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

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Gastric Bypass Outperforms the Band!

The bottom line: Dr. Campos and his team noted that the patients who underwent gastric bypass: *achieved greater weight loss, *had a higher rate of diabetes remission, * experience greater improvement in their quality of life
The researchers concluded that the gastric bypass surgery might be better than the band.

200 patients with severe obesity underwent gastric banding surgery and half who had gastric bypass surgery.

The subjects who had gastric bypass surgery lost an average of **64%** of their excess weight, whereas the gastric banding patients only lost **36%** of their excess weight.

What’s really striking is the effect gastric bypass had on type 2 diabetes.

76% of the gastric bypass patients with DM experienced remission, compared to 50% of band patients.

After one year 75% of bypass patients who started on insulin no longer needed it; only 17% of the band patients were able to go off insulin.

Band patients had a higher risk of re-operation

Amplify’d from health.yahoo.net

Johns Hopkins

Gastric Bypass Surgery: Better than the Gastric Band?

A study released published in the February issue of JAMA’s Archives
of Surgery
now provides a good comparison between the two main surgical
procedures for weight loss, gastric bypass surgery and gastric band
surgery
.

This is big news, since over 220,000 gastric bypass
and gastric banding surgeries are done in the U.S. every year. The new study
provides consumers and physicians with much more information when they are
deciding which procedure is best.

Currently, insurance companies cover this surgery for
persons with a BMI of 35 or greater who have significant medical issues, or with a
BMI of 40 or greater without health problems. Now the FDA has lowered the BMI requirement to 30 for gastric band surgery after research concluded that it is an effective treatment for obesity in this group, although these
patients are not yet covered by insurance.

So what’s the difference?

In gastric bypass surgery (technically known to clinicians
as Roux-en-Y gastric bypass), the surgeon makes the football-sized stomach much smaller, reducing it to
the size of a small egg. When genuine hunger pangs return about 6 months after surgery, this new
egg-sized stomach (known as a pouch) will help the person to feel full
even after very small meals.

This
operation bypasses the duodenum, or first part of the small intestine and, for
reasons that are not yet fully understood, brings about significant
weight-friendly changes in the body. First, the surgery increases the metabolism
(the rate at which calories are burned) for several months, and it also makes
hunger pangs disappear for at least 6 months after the operation.

Gastric bypass surgery is
considered by many experts in weight-loss surgery to be a gold standard for
diabetes treatment because the brain becomes content at a lower set point or “happy weight.”
This fine-tuning can actually help change insulin receptors.

The gastric band procedure, on the other hand, is a purely
restrictive solution to weight loss that surgically positions a silicone band near
the top of a person’s stomach. The clinician tightens the band by injecting saline into it. The tighter the band, the smaller the stomach and the smaller the amount of solid food a person can eat at a meal.
This method is adjustable and reversible.

Which one is more effective?

Dr. Guilherme Campos, an experienced bariatric surgeon and
researcher out of the University of Wisconsin School of Medicine and Public
Health in Madison, has completed a well-designed study that compared various
measures of success for the gastric band and gastric bypass surgeries.

He looked at 200 patients with severe obesity—all with BMIs
of 40 or greater—half who underwent gastric banding surgery and half who
had gastric bypass surgery. Patients in both groups were matched by sex, race, age, and initial BMI. The differences in the two groups’ outcomes were quite
significant. Interestingly, the subjects who had gastric bypass surgery lost an
average of 64 percent of their excess weight, whereas the gastric banding
patients only lost 36 percent of their excess weight. What’s more, 86 percent of the gastric bypass patients lost
more than 40 percent of their extra weight, compared to just 31 percent of the
band patients.

What’s really striking is the effect gastric bypass had on type 2 diabetes. Thirty-four subjects in each group had type 2 diabetes mellitus (DM).
At the study’s end, 76 percent of the gastric bypass patients with DM experienced
remission, compared to 50 percent of band patients. After one year of
follow-up, 75 percent of those gastric bypass patients who started the study on
insulin no longer needed it; only 17 percent of the band patients in this
category were able to go off insulin.

Both procedures caused comparable numbers of complications
(15 percent in the gastric bypass group vs. 12 percent in the band group),
although early complications (within the first month after surgery) were higher
in the gastric bypass group (11 percent vs. 2 percent). Band patients,
however, had a higher risk of re-operation (that is, of having to go back into
the OR because the band slipped, etc.). No one died in either group. 

The bottom line

Dr. Campos and his team noted that the patients who underwent gastric bypass surgery

  • achieved greater weight loss
  • had a higher rate of diabetes remission
  • experience greater improvement in their quality of life

The researchers therefore concluded that the benefit/risk
profile of gastric bypass surgery might be better than the gastric
band.

But the process of choosing the
best weight-loss surgery procedure is more complex than this. If your BMI meets the weight loss criteria for surgery, I highly recommend that you do extensive research and find a bariatric Center of Excellence, which ensures
that the surgeons and staff have done a large number of these procedures
and follow high standards of practice.

Read more at health.yahoo.net

 

Effects of Gastric Bypass Surgery on Ghrelin

Effects of Gastric Bypass Surgery on Ghrelin

Paradoxically “Fasting serum ghrelin levels were ** lower ** in obese subjects compared with controls “

Despite a 10% weight loss, fasting serum ghrelin levels were paradoxically further decreased in obese subjects 6 weeks after RYGBP

Amplify’d from www.nature.com

Obesity Research (2004) 12, 1108–1116; doi: 10.1038/oby.2004.139

Short-Term Effects of Gastric Bypass Surgery on Circulating Ghrelin Levels**

Rosa Morínigo
  1. *Obesity Unit, Clínic Universitari, Barcelona, Spain
  1. Hormonal Unit, Hospital Clínic Universitari, Barcelona, Spain

Abstract

Objective: To prospectively evaluate the short-term effects of Roux-en-Y gastric bypass (RYGBP) on ghrelin secretion and its relevance on food intake and body weight changes.

Results: Fasting serum ghrelin levels were lower in obese subjects compared with controls (p < 0.05). Meal ingestion significantly suppressed ghrelin concentration in controls (p < 0.05) and obese subjects (p < 0.05), albeit to a lesser degree in the latter group (p < 0.05). Despite a 10.3 plusminus 1.5% weight loss, fasting serum ghrelin levels were paradoxically further decreased in obese subjects 6 weeks after RYGBP (p < 0.05). Moreover, at this time-point, food intake did not elicit a significant ghrelin suppression. The changes in ghrelin secretion after RYGBP correlated with changes in insulin sensitivity (p < 0.05) and caloric intake (p < 0.05).

Discussion: This study showed that the adaptive response of ghrelin to body weight loss was already impaired 6 weeks after RYGBP. Our study provides circumstantial evidence for the potential role of ghrelin in the negative energy balance in RYGBP-operated patients.

Read more at www.nature.com