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Mini-Gastric Bypass

Dr Robert Rutledge and the ‘Mini-Gastric Bypass’ (Part 3)

The MGB and the Carbajo one-anastomosis gastric bypass (OAGB) are similar procedures and both are very effective in the right hands
It is crucial that surgeons understand the specific differences between the procedures, because when done incorrectly it can lead to poor outcomes

In the final part of his interview, Dr Robert Rutledge outlines why it is important that surgeons recognise the unique characteristics of the MGB and the Carbajo one-anastomosis gastric bypass (OAGB), why he is working to standardise the operation hoping to help surgeons learn to apply the operation safely and effectively, and he encourages surgeons to attend the inaugural MGBCON2016 meeting...

The naming of the MGB has been somewhat contentious, especially as there are people performing variations of the procedure. According to Rutledge, the MGB and the Carbajo one-anastomosis gastric bypass (OAGB) are similar procedures and both are very effective in the right hands.

“It is my opinion that any ‘single’ anastomosis operation is an MGB. It is not true to say that anything with a single anastomosis is the same operation.”

“The important thing is that surgeons must use the correct technique if they are going to perform a MGB. In addition, if you are going to perform an OAGB a surgeon must follow the correct technique first described by the wonderful surgeon, Dr Miguel Carbajo.”

The definitions of the MGB and the OAGB proedures have been clearly stated and pertain to the very particular anatomy and physiology of those procedures. But he warned that some surgeons have altered the technique and therefore they are not MGB or OAGB procedures, but a different procedure that is resulting in complications.

“It is my opinion that any ‘single’ anastomosis operation is an MGB. It is not true to say that anything with a single anastomosis is the same operation. We think it is important that if you are performing any surgery you should know the underlying anatomy and physiology, and learn and educate yourself on the performance of the procedure. We feel it is important that new MGB surgeons should adhere to the correct technique for the procedure, because this helps to maintain standards and informs the patients about what procedure they will receive.”

This may sound obvious, he added, but it is crucial that surgeons understand the specific differences between the procedures, because when done incorrectly it can lead to poor outcomes.

from left: Arun Prasad, Kuldeepak Singh Kular, Mervyn Deitel and Robert Rutledge at the Mini Gastric Bypass Conclave Meeting in New Dheli, July 2016

MGBCON2016

Rutledge said that there is a generation of surgeons who are experienced and confident in sleeve and bypass procedures. Nevertheless, at international meetings, online and in the published literature often these ‘new’ MGB surgeons misunderstand many of the basics of the MGB. He added that experience with the band, the sleeve and Roux-en-Y does not always lead to the use of optimal technique when performing the MGB.

“This is not a criticism - when understanding a new procedure there is a learning curve for any surgeon. But, surgeons must appreciate of the effectiveness and power of the MGB procedure. Having developed and taught the MGB procedure, we have noticed that some surgeons are making errors when performing the procedure because they are unfamiliar with the anatomy and physiology of the procedure.”

As a result, there will be a new meeting - MGBCON2016 - in London 19-20 August 2016. The purpose of this conference will be to show surgeons how to perform the procedure. MGBCON2016, will be hosted and organised by the MGB/OAGB International Club, who have sent out a survey to over 60 surgeons, and another 40 surgeons have agreed to answer the surgery, and are planning to publish a consensus paper at the meeting.

“We are also thinking about creating a 3-level MGB Certification of Recognition, the elements of which will be determined at the conference. The idea is surgeons would demonstrate their level of competence by answering a questionnaire, showing us their surgical competence via videos and sending us their results so we can assess their performance. Depending on their competence they would receive a gold, silver of bronze certificate. However, this is all under discussion at the moment. The aim is to raise surgical standards and increase the protection of patients through education.”

“My main concern at the moment is not whether the MGB is a valid procedure, I think we have now shown that it is, but to teach the few tips and tricks so that the MGB will be performed correctly.”

The organisers are hoping that two groups of surgeons will come to the meeting – experts and those who are interested in the procedure. This is not going to be an exclusive meeting, he added, and anyone with an interest in MGB/OAGB is welcome to attend.

Overall, he said that the MGB is an adaptable procedure depending on the wishes of the patient and must be adapted to suit the individual patient – it can treat the thin diabetic with no weight loss, or the obese and the super-obese. He added that the MGB can usually be performed in a 20-30 mins procedure in the hands of an experienced surgeon with one day hospital stay and long term durability. If it is not suitable for that patient it is revisable in the same amount of time. But, he cautioned, the procedure should only be considered by very experienced surgeons and surgeons who are new to the procedure should remain conservative in their approach.

“Our future is metabolic surgery. Even the best medical treatment of diabetes does not remove the risk of blindness, stroke, kidney disease and amputation. What we have is a growing wave of diabetes, predominantly brought about by the obesity epidemic and MGB can markedly improve and/or resolve both,” he concluded. “I look back on my career and am happy that I was right about the benefits of the MGB.  OK, so it has taken 20 years for some people to be convinced but I don’t mind scepticism, I don’t mind criticism, as long as it is balanced and justified. My main concern at the moment is not whether the MGB is a valid procedure, I think we have now shown that it is, but to teach the few tips and tricks so that the MGB will be performed correctly.”

To here more about MGBCON2016 meeting, please click on the image above or click here

Click here to read Dr Robert Rutledge and the ‘Mini-Gastric Bypass’ (Part 1)

Click here to read Dr Robert Rutledge and the ‘Mini-Gastric Bypass’ (Part 2)

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