needing some clarification re MGB PLEASE READ , THANKS :)

This message is so misinfomed I felt obliged to register and set the issue straight. How do you measure effectiveness, if it by weight loss then the MGB is VERY effective,  One of the things I liked about CLOS is that they make you become informed about different types of WL surgery so you go in with your eyes open. It seems to me from the CLOS Yahoo groups that there are a huge number of patients from Canada (there was one in my litter) AND they get the op under insurance unlike US citizens.  At 5.1 you will not have to put much weight on to qualify, CLOS want a BMI of at least 40 or 35 with Co-morbs, I am not sure about the insurance companies.  To say that the MGB is dangerous is nonsense, I had the surgery because it is one of the safest around, results on 4000+ patients showed the risks to be about half that of RnY,  For me what impressed was the reversal, it takes 3 hours to reverse a RnY and it is a complex procedure with a lot of risk.  With the MGB they disconnect the new stomach from the lower bowel and attach it to the original stomach which was left in place when the new stomach was formed by stapling.  The procedure takes about 35 minutes and has the same low risk as the original op, in fact probably less. There is no removal of the intestine, the surgical procedure is covered step by step in the paitent manual.  In fact one of the reasons the MGB is a safer operation is that there are less cuts which is why there is virtually no bleeding.  When you see the RnY on YouTube they always take the camera away while they do all the cutting.  The MGB simply connects the new stomach to the side of the bowel, the connection method has been used since the 1800's and is routinely performed in Cancer and Trauma operations.  Some people make the mistake of thinking the MGB is the old LOOP system it similar but it has important differences, most importantly is does not stretch or stress the connection.  The connection is also double connected first they staple it then they reinforce with stitches. Another key difference is the "pouch"  the RnY creates a horizonal pouch while the MGB creates a near vertical tube, the impact of this that in the MGB food passes through more quickly and has less time to be absorbed. Everyone has a slightly different reaction to WL surgery and to the MGB itself.  I used to have a lot of acid reflux and have had none since the op.  I asked an 8 year MGB veteran before my op and she told me she had 5 occurences in 8 years.  Typically with a 6ft MGB you will lose weight for 2 years although men lose weight faster, what you do in those two years determine the way ahead.  If you go back to bad habits you will regain some weight but not like before.  I know one MGB patient who stopped losing after 11 months and then 5 months later started losing again and lost 70 more in the second stage.  Your new stomach will stretch over those two years but you will still only manage 1/4 portions typically. If you stuff yourself with chocolate your body will obviously not do as well as if you eat a healthy diet.  Most people report that their tastes change and that they like more fruit.  Some tolerate fats less anyway. You have to weigh up all the benefits of weight loss with some of the things you have to do like no tea or coffee for life (because the tannic acid damages the new stomach) or the taking vitamins for the rest of your life. If you really want to know about the MGB download their patient manual and take the time to learn it, I know it is a horrible document with too much information but it is worth it when considering such life changing surgery.

Hi!  I'm new to this site - again!  Haven't been on in years.  I had an RNY in July of 2001, and I highly recommend my surgeon and the procedure.  I have had a few complications indirectly related to my surgery, but nothing that I blame the surgeon for.  I had a hernia, which is common after an open surgery - but I got an all-expense paid tummy tuck because of it, so I'm not complaining!  I rejoined today because my best friend's daughter is looking into WLS, and I wanted to see what's new and different since 7 years ago.  My friend was reading about the MGB, and I wanted to see if anything has changed in the procedure.  It doesn't sound like it.  As long as I'm here, I can give you some insights as someone who was there kind of from the beginning.  I think that 30 revisions number is may be the number of revisions Dr. Rutledge himself has done, but everyone I know who had a revision had it converted to an RNY by another doctor.  I can think of 5 people I knew who had revisions back then - about one year post-op, plus another lady who had to have Dr. Rutledge do a take down due to severe anemia.  That was when Dr. Rutledge was the only one doing the surgery, and there had been about 800 total.  There has always been an awful lot of argument about the MGB, which I first researched back in 2000, when it was brand new.  It seems that most people are happy with their weight loss, but the people who I knew who had complications were seriously ill.  I had a friend who had complications and almost died before having a revision to an RNY. I knew another woman who couldn't work.   If you understand anything about plumbing, you can look at the MGB and see exactly why some people have reflux problems - the intestine, which is filled with bile, which is an alkaline base, is connected directly to the pouch/stomach.  As long as people are standing up, it's fine, but since there is no flap (pyloric valve), the alkaline bile can back up into the stomach when someone is lying down.  Think about how your sink would drain if you laid teh plumbing on its side.  In most  people, it doesn't seem to be a problem.  But in the people I knew who had the reflux problems, it was explosive - really unbelievable and horrