Meeting Day Survey: Consensus Conference on the Mini-Bypass / One Anastomosis Bypass

Meeting Day Survey: Consensus Conference on the Mini-Bypass / One Anastomosis Bypass

Question Title

* 1. Physician ID

Question Title

* 2. Estimated Number (#) of General Surgery Operations in your Practice last year

Question Title

* 3. Number (#) of Bariatric Surgery Operations in your Practice last year

Question Title

* 4. I want a copy of this survey results Y/N

Question Title

* 5. You may contact me: Y/N

Question Title

* 6. Keep my information confidential Y/N

Question Title

* 7. Do you belive in Honor and Justice / Truth and Goodness?

Question Title

* 8. BandPts: Your Best Estimate/Expert Judgment of these *MEAN YEARLY* Values
(Your Program's or Your Opinion of Other's Actual Results)

Question Title

* 9. BandPts: Your Best Estimate/Expert Judgment of these *MEAN YEARLY* Values
(Your Program's or Your Opinion of Other's Actual Results)

Question Title

* 10. BandPts: Your Best Estimate/Expert Judgment of these *MEAN YEARLY* Values
(Your Program's or Your Opinion of Other's Actual Results)
WARNING: THIS Question Is VERY VERY Picky.
Please READ CAREFULLY!!!
Leave it Blank or Use ONLY, WHOLE NUMBERS.
Use only 1,2,3,4,5,6,7,8,9,0 For values < 0.5 use 0 for values => 0.5 use 1
NO Decimals, NO Percent Signs (%) No Periods (.) No Commas (,)
ONLY WHOLE NUMBERS!!!
NOTHING else is allowed

Question Title

* 11. SleevePts: Your Best Estimate/Expert Judgment of these *MEAN YEARLY* Values
(Your Program's or Your Opinion of Other's Actual Results)
WARNING: THIS Question Is VERY VERY Picky.
Please READ CAREFULLY!!!
Leave it Blank or Use ONLY, WHOLE NUMBERS.
Use only 1,2,3,4,5,6,7,8,9,0 For values < 0.5 use 0 for values => 0.5 use 1
NO Decimals, NO Percent Signs (%) No Periods (.) No Commas (,)
ONLY WHOLE NUMBERS!!!
NOTHING else is allowed

Question Title

* 12. RNYPts: Your Best Estimate/Expert Judgment of these *MEAN YEARLY* Values
(Your Program's or Your Opinion of Other's Actual Results)
WARNING: THIS Question Is VERY VERY Picky.
Please READ CAREFULLY!!!
Leave it Blank or Use ONLY, WHOLE NUMBERS.
Use only 1,2,3,4,5,6,7,8,9,0 For values < 0.5 use 0 for values => 0.5 use 1
NO Decimals, NO Percent Signs (%) No Periods (.) No Commas (,)
ONLY WHOLE NUMBERS!!!
NOTHING else is allowed

Question Title

* 13. MGB-OABPts: Your Best Estimate/Expert Judgment of these *MEAN YEARLY* Values
(Your Program's or Your Opinion of Other's Actual Results)
WARNING: THIS Question Is VERY VERY Picky.
Please READ CAREFULLY!!!
Leave it Blank or Use ONLY, WHOLE NUMBERS.
Use only 1,2,3,4,5,6,7,8,9,0 For values < 0.5 use 0 for values => 0.5 use 1
NO Decimals, NO Percent Signs (%) No Periods (.) No Commas (,)
ONLY WHOLE NUMBERS!!!
NOTHING else is allowed

Question Title

* 14. Your Opinion about the LAP BAND

Question Title

* 15. Your Opinion about the SLEEVE

Question Title

* 16. Your Opinion about the RNY

Question Title

* 17. Your Opinion about the Mini-Bypass / One Anastomosis Bypass

Question Title

* 18. Your Opinion of the Reason for Failure after the LAP BAND

Question Title

* 19. Your Opinion of the Reason for Failure after the SLEEVE

Question Title

* 20. Your Opinion of the Reason for Failure after the RNY

Question Title

* 21. Reason for Failure after the MGB / OAGB

Question Title

* 22. Band Survey: In a survey of over 2,000 patients on the results of the LAP BAND in their friends and family how do you think they answered

Question Title

* 23. Sleeve Survey: In a survey of over 2,000 patients on the results of the Sleeve in their friends and family how do you think they answered

Question Title

* 24. RNY Survey: In a survey of over 2,000 patients on the results of the RNY in their friends and family how do you think they answered

Question Title

* 25. MGB Survey: In a survey of over 2,000 patients on the results of the MGB in their friends and family how do you think they answered

Question Title

* 26. Did you once use the band in your practice and then stop?

