Mgb Done Wrong

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Mini-Gastric Bypass Done WRONG WRONG Dr. Rutledge Dr. Rutledge

Transcript of Mgb Done Wrong

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Mini-Gastric Bypass Done WRONGWRONG

Dr. RutledgeDr. Rutledge

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Mini-Gastric Bypass

• Anyone can do a “single Anyone can do a “single anastomosis gastric bypass”anastomosis gastric bypass”• That Does Not mean they That Does Not mean they

can/are doing the true can/are doing the true “Mini-Gastric Bypass” (MGB)“Mini-Gastric Bypass” (MGB)• See the Following Example...See the Following Example...

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No No NoThis is NOT an Mini-Gastric BypassThis is NOT an Mini-Gastric Bypass

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Edward E. Mason, MD, PhDNOT Mini-Gastric BypassNOT Mini-Gastric Bypass

NOT NOT Mini-Gastric Mini-Gastric

BypassBypass

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Surgeons are FoolishConfusing Old Mason Loop w MGBConfusing Old Mason Loop w MGB

Gastro-Gastro-JejunostomyJejunostomy

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MGB Gastro-Jejunostomyat the Level of the Transverse Colon

Bowel LoopBowel Loop

Gastro-Gastro-JejunostomyJejunostomy

Gastric PouchGastric Pouch

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For Example:Bird's Beak Defect

Short PouchShort Pouch

Bird's Beak DefectBird's Beak Defect

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WrongThis is Not an MGB!

Short PouchShort Pouch

Old Mason Loop Bypass Error!Old Mason Loop Bypass Error!

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Mini-Gastric BypassDone Right

LONGLONG Gastric Pouch Gastric Pouch

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Surgeons Need to Understand Basic General Surgery

• Misunderstanding BasicsMisunderstanding Basicsof General Surgeryof General Surgery• Difference betweenDifference between

Total/Subtotal GastrectomyTotal/Subtotal GastrectomyVs.Vs.Distal Gastrectomy/AntrectomyDistal Gastrectomy/Antrectomy

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Distal Gastrectomy/Antrectomy

• Understand AnatomyUnderstand Anatomy• EsophagusEsophagus• Body Body • AntrumAntrum• Antrectomy + Billroth II Antrectomy + Billroth II

= Routine General = Routine General SurgerySurgery

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Distal Gastrectomy + Billroth II= Routine General Surgery

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MGB = Antrectomy w Billroth IIRoutine General Surgery!

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Total/Subtotal Gastrectomy

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Total/Subtotal GastrectomyBasic General Surgery: Basic General Surgery:

Total/Subtotal GastrectomyTotal/Subtotal GastrectomyNever Reconstruct with Loop Billroth IINever Reconstruct with Loop Billroth II

Only RNYOnly RNY

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Mason LoopViolation of Basic General Surgery

• Basic General SurgeryBasic General Surgery• Total/Subtotal Gastrectomy Total/Subtotal Gastrectomy

NEVER Reconstruct w NEVER Reconstruct w Loop!Loop!

• Mason Loop BypassMason Loop BypassReconstruct w Loop Reconstruct w Loop

• Thus Mason Loop => Thus Mason Loop => FailureFailure

• Violation of Basic General Violation of Basic General Surgical PrinciplesSurgical Principles

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Mason LoopViolation of Basic General Surgery

• Mason Loop BypassMason Loop BypassReconstruct w Loop Reconstruct w Loop

• Thus Mason Loop Thus Mason Loop => Failure=> Failure

• Violation of Basic Violation of Basic General Surgical General Surgical PrinciplesPrinciples

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Total/Subtotal Gastrectomy• Basic General SurgeryBasic General Surgery• NEVER ReconstructNEVER Reconstructw Billroth IIw Billroth II• NEVER ReconstructNEVER Reconstructw Billroth IIw Billroth II• NEVER ReconstructNEVER Reconstructw Billroth IIw Billroth II• NEVER ReconstructNEVER Reconstructw Billroth IIw Billroth II

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Conclusion

• Mini-Gastric BypassMini-Gastric BypassShown to be an excellent Shown to be an excellent operationoperation• But Many New Surgeons Do But Many New Surgeons Do

Not Know the Critical Factors Not Know the Critical Factors to Do the MGB Correctlyto Do the MGB Correctly