The Story for Mini-Gastric Bypass

The Story for Mini-Gastric Bypass

Much like those who struggle with their weight must endure the unjust persecutions of a cruel society; the Mini-Gastric Bypass has endured its own share of unfair mistreatment through the years. It is for this reason that I was motivated to share its story.

It all started one late night in the fall of 1997 when Dr. Robert Rutledge, a professor of surgery at North Carolina State University School of medicine was on trauma call. A drug deal gone badly resulted in a multiple gunshot wound victim arriving at the hospital in need of emergency surgery. Six bullets penetrated the drug dealer’s abdomen, injuring his stomach, intestine, spleen and pancreas. After removing the injured organs, Dr. Rutledge did what any trauma surgeon would do when faced with the injuries that this patient had; he brought up a loop of small intestine and connected it to the bottom of the stomach. This configuration of stomach connected to small intestine is referred to as a Billroth II anastomosis.

Trauma surgery was not Dr. Ruteldge’s only area of expertise. He was also a bariatric surgeon, and when he wasn’t taking care of gunshot wounds and stabbings, he was caring for obese patients by performing the laparoscopic Roux-en-Y gastric bypass. As a matter of fact, Dr. Rutledge was one of the first surgeons in the country to offer the laparoscopic approach for weight loss to his patients.

It just so happened that the following morning, he had a laparoscopic Roux-en-Y procedure scheduled for an operating room nurse who is also his friend. With the gunshot wound case fresh on his mind, he made a crazy proposition to his patient. He suggested that instead of performing a standard Roux-en-Y as had been previously planned, that he simply bring up a loop of small bowel to the stomach much like he done for his gunshot patient. Because of her OR nursing experience, she was very familiar with the Billroth II anastomosis Dr. Rutledge was referring to. With her consent, Dr. Rutledge performed the first Mini-Gastric Bypass.

A few years later, at the 2000 annual meeting of the American Society for Bariatric Surgeons, Dr. Rutledge would champion his new approach to weight loss by presenting a paper reporting on the outcomes of his first 1,200 patients. By all measures, his data showed that the Mini-Gastric Bypass was as good as, if not better than, the popular Roux-en-Y gastric bypass. Operating time was shorter, length of hospital stay was shorter, complication rates were fewer, and weight loss was comparable to the Roux-en-Y. Yet when Dr. Rutledge finished his presentation, he was virtually booed off the stage. The next two speakers waived their time so the discussion could continue as the audience of bariatric surgeons stood up to voice their opinions and more precisely, their opposition.

You see, the old loop bypass had been tried before. “Dr. Mason abandoned that operation over 30 years ago!” they said. “These patients will end up with terrible bile reflux and maybe even stomach cancer.”. “Why in the world would Dr. Rutledge’s results be any different than those of Dr. Mason?”.

Not moved by the negative criticisms, Dr. Rutledge continued to promote the Mini-Gastric Bypass as a safer and simpler approach to weight loss. He invited several of his colleagues to co-author a paper with him, comparing the results of his MGB with their sacred cow, the Roux-en-Y. He had no takers.

Over the next several years, Dr. Rutledge was able to find only a handful of surgeons who were willing to look at the data objectively and join his movement. I was his first. Dr. Rutledge took me under his wing and showed why the MGB was not the same as the old Mason loop procedure. The configuration of the stomach pouch was the key. While Dr. Mason created his stomach pouch at the top of the stomach, Dr. Rutledge created a long tubular stomach that included the lower portion of the stomach. This minor modification of Dr. Mason’s procedure completely changed the mechanics, the risks, and the outcomes. The fact that Dr. Rutledge had literally thousands of patients who had undergone the MGB with excellent results, his claims were not just theoretical, he had the data to back up his claims. This didn’t seem to matter to the movers and shakers in the American bariatric world.

Fortunately, academic surgeons from Europe and Asia began to evaluate the Mini-Gastric Bypass for themselves. All of these surgeons have been performing other types of bariatric surgery and all agreed that the Mini-Gastric Bypass is safe, simple, and effective.

Dr. Rutledge began to get invitations to teach his procedure all over the world. Through his dedication and perseverance, the Mini-Gastric Bypass was growing in popularity.

Since 2002 I have been performing the Mini-Gastric Bypass in the quiet little town of Joplin, Missouri. With well over 1,000 cases, my experience has been similar to those reported by surgeons from around the world, and yet, even my own hospital’s insurance policy would not cover the MGB for its employees.

A trip to Paris, France in October of 2013 for a meeting of MGB surgeons would reignite my enthusiasm and optimism that the tide might be changing. I realized at that moment that the MGB was actually starting to catch on. Any doubts that remained quickly vanished after attending the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) 19th World Congress in August of 2014. This week-long meeting of bariatric surgeons is a place where papers are presented, ideas are exchanged, and cutting edge technology is reviewed. Also at these meetings, surgeons can participate in various courses related to weight loss surgery. One of the courses at this year’s meeting was on the Mini-Gastric Bypass!


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