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Dr. Robert RUTLEDGETitle of Paper: BLAMING THE VICTIM; NEED FOR A

MULTIDISCIPLINARY TEAM FOR BARIATRIC SURGERY, MINI-GASTRIC BYPASS

Nationality: United States of AmericaPosition: Director

Department: SurgeryOrganization: Center For Laparoscopic Obesity Surgery

Tel: +1-702 714 0011E-mail: drr@clos.net

BLAMING THE VICTIM; NO NEED FOR A

MULTIDISCIPLINARY TEAM FOR BARIATRIC SURGERY, MINI-

GASTRIC BYPASS

Robert RUTLEDGE11Director, Surgery, Center For Laparoscopic Obesity Surgery, United States of America

Gallbladder Disease

• Gall stones Cholecystitis• Cholecystectomy• Cure• No need for

Multidisciplinary Team• No need for psychologist,

dietitian, physical therapist, support group, multiple follow ups etc….

Introduction

• The results of numerous bariatric procedures is marked by failure.

• Patients' weight regain or Failure to lose weight is often attributed to Patients' failures,

• “A good operation sabotaged by a poor patient”• Many Believe that these failures can be

ameliorated by non-surgical support by the use of Multi-Disciplinary Team (MDT).

Introduction

• The hypothesis of this study was that the critical success factor for weight loss following bariatric surgery is the operative procedure and

• NOT patient motivation, education or use of a multidisciplinary team (MDT).

Corollaries

• Corollaries to the Primary hypothesis: • The WORSE the Bariatric Procedure;• The MORE Need for a Multi-Disciplinary

Team• Combination of an POOR procedure with• Excellent multidisciplinary team will still• Lead to POOR patient outcomes

Methods:

• Four surgeons offering the Mini-Gastric Bypass WITHOUT an MDT were queried as part of the

• First International Consensus Conference on the Mini-Bypass / One Anastomosis Bypass, Paris 2012 October 18-19.

• Patient results were assessed in these 7150 patients treated without MDT.

Results

• The results in patients with no MDT were excellent.

• Lost More than 50% of EW (%) in 83%. • Weight Loss "Failure" (%) 1.7% • Excess Weight Loss (%) was 79%. • Mean length of follow up was 5.4 years.

Results

• The rate of long term revision was 2.6%.

• Bowel obstruction rate was 0.3%. • Postop GE Reflux rate (%) 5.8%, • Marginal Ulcer rate was 2.4%.

Conclusions:

• The critical factor in excellent outcomes following bariatric surgery is likely

• NOT the presence or absence of patient motivation or a Multidisciplinary Team.

• The critical success factor in the outcome of the surgical treatment of obesity and metabolic diseases is

• An excellent, effective, low risk operative procedure.

MDT and Cholecystectomy

• No MDT is Needed post Cholecystectomy

• Why?

• Because the Operation Cures the Disease

For Discussion

• Imagine:

• Excellent Bariatric Procedure with

• Complete/Near Complete Resolution of

• Obesity and Associated Co-Morbities