This document summarizes the results of a survey of 102 bariatric surgeons from around the world on their opinions of various weight loss procedures. The survey found that the experts judged the lap band as the worst procedure and the mini-gastric bypass (MGB) as the best procedure. Specifically, 46.4% said the band was a bad operation, while only 3.6% said the MGB was bad. Additionally, 67.9% of experts said the MGB was the best procedure, more than any other operation. The document concludes the MGB is a short, simple, and effective procedure that is durable long-term and better treats obesity and diabetes than restrictive procedures like the band or sleeve.

1. First International Consensus
Conference on the Mini-Bypass / One
Anastomosis Bypass
Paris 2012 October 18-19
Email DrR@CLOS.Net

2. Failure.
Power.
&
Success!

3. Failure of Sleeve & Band.
Power of Mini-Gastric Bypass.
&
Successful Treatment of
Obesity & Diabetes!

4. Expert Judgment of
Weight Loss Surgery
Procedures

5. 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?

6. Multidisciplinary Team
• For Cholecystectomy?
• Why no Multidisciplinary Team for
Gallbladder Surgery?
• Support Group?
• Pre Op Liquid Diet
• Psychiatric counseling?
• Dietician?
• No.
• Why?

7. No Multidisciplinary Team for
Cholecystectomy
Because
Cholecystectomy
Cures the Disease
of
Cholelithiasis

8. 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…

9. Multidisciplinary Team’s
Abuse 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)

10. What do the Experts Say?

11. 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. 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. 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. 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. 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%

16. These results are shown
graphically

17. 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.

18. 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.

19. Frequency of Negative Judgment

20. Frequency of Choice as
"Best" form of Surgery

21. Judgment of the Band

22. Judgment of the Sleeve

23. Judgment of the RNY

24. Judgment of the MGB/OAB
Highest Good / Lowest Bad

25. Success: Mini-Gastric Bypass
Simplicity, Power & Safety

26. Failed Sleeve to RNY; Sept 2012
Less 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, gautier.tho@gmail.com.

27. Band, Sleeve vs
the 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)

28. Band & Sleeve
Block Normal Healthy Foods
• Weight Loss =>
• Increased Hunger
• Decreased Satiety
• Healthy Foods Blocked
• Drive to Eat UP
• What Happens?

29. Band & Sleeve;
Block Intake Normal Healthy Food
Sleeve Band

30. Restrictive Procedures
• Successfully Block
Normal Healthy Diet
But
• They DO NOT BLOCK ...

31. Pathologic Dietary Choices
Calories:
Ice Cream 200g/540 cal,
2 Milky-way Bars, 1,000 cal
2 L Bottle Coke 830 cal
Total: 2,370 cal

32. Diet Induced
Increased Hunger

33. 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!

34. SOLUTION?

35. Diet Induced
Increased Hunger

36. Mini-Gastric Bypass
The Mongoose!

37. Mini-Gastric Bypass
• Blocks
Neuro-Humoral
Hunger System
• Short, Simple,
Durable, 30 minute
Surgery that:
• Decreases Hunger & The Mongoose
He is a Little Bit Ugly, No?
Increases Satiety

38. Mini-Gastric Bypass Decreases Hunger
Survey 2,783 Pts

39. 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.

40. IFSO Varianational Committee Survey
Over 100 Surgeons from Around the World:

41. MGB Best Rx Diabetes

42. Both Kular and Rutledge, Op Time < 40 min

45. Risk of
Esophageal
Cancer?

53. 30% Reflux &
Esophageal
Cancer?

54. Leaks
Surg Obes Relat Dis. 2008 Jul-Aug;4(4):528-33.
Laparoscopic sleeve gastrectomy:

55. Band/Sleeve
Road to Failure
Initial Weight Loss
Return of Hunger
Eat Normal Foods Eat Liquid Calories
Obstruction Weight
Acid Reflux/Cancer Regain

56. In Summary
• Restrictive Procedures Fail
• In as Little as 2 Years
• Restrictive Procedures Push Patients
towards Liquid Calories
• (Can a Sleeve stop Coke!)
• Weight Regain is Common
• Acid Reflux 30%+
• Acid Reflux = Esophageal Cancer

57. 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