1. Irrational Fear of Gastric Cancer: CHOOSING THE BEST WEIGHT LOSS SURGERY R Rutledge MD, The Centers for Laparoscopic Obesity Surgery www.CLOS.net Email: DrR@clos.net

5. Dr. Rutledge USA 001-702-714-0011 DrR@clos.net CONSIDERING THE MGB? MGB IS A SUPERB SURGERY BUT… WARNING: “ THERE ARE “TRICKS AND TRAPS ”

9. HUMAN DECISION MAKING ERRORS Recent Research in Psychology and Neurobiology Shows that: The Human Brain is a Notoriously Bad Decision Maker

12. PRIMITIVE RESPONSE SYSTEMS MODIFY RISK ASSESSMENT

16. SURGERY HISTORY OF POOR DECISIONS JOSEPH LISTER: AMERICAN SURGEONS DELAYED ADOPTION OF ANTISEPSIS 10 YEARS

20. Problem Definition: Bariatric Surgery: A HISTORY OF FAILURE Procedure Assessment Jejuno-ileal Bypass (Failure) Vertical Banded Gastroplasty (Failure) Lap Band (Fail?) RNY Bypass (Fail?) BPD/DS (Fail?) Sleeve: 5% Leak, 60-80% GE Reflux, Irreversible, Weight regain (Fail?)

21. 1. Low Risk 2. Major Weight Loss 3. Easily performed 4. Short operative times 5. Outpatient or short hospital stay 6. Minimal Blood Loss 7. No Need for ICU Stay 8. Minimal Pain 9. Very High Patient Satisfaction 10. A Good "Exit Strategy" SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY

22. SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY 11. Change Behavior & Preferences; Marked Decrease in Hunger and Increased Satiety 12. Minimal Retching and Vomiting 13. Few adhesions or hernias 14. Minimal impact on Heart and Lung Function 15. Low Failure Rate 16. Low Cost 17. Short Recovery Time 18. Rapid Return to Work 19. Low Risk of Pulmonary Embolus 20. Durable weight loss

23. SUCCESS CRITERIA "IDEAL" WEIGHT LOSS SURGERY 21. Low Risk of Ulcer 22. Fat Malabsorption; low cholesterol & CV risk 23. No Plastic Foreign Body 24. Easily Verifiable Results; > 10 years of Results 25. Low Risk of Bowel Obstruction 26. Based upon sound surgical principles 27. Independent confirmation of results 28. Healthy life after surgery 29. Supported by LEVEL I Evidence; RCT (Controlled Prospective Randomized Trial) 30. Block “Sweet Eater” Failures

27. C: Consequences / Results / Outcomes RNY Band SG MGB 1. Low Risk - + - + 2. Major Weight Loss + - - ++ 3. Easily performed - - + + + 4. Short operative times - + + + 5. Short hospital stay - - + + + 6. Minimal Blood Loss - + + + 7. No Need for ICU Stay - + + + 8. Minimal Pain - + + + 9. High Patient Satisfaction - - - + 10. A Good "Exit Strategy" - - - + - - +

28. C: Consequences / Results / Outcomes RNY Band Sleeve MGB 11. Decrease Hunger + - + + 12. Min Vomiting + + + + 13. No Internal hernias - + + + 14. Min Heart/Lung - + + + 15. Low Failure Rate - - - + 16. Low Cost - - - + 17. Short Recovery - + + + 18. Return to Work - + + + 19. Low Risk of PE - + + + 20. Durable Weight Loss - - - +

29. C: Consequences / Results / Outcomes RNY Band SG MGB 21. Low Risk of Ulcer - + + - 22. Malabsorption of fat + - - + 23. No Foreign Body + - + + 24. Verifiable Results - - - ++ 25. Bowel Obstruction - - + + ++ 26. Sound Surgical + - + + 27. Independent confirm - - - ++ 28. Healthy life - - - ++ 29. RCT; LEVEL I Evidence - - - ++ 30. Block Sweet Eater + - - ++

44. CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B A B

53. FEAR OF GASTRIC CANCER A Billroth II Probably Makes No Difference

54. FEAR OF GASTRIC CANCER A Billroth II Probably Makes No Difference

55. C: Consequences / Results / Outcomes RNY Band SG MGB 1. Low Risk - + - + 2. Major Weight Loss + - - ++ 3. Easily performed - - + + + 4. Short operative times - + + + 5. Short hospital stay - - + + + 6. Minimal Blood Loss - + + + 7. No Need for ICU Stay - + + + 8. Minimal Pain - + + + 9. High Patient Satisfaction - - - + 10. A Good "Exit Strategy" - - - + - - +

56. C: Consequences / Results / Outcomes RNY Band Sleeve MGB 11. Decrease Hunger + - + + 12. Min Vomiting + + + + 13. No Internal hernias - + + + 14. Min Heart/Lung - + + + 15. Low Failure Rate - - - + 16. Low Cost - - - + 17. Short Recovery - + + + 18. Return to Work - + + + 19. Low Risk of PE - + + + 20. Durable Weight Loss - - - +

57. C: Consequences / Results / Outcomes RNY Band SG MGB 21. Low Risk of Ulcer - + + - 22. Malabsorption of fat + - - + 23. No Foreign Body + - + + 24. Verifiable Results - - - ++ 25. Bowel Obstruction - - + + ++ 26. Sound Surgical + - + + 27. Independent confirm - - - ++ 28. Healthy life - - - ++ 29. RCT; LEVEL I Evidence - - - ++ 30. Block Sweet Eater + - - ++

63. CRITICS OF THE MINI-GASTRIC BYPASS SHOULD BE EMBARRASSED

64. Dr Rutledge; USA 001-702-714-0011 DrR@clos.net ARE YOU CONSIDERING THE MGB? WARNING: THERE ARE “TRICKS AND TRAPS”