Question Title

* 27. LAP BAND is a short simple operation

Question Title

* 28. The Sleeve is a short simple operation

Question Title

* 29. RNY is a short simple operation

Question Title

* 30. MGB is a short simple operation

Question Title

* 31. Band patients routinely get get major weight loss

Question Title

* 32. Sleeve patients routinely get get major weight loss

Question Title

* 33. RNY patients routinely get get major weight loss

Question Title

* 34. MGB patients routinely get get major weight loss

Question Title

* 35. LAP BAND patients rarely suffer from long term complications

Question Title

* 36. Sleeve patients rarely suffer from long term complications

Question Title

* 37. RNY patients rarely suffer from long term complications

Question Title

* 38. MGB patients rarely suffer from long term complications

Question Title

* 39. LAP BAND patients rarely regain their weight

Question Title

* 40. Sleeve patients rarely regain their weight

Question Title

* 41. RNY patients rarely regain their weight

Question Title

* 42. MGB patients rarely regain their weight

Question Title

* 43. Revision of LAP BAND is relatively easy

Question Title

* 44. Revision of the Sleeve is relatively easy

Question Title

* 45. Revision of RNY is relatively easy

Question Title

* 46. Revision of MGB is relatively easy

Question Title

* 47. Lap Band: GE Reflux / Nausea & Vomiting is Common

Question Title

* 48. Sleeve: GE Reflux / Nausea & Vomiting is Common

Question Title

* 49. RNY: GE Reflux / Nausea & Vomiting is Common

Question Title

* 50. MGB: GE Reflux / Nausea & Vomiting is Common

Question Title

* 51. Bile Reflux in MGB Patients

Question Title

* 52. I Fear that MGB patients can have an increased risk of gastric cancer from bile reflux

Question Title

* 53. Many large scale studies; No increased risk of Gastric Cancer after BII:
ie: 30 yr f/u, over 500 pts,"Risk of gastric cancer is * Not * increased after BII."
Bassily R, J Gastro Hepatl. 2000

Question Title

* 54. I understand the difference between "Association" and "Causation"

Question Title

* 55. Netherlands Study, 58,279 pts, 162 Stomach Cancers
Lower Education => Higher rate stomach cancer
Do you think; Lower Education "CAUSES" Stomach Cancer?

Question Title

* 56. Some studies, Slight increased risk of gastric cancer 20-30 years after Billroth II.
BUT patients have Billroth II for *ULCERS*
*Ulcer* & *Gastric Cancer* have Common Cause;
H. Pylori.

Question Title

* 57. Gastric Ulcer patients have double the risk for Gastric Cancer:
Am J Gastroent. 2007 Jun:1185

Question Title

* 58. Processed meats (bacon, sausage, hot dogs, etc.) shown to increase gastric cancer.
100 g of processed meat/d Increases Gastric Cancer 3.5 times; Natl Cancer Inst. 2006 Mar 1;98(5):345-54.
(Hint: A Hot Dog weight 3.7 oz = 100 g = INCREASED RISK 3.5!)
Which is more deadly a Hot Dog or a Billroth II?

Question Title

* 59. Gastric Cancer; Most Common Cancer Korea/Japan
Moving from Japan/Korea to USA Drops Risk to Low USA Rates.
Gastric Cancer is from Environmental Causes. 
(Smoking, H. Pylori, Diet: high salt intake, processed meats, salted, pickled, or smoked foods & low intake of green leafy veges & fruit)  World J Gastroent 2006 Jan 21;12(3):354 "Epidemiology of gastric cancer"

Question Title

* 60. Gastric Cancer Rates are Declining:
United States stomach cancer death rate has dropped from 28 to 5 per 100,000 people

Question Title

* 61. The long term risk of gastric cancer after MGB

Question Title

* 62. The long term risk of gastric cancer in the General Population

Question Title

* 63. I have recently reviewed the literature on gastric cancer and am very knowledgeable about the risk of gastric cancer

Question Title

* 64. The association between H pylori infection and the development of gastric cancer is well established

In 1994, the International Agency for Research on Cancer classified H pylori as a
Type I (definite) carcinogen in human beings.

