Need for Further Study

–      Emilio Manno,     Long term experience, Complications and Management
1. Italian Experience of MGB
2. Anemia
3. Ulcer
4. Inadequate / Excess Weight Loss / Other Complications

–    Michael Van den Bossche; UK experience with MGB; Complications and Management

Time 8 min

1. UK Experience of MGB
2. Anemia
3. Ulcer
4. Inadequate / Excess Weight Loss / Other Complications

** Friday morning : TIPS and Tricks , COMPLICATIONS and risks

–     K S Kular: How I Came to the MGB; My Path Cannot Be Your Path
Time 8 min
1. Background Leading to Consideration of MGB
2. Data Supporting My Decision to Choose MGB 5 years Ago
3. Struggle to Offer MGB
4. Advice from My Experience

–     Karl-Peter.Rheinwalt Germany Starting/Integrating New MGB Program
Time 8 min
1. Background Leading to Consideration of MGB
2. Data Supporting My Decision to Choose MGB 5 years Ago
3. Struggle to Offer MGB
4. Advice from My Experience

–     Maurizio De Luca   Complication of mini-gastric bypass
Time 8 min
1. My Consideration of MGB
2. My Results of MGB
3. Complications and Outcomes
4. Advice from My Experience

Voting CONSENSUS : QUESTIONS AND ANSWERS
Questionnaire and the answers of the floor
Plans for Future
— IFSO European Chapter
— IFSO 2013 1 day MGB Interest Group
— Paris Oct 2013?
— Excess Funds from Meeting? Use
— International Collaboration and Assistance / Organization and Founding Members and Officers

Bold Database Interface

Optional ADDED Saturday LIVE Surgery
4 Select Surgeons Invited to View Live Surgery in Paris with Dr Jean Cady/DrRutledge
Surgeons and 20 Other Slots Added to Watch Live Streaming Surgery
Meet Following Surgery for Group Discussion
Possible Dinner Meeting to Follow

Short Stay Deadly in the Wrong Hands

Outpatient and 1 day stay has been safe and successful in over 6,000 MGB patients with Dr. Rutledge.

This study shows a 1 day stay in RNY patients in the BOLD database canbe deadly!

“Stanford University researchers found patients discharged on the same day of surgery were 13 times more likely to die Stanford University researchers found patients discharged on the same day of surgery were 13 times more likely to die “

Amplify’d from www.newswise.com

Outpatient Bariatric Surgery May Lead to Higher Mortality and Complications

Released:
6/13/2011 12:05 AM EDT

Embargo expired:

6/15/2011 12:05 AM EDT


Source:

American Society for Metabolic & Bariatric Surgery

Releasing Patients Same Day as Surgery, Sooner than National Average Leads to 13-Fold Increase in 30-day Mortality

Newswise — ORLANDO, FL – June 15, 2011 – A new study of nearly 52,000 patients found that people who had gastric bypass surgery and were discharged from the hospital sooner than the national average of a two-day length of stay, experienced significantly higher rates of 30-day mortality and complications. The findings* were presented here at the 28th Annual Meeting of the American Society for Metabolic & Bariatric Surgery (ASMBS).

Stanford University researchers found patients discharged on the same day of surgery were 13 times more likely to die than patients who left after two days (risk adjusted), and were 12 times more likely to have serious complications (1.9% vs. 0.16%). Patients who spent more time in the hospital but were discharged in less than 24 hours after an overnight stay, were two times more likely to die than patients who left after two days of recovery. The overall 30-day mortality rate was 0.1 percent for patients who stayed in the hospital for two or more days, and about 0.8 percent for those who were discharged on the same day of surgery.

Read more at www.newswise.com

 

Gastric Bypass Appropriate for Lower Weight Diabetics

Gastric Bypass Appropriate for Lower Weight Diabetics

Amplify’d from www.medscape.com

From Medscape Medical News

Gastric Bypass Has Advantages in Less Obese Patients

Megan Brooks

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June 16, 2011 — There are benefits to performing laparoscopic Roux en Y gastric bypass (RYGB) in obese patients who have a body mass index (BMI) below 35 kg/m2, according to a study reported at the American Society for Metabolic and Bariatric Surgery 28th Annual Meeting in Orlando, Florida.

Among patients who underwent the surgery, the rates of remission of type 2 diabetes were higher in those with a BMI below 35 kg/m2 than in those with higher BMIs. The “less obese” patients also lost a greater percentage of their excess weight in the first year after surgery than their peers with higher BMIs.

“The study raises the question of whether early referral leads to better outcomes,” John Morton, MD, director of bariatric surgery at Stanford Hospital & Clinics at Stanford University in Palo Alto, California, and an investigator with the study, noted in a conference statement.

“Bariatric surgery is tremendous for weight loss, but its other big advantage is improving medical problems, in particular type 2 diabetes,” Dr. Morton noted in an interview with Medscape Medical News.

Outcomes Better at Lower BMI

Current guidelines from the National Institutes of Health recommend that gastric bypass be reserved for patients who have a BMI of 35 kg/m2 or higher and an obesity-related condition, or who have a BMI of at least 40 kg/m2.

