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Mini-Gastric Bypass Done WRONGWRONG
Dr. RutledgeDr. Rutledge
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...
No No NoThis is NOT an Mini-Gastric BypassThis is NOT an Mini-Gastric Bypass
Edward E. Mason, MD, PhDNOT Mini-Gastric BypassNOT Mini-Gastric Bypass
NOT NOT Mini-Gastric Mini-Gastric
BypassBypass
Surgeons are FoolishConfusing Old Mason Loop w MGBConfusing Old Mason Loop w MGB
Gastro-Gastro-JejunostomyJejunostomy
MGB Gastro-Jejunostomyat the Level of the Transverse Colon
Bowel LoopBowel Loop
Gastro-Gastro-JejunostomyJejunostomy
Gastric PouchGastric Pouch
For Example:Bird's Beak Defect
Short PouchShort Pouch
Bird's Beak DefectBird's Beak Defect
WrongThis is Not an MGB!
Short PouchShort Pouch
Old Mason Loop Bypass Error!Old Mason Loop Bypass Error!
Mini-Gastric BypassDone Right
LONGLONG Gastric Pouch Gastric Pouch
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
Distal Gastrectomy/Antrectomy
• Understand AnatomyUnderstand Anatomy• EsophagusEsophagus• Body Body • AntrumAntrum• Antrectomy + Billroth II Antrectomy + Billroth II
= Routine General = Routine General SurgerySurgery
Distal Gastrectomy + Billroth II= Routine General Surgery
MGB = Antrectomy w Billroth IIRoutine General Surgery!
Total/Subtotal Gastrectomy
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
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
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
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
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