Question Title

* 65. H. Pylori Treatment Normalizes Risk of Gastric Cancer in Ulcer Patients.

Early treatment of H. Pylori in Gastric Ulcer patients =>
Risk of Gastric Cancer decreased to NORMAL!
Decrease risk from 1.60 to 1.05 ( = general population);

"Early Helicobacter pylori eradication decreases risk of gastric cancer in patients with peptic ulcer disease."  Wu CY,et al.  Div of Gastro., Taichung, Taiwan

Question Title

* 66. Gastric cancer can be prevented by treating H. Pylori, eating a diet of fresh fruit and vegetables and avoiding smoking, alcohol and nitrates in preserved foods

Question Title

* 67. GERD Increases Risk of Cancer of Esophagus. Longer GERD = More Risk.

GERD can cause Barrett's = even higher risk, from the American Cancer Society.

JAMA. 2002 Apr 17;287(15):1972-81. Gastroesophageal reflux, barrett esophagus, and esophageal cancer: scientific review. Shaheen N, Ransohoff DF. Division of Digestive Diseases and Nutrition, Center for Esophageal Disease and Swallowing, CB#7080, University of North Carolina-Chapel Hill, Chapel Hill, NC 27599-7080, USA. nshaheen@med.unc.edu

Question Title

* 68. Treating or Avoiding GERD may protect & prevent Barrett's & Esophageal cancer.

Question Title

* 69. Numerous Studies Now Show that the Band and the Sleeve can increase acid reflux and be associated with Barretts & Esophageal Caner.

Dis Esophagus. 2011 Jan;24(1):E8-10. Esophageal adenocarcinoma after laparoscopic gastric band placement for obesity Stauffer JA, Mathew J, Odell JA, Department of General Surgery, Mayo Clinic, Jacksonville, Florida, USA.

Ann Surg. 2010 Aug;252(2):319-24. Long-term results of laparoscopic sleeve gastrectomy for obesity. Himpens J, Division of Bariatric Surgery, AZ St-Blasius, Kroonveldlaan, Dendermonde, Belgium.

Obes Facts. 2011;4 Suppl 1:42-6. Epub 2011 Apr 4. Failure of laparoscopic sleeve gastrectomy--further procedure? Weiner RA, Theodoridou S, Weiner S. Department of Surgery, Krankenhaus Sachsenhausen, Frankfurt/M, Germany. rweiner@khs-ffm.de

Surg Obes Relat Dis. 2011 Nov-Dec;7(6):709-13. Epub 2011 Aug 16. Gastroesophageal reflux after sleeve gastrectomy in morbidly obese patients. Howard DD, Caban AM, Cendan JC, Ben-David K. Department of Surgery, Minimally Invasive, Gastroesophageal and Bariatric Surgery Service, University of Florida, Gainesville, Florida 32610, USA.

Obes Surg. 2010 Feb;20(2):244-6. Epub 2009 Dec 8, Barrett's esophagus: a late complication of laparoscopic adjustable gastric banding, Varela JE., Minimally Invasive and Bariatric Surgery, Washington University, 660 South Euclid, Box 8109, St Louis, MO 63110, USA. varelae@wudosis.wustl.edu

Question Title

* 70. Gastrectomy for peptic ulcer disease does not increase the risk of *Esophageal* cancer:

Eur J Cancer. 2012 Mar;48(5):749 "The risk of oesophageal adenocarcinoma after gastrectomy for peptic ulcer disease.
Lagergren J, Lindam A. Upper Gastrointestinal Research, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden

Question Title

* 71. Mortality Rate in Bowel Obstruction

Question Title

* 72. Oncologic Surgeons Use the Billroth II

Oncologic Surgeons have reported over 800 articles recently of
Distal Gastrectomy and Billroth II for Distal Gastric Cancer,

Including more than 20 in the first 3 month 2012.