Dr. Morton’s team took a look back at 980 patients who underwent laparoscopic RYGB at their institution between 2004 and 2010. “We ask patients to lose some weight before surgery because it’s a good way to make sure they are committed to the program, and it makes the surgery a little bit safer,” Dr. Morton said. “Therefore, we had some patients below a BMI of 35 kg/m2 at the time of surgery.”

For the analysis, the patients were grouped according to their presurgery BMI: below 35 kg/m2, 35 to 39.9 kg/m2, 40 to 49.9 kg/m2, and above 50 kg/m2.

“When we examined type 2 diabetes resolution rates, we found that those with the lowest BMI had the best resolution rates,” Dr. Morton reported. All 12 patients with a BMI below 35 kg/m2 no longer had type 2 diabetes after surgery, whereas patients with higher BMIs had remission rates of roughly 75%.

“We are looking to entertain the idea that maybe obese patients should have the option of surgical intervention for their diabetes sooner rather than later because, as the study showed, as the BMI gradient goes up, your diabetes resolution rate with surgery goes down,” Dr. Morton said.

The researchers also found that patients with a BMI below 35 kg/m2 who had the surgery had lost more of their excess weight at 3, 6, and 12 months than patients with a higher BMI.

After 1 year, the patients with BMIs below 35 kg/m2 had lost 167% of their excess weight. By comparison, those with a BMI from 35 to 39.9 kg/m2 had lost 112%, those with a BMI from 40 to 49.9 kg/m2 had lost 85%, and those with a BMI above 50 kg/m2 had lost 67% of their excess weight.

Laparoscopic RYGB also took less time in patients with the lowest BMI (170 minutes) than in those with higher BMIs (177 minutes, 182 minutes, and 194 minutes, respectively).

Reevaluation of BMI Guideline Needed

In an interview with Medscape Medical News, John David Scott, MD, a bariatric surgeon at Greenville Hospital System University Medical Center in South Carolina, who was not involved in the study, said that “the BMI level of 35 is an arbitrary standard set many years ago that certainly needs to be reevaluated.”

“Most of the evidence that has been coming out lately has shown not only a positive weight loss benefit for that particular group, but also positive overall health effects,” he added. “In particular, the resolution of diabetes is astounding. To be able to offer patients a surgical cure for their type 2 diabetes is very exciting,” Dr. Scott said.

Dr. Morgan has disclosed no relevant financial relationships. Dr. Scott reports receiving speaker fees from WL Gore & Associates and fellowship support from Ethicon Endo Surgery.

American Society for Metabolic and Bariatric Surgery (ASMBS) 28th Annual Meeting: Abstract P-54. Presented June 16, 2011.

Authors and Disclosures

Journalist

Megan Brooks

Megan Brooks is a freelance writer for Medscape.

Disclosure: Megan Brooks has disclosed no relevant financial relationships.

 

Read more at www.medscape.com

 

RNY Bypass Fails to Help Veterans

The Roux-en-Y (RNY) procedure is “inherently more difficult” because of anatomical differences from women. The procedure also has a higher perioperative mortality rate in large men.

Analysis showed:
Eleven of 850 surgical case patients (or 1.3%) died within 30 days of surgery.

Any RNY benefit vanished in a statistically rigorous analysis that controlled for a host of co-varying factors, Maciejewski and colleagues reported online in the Journal of the American Medical Association and at the Academy Health Annual Research Meeting in Seattle

But the benefit vanished in a statistically rigorous analysis that controlled for a host of co-varying factors, Maciejewski and colleagues reported online in the Journal of the American Medical Association and at the AcademyHealth Annual Research Meeting in Seattle

Amplify’d from www.medpagetoday.com
Limited Benefit for Bariatric Surgery
By Michael Smith, North American Correspondent, MedPage Today
Published: June 12, 2011
Reviewed by Robert Jasmer, MD; Associate Clinical Professor of Medicine, University of California, San Francisco and
Dorothy Caputo, MA, RN, BC-ADM, CDE, Nurse Planner
In a retrospective cohort study of predominantly male U.S. veterans, crude mortality rates were lower over six years for those who had the surgery than for controls, according to Matthew Maciejewski, PhD, of the Durham VA Medical Center in Durham, N.C., and colleagues.
But the benefit vanished in a statistically rigorous analysis that controlled for a host of co-varying factors, Maciejewski and colleagues reported online in the Journal of the American Medical Association and at the AcademyHealth Annual Research Meeting in Seattle

In large men, they noted, the Roux-en-Y procedure is “inherently more difficult” because of anatomical differences from women. The procedure also has a higher perioperative mortality rate in large men.

On the other hand, no studies have focused on high-risk patients, they noted. To help fill the gap, they turned to a cohort of 850 older, high-risk patients who had bariatric surgery between January 2000 and December 2006 at 12 Veterans Affairs medical centers.

They were matched with 41,244 nonsurgical controls from the same centers, with follow-up through December 2008 for an average of 6.7 years, the researchers reported.

