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New organisation

A new organisation – The MGB/OAGB Club

New organisation formed at IFSO 2015 World Congress in Vienna

Having performed the other bariatric operations, Dr Robert Rutledge (following a similar reconstruction on an abdominal gunshot wound) conceived the Mini-Gastric Bypass (MGB) in 1997. Despite scepticism by other bariatric surgeons, he persisted in his findings that this is a superior bariatric operation. The MGB (Figure 1) has since been adopted by a large number of bariatric surgeons. Dr Rutledge and others have followed and reported on thousands of MGBs with excellent results.

Figure 1: MGB created by horizontal division ~3cm distal to crow’s foot, and then vertical division upwards (~18cm length) to the left of the angle of His. Antecolic gastrojejunostomy is performed 200cm (varied as indicated) distal to Treitz’ ligament

In 2002, Dr Miguel A Carbajo and Dr Manuel Garciacaballero in Spain modified the MGB to the One Anastomosis Gastric Bypass (OAGB or BAGUA in Spanish), by adding an anti-reflux mechanism to prevent gastro-oesophageal bile reflux by means of a latero-lateral gastroenteric anastomosis between the side of the gastric pouch and the afferent loop (suspended 8-10cm above the anastomosis through an initial continuous suture which secures the loop to the gastric pouch´s staple-line, with final fixation of the loop's apex to the excluded stomach (Figures 2 and 3)). They have numerous disciples worldwide.

Figure 2: OAGB with gastric pouch (~15cm) and latero-lateral anastomosis between pouch and afferent loop which is suspended ~ 8-10cm above the anastomosis through an initial continuous suture which secures the loop to the gastric pouch’s staple-line and with final fixation of the loop´s apex to the excluded stomach. Biliopancreatic limb averages 250-350cm

These two procedures are now mainstream. Whether the MGB channel constructed at 3cm distal to crow’s foot provides equal antireflux to the OAGB variant is presently unknown.
Other names recently introduced for the MGB/OAGB dilute the number of papers reported and merely add confusion.

Figure 3: Presentation by Dr Rutledge in Spain 12 years ago

Organisation of the MGB/OAGB Club

Interested bariatric surgeons had met in Paris (2012 and 2013), Montreal 2014, and now in Vienna with >150 attendees, for colloquia on the MGB/OAGB by experts. At the MGB Conclave in New Delhi (July 2015), it was decided to create a formal organisation. Thus, during the 20th Congress of IFSO in Vienna August 27 2015, a dinner-meeting of 42 bariatric surgeons was held to found the MGB/OAGB Club (Figure 4).

Figure 4: Founders of MGB/OAGB Club, Vienna August 27 2015

The positions below were decided, with a view to future annual scientific symposia. The President (Dr Kular) will hold office for two years, with ensuing Presidents (Musella and Garciacaballero) each holding office for one year. The Executive will guide in questions of membership, annual meetings, certification, etc., aided by a Board.

The designation “Club” indicates that this is a friendly and supportive academic organization. It is interested in dissemination of information about this rapid, generally safe procedure with excellent reversal of co-morbidities (94% resolution of diabetes), good quality of life, usual durable weight loss, easily revisable and reversible. At the Vienna course, Prasad and Bhandari demonstrated the ease of the procedure using robotics.

Director of the Club is Mervyn Deitel, Honorary President Robert Rutledge, Honorary Advisor Pradeep Chowbey. Executive: Arun Prasad, Miguel A Carbajo, Jean-Marc Chevallier, Gurvinder S Jammu, David Hargroder, Enrique Luque-de-León. Board: Om Tantia, Omar Fonseca G, Mohit Bhandari, Cesare Peraglie, Francesco Greco, Rui Ribeiro, Jan Apers, Francesco Greco, Emilio Manno, Roger Charles Luciani.

Founding Members were Fernando Ceron, Michal Cierny, Marcelo Luis Fage, Miguel Flores, Martino Guenzi, Luigi Piazza, Hector Pérez, Karl Rheinwalt, Antonio Susa, Villy Vage, Sergio Verboonen. Founding Associate Members: Ahmed M Forrig, Duc Vuong (figure 4).

The club has a website - www.mgb-oagb-org and Facebook page www.facebook.com/groups/mgboagbclub, which is private for Members but provides a membership application Form. The websites show discussions, clinical advice, papers, videos, meetings, etc. The Club now has >150 members. Members are those who have performed >100 MGB/OAGBs, or have done considerable organisational work, travelled and published for this operation. Associate Members are those performing MGB/OAGB with particular interest.

A list of key papers on MGB/OAGB is available from: book@obesitysurgery.com

The authors of this article were: Mervyn Deitel (Canada), Kuldeepak S Kular (India), Mario Musella (Italy), Miguel Carbajo (Spain) and Enrique Luque-de-León (Mexico)

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