GASTRIC VS. COMBINED GASTRO-INTESTINAL PROCEDURES FOR CONTROL OF OBESITY 1. Bariatric surgery history is replete with failed Primary Gastric Procedures for obesity, 2. Physiologically it is easy to see how an excess of 2, 000 calories a day can be ingested as liquid/soft calories (Coke and Cake) thus “Beating” the operations’ “gastric restriction” Band/Sleeve. 3. Studies in Gastric Cancer patients show that Combined Gastro-Intestinal Procedures outperform Primary Gastric Procedures 4. Primary Gastric Procedures can be predicted to fail even following initial success (see Lap Band(r))

1. a-00119
Dr. Robert RUTLEDGE
Title of Paper: GASTRIC VS. COMBINED GASTRO-INTESTINAL
PROCEDURES FOR CONTROL OF OBESITY
Nationality: United States of America
Position: Director
Department: Surgery
Organization: Center For Laparoscopic Obesity Surgery
Tel: +1-702 714 0011
E-mail: drr@clos.net

2. GASTRIC VS. COMBINED
GASTRO-INTESTINAL
PROCEDURES FOR CONTROL OF
OBESITY
Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
Obesity Surgery, United States of America

3. Introduction
• The history of bariatric surgery is filled with
failed
• Primary Gastric Procedures (PGP)
• (e.g. jaw wring, horizontal
gastroplasty, silicone ring and vertical
banded gastroplasty, LAP BAND, Sleeve
etc.)

4. Methods:
• Review of published studies of gastric
cancer patients treated with either
• 1. Primary Gastric Procedure (PGP) or
• 2. Combined Gastro-Intestinal
Procedure (CGIP) on weight loss and
diabetes.

5. Results PGP vs CGIP:
•
•
•
•
•
403 gastric cancer patients with DM.
PGP vs. CGIP
Reduction in BMI 7.6 vs. 11.4 (5)
Diabetes Improve/Resolve:
CGIP 37% vs. CGIP 52%
• (Outcome after gastrectomy in gastric cancer
patients ..., Kim et.al., Korea, World J Gastro
2012, Jan.)

6. Resolution of Diabetes
• 71% CGIP resolution improvement
• (Zervos “Amelioration of insulin requirement in
patients undergoing duodenal bypass for reasons
other than obesity...” J Am Coll Surg. 2010 May)

7. Results: PGP vs. CGIP
• 75 Gastric Cancer Patients 1996-2009
• Improvement in DM status was
• 7.5 times higher in CGIP than in PGP
patients
• (Kang "Influence of gastrectomy for stomach cancer
on type 2 diabetes mellitus..." J Korean Surg Soc
2012 Jun.)

8. Results PGP vs. CGIP
• 229 Gastric Cancer Patients,
• the DM remission or improvement rate
was higher in the CGIP than PGP group
• (67% vs. 49%, P=0.02)
• (Lee, “Comparative study of diabetes mellitus
resolution according to reconstruction type after
gastrectomy”, Obes Surg. 2012 Aug).

9. Conclusions:
• 1. Bariatric surgery history is replete with
failed Primary Gastric Procedures for
obesity,
• 2. Physiologically it is easy to see how an
excess of 2, 000 calories a day can be
ingested as liquid/soft calories (Coke and
Cake) thus “Beating” the operations’
“gastric restriction” Band/Sleeve.

10. Conclusions:
• 3. Studies in Gastric Cancer patients show
that Combined Gastro-Intestinal
Procedures outperform Primary Gastric
Procedures
• 4. Primary Gastric Procedures can be
predicted to fail even following initial
success (see Lap Band(r))

11. Conclusions
• 5, Operations designed to treat obesity
need long term treatment success should
have a Combined Gastro-Intestinal
Component.