Question Title

* 73. Most Gastroenterologists DO NOT recommend follow up screening endoscopy in Billroth II patients because of the low risk of gastric cancer

Question Title

* 74. There were approximately 40 deaths from stomach cancer per 1,000,000 population in USA 2009.
= Median age at death for cancer of the stomach 73 years
= 2/3 stomach cancer patients are > 65
Howlader N, Noone AM, Krapcho M, Neyman N, Aminou R, Altekruse SF, Kosary CL, Ruhl J, Tatalovich Z, Cho H, Mariotto A, Eisner MP, Lewis DR, Chen HS, Feuer EJ, Cronin KA (eds). SEER Cancer Statistics Review, 1975-2009 (Vintage 2009 Populations), National Cancer Institute. Bethesda, MD, http://seer.cancer.gov/csr/1975_2009_pops09/, based on November 2011 SEER data submission, posted to the SEER web site, 2012.

Question Title

* 75. Endoscopy of MGB patients by Cevallier in France, Kular in India and Carbajo in Spain shows no dysplasia at 4+ years.

Question Title

* 76. According to the National Inpatient Sample from USA, over 16,000 Billroth II operations were performed in 2007 in the USA.
The Nationwide Inpatient Sample (NIS) is a unique and powerful database of hospital inpatient stays. Researchers and policymakers use the NIS to identify, track, and analyze national trends in health care utilization, access, charges, quality, and outcomes.

Question Title

* 77. Korea has the Highest Risk of Gastric Cancer in the World.  

In April 2012 two different papers by Oncologic Surgeons from Korea (379 cases) and China (70 cases) reported on 2 series of Laparosocpic Antrectomy & Billroth II for distal Gastric Cancer.    

In the first 3 months of 2012 there 20 other similar papers.  

Antrectomy & Billroth II by these surgeons was a  *reasonable and acceptable* surgical choice.

Question Title

* 78. A Billroth II gastro-jejunostomy is a common and accepted reconstruction after antretomy;
A BII * IS NOT * an acceptable reconstruction following total or sub total gastrectomy
because of bile reflux into the esophagus.

Question Title

* 79. Billroth II with anastomosis at the junction of the body and the antrum of the stomach in the Mini-Gastric Bypass / One Anastomosis Gastric Bypass is a *reasonable and acceptable* surgical choice.    

The OLD Mason Loop Gastric Bypass placed the Billroth II high on the stomach adjacent to the esophagus, NOT *reasonable or acceptable* and could be predicted to fail.

Question Title

* 80. A CRITICAL FACTOR in avoiding bile reflux in the Mini-Gastric Bypass / One Anastomosis Gastric Bypass is a ** LONG NARROW GASTRIC POUCH ** placing the gastro-jejunostomy well into the antrum of the stomach.
A SHORT GASTRIC POUCH will routinely lead to crippling bile reflux!

Question Title

* 81. A CRITICAL SUCCESS FACTOR in the MGB is NARROW Gastric Pouch with a Non-Obstructing Outlet. This allows intra-abdominal pressure to close the pouch like a flap valve, reducing reflux

Question Title

* 82. A CRITICAL SUCCESS FACTOR of the MGB is the Long (2 meter) Bypass. The Bypass adds approximately 50% to the weight loss of the sleeve type gastric pouch (i.e. mean weight loss with sleeve = 35 kg mean weight loss with the sleeve + bypass = 70 kg)

Question Title

* 83. Warning: 90% of Leaks after the Sleeve are from the EG junction. In the MGB it is a
CRITICAL SUCCESS FACTOR to AVOID dissection of the EG junction!!!

Question Title

* 84. Managing a Anastomotic LEAK after MGB is Straight-forward:
Day 1-3 = Laparoscopic Repair of Leak or
Day 5-10 = Complete Take Down of G-J, Gastro-gastrostomy, Drain, NG 7 days

Question Title

* 85. The Most Dangerous Long Term Complication of MGB is Marginal Ulcer (Rate 0.3 - 5%)
Marginal ulcers one of the most problematic complications RNY. (Rate 1 - 16%).
The true incidence is likely much higher

Question Title

* 86. Do You Offer the Mini-Gastric Bypass / One Anastomosis Gastric Bypass?

Question Title

* 87. The "Mini-Gastric Bypass" may not be the best name. Should the MGB name be changed?

Question Title

* 88. What topics would you most like discussed at this Consensus Conference on the Mini-Gastric Bypass / One Anastomosis Gastric Bypass

Question Title

* 89. Are there any questions you would like to be addressed at this event?

( Privacy & Cookie Notice

T