failure of sleeve & band
DESCRIPTION
Failure of Sleeve & Band.Power of Mini-Gastric Bypass.& Successful Treatment of Obesity & Diabetes!TRANSCRIPT
First International Consensus Conference on the Mini-Bypass /
One Anastomosis Bypass
Paris 2012 October 18-19
Email [email protected]
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, [email protected].
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