Analysis showed:

  • Eleven of 850 surgical case patients (or 1.29%) died within 30 days of surgery.

To get a clearer picture, they conducted a propensity-matched analysis of 847 cases and 847 controls, which created cohorts that were similar in all observed characteristics except year of study entry.

In that analysis, Maciejewski and colleagues reported, the mortality differences all but vanished.

The study was supported by the Department of Veterans Affairs.

Maciejewski reported financial links with Takeda Pharmaceuticals, Novartis, the Surgical Review Corporation, the Research Data and Assistance Center at the University of Minnesota, and Amgen.

Read more at www.medpagetoday.com

 

Reflux (GERD) from Sleeve and the Band

Among bariatric procedures,
** gastric sleeve ** and
vertical banded gastroplasty were shown to worsen reflux symptoms

** Gastric banding ** is associated with reflux symptoms in a considerable proportion of patients.

Amplify’d from www.ncbi.nlm.nih.gov
Curr Gastroenterol Rep. 2011 Jun;13(3):205-12.

Obesity and GERD: Pathophysiology and Effect of Bariatric Surgery.

Source

Division of Gastroenterology, University Clinics of Visceral Surgery and Medicine, Bern University Hospital, Inselspital Bern, Bern, Switzerland, radu.tutuian@insel.ch.

Abstract

Epidemiologic, endoscopic, and pathophysiologic studies document the relationship between obesity and gastroesophageal reflux disease (GERD). Increased body mass index and accumulation of visceral fat are associated with a two- to threefold increased risk of developing reflux symptoms and esophageal lesions. Given this association, many studies were designed to evaluate the outcome of reflux symptoms following conventional and surgical treatment of obesity. Among bariatric procedures, gastric sleeve and banded gastroplasty were shown to have no effect or even worsen reflux symptoms in the postoperative setting. Gastric banding improves reflux symptoms and findings (endoscopic and pH-measured distal esophageal acid exposure) in many patients, but is associated with de novo reflux symptoms or lesions in a considerable proportion of patients. To date, Roux-en-Y gastric bypass is the most effective bariatric procedure that consistently leads to weight reduction and improvement of GERD symptoms in patients undergoing direct gastric bypass and among those converted from restrictive bariatric procedures to gastric bypass.

Read more at www.ncbi.nlm.nih.gov

 

Surgery Can Resolve Diabetes

Surgery Can Resolve Diabetes

Emerging data suggest that bariatric surgery results in substantial improvements in glycemia, blood pressure, and cholesterol; weight loss is durable; survival may be improved; and surgical risks are low.

Amplify’d from www.medscape.com

The Great Debate: Medicine or Surgery: Mechanisms of Weight Loss after Bariatric Surgery

Mechanisms of Weight Loss after Bariatric Surgery

The effectiveness of bariatric surgical procedures in improving type 2 diabetes was originally ascribed to substantial dietary changes and weight loss.[13] More recently, several lines of evidence suggest that bariatric surgical procedures, especially the Roux-en-Y gastric bypass (RYGB), have glycemic effects in part independent of weight loss. Such evidence includes 1) animal data showing that diversion of enteral flow from the duodenum, which occurs in RYGB, improves type 2 diabetes even in nonobese animals;[14] 2) patients receiving RYGB experience greater early improvements in glycemia compared with patients receiving laparoscopic adjustable gastric band (LAGB) on the same postoperative diet;[15] 3) in contrast with LABG, very early improvements in insulin sensitivity and β-cell function have been demonstrated;[15,16] 4) a small group of patients have recently been identified who have developed late-onset hyperinsulinemic hypoglycemia after RYGB, usually manifesting after maximal weight loss results have been realized,[17,18] implicating a potential chronic stimulatory effect on the β-cell; and 5) altered nutrient delivery through the gastric compared with gastric bypass route alters glucose tolerance, insulin dynamics, and other metabolic measures.[19,20]

Read more at www.medscape.com

 

More Surgeons Abandoning the Band; The Band is a "Disservice" to Morbidly Obese!

Canadian Group call the Band a “Disservice” to the Morbidly Obese and that it “cannot be justified”
Amazing and strong words but consistent with Dr. Rutledge’s opinion for the last 10 years.

Amplify’d from clos.net

Stunning New Research Statement from Canadian Lap Band Group:




“… Placement of a gastric band appears to be a disservice …”

“The placement of a gastric band
appears to be a disservice to many morbidly obese patients

and therefore, in the current culture of evidence based
medicine, the prevalent use of laparoscopic gastric banding
can no longer be justified.
“  Dr.’s Guller, Klein and
Hagen from the Center for Excellence in Bariatric Surgery,
University of Toronto, Department of Surgery, Ontario, Canada.
uguller@yahoo.com


Furthermore, they state: “There is
mounting and convincing evidence that laparoscopic gastric
banding is suboptimal at best
in the management of morbid
obesity. “
“Although short-term morbidity is low and hospital length of
stay is short, the rates of long-term complications and band
removals are high, and failure to lose weight after laparoscopic
gastric banding is prevalent.”

Read more at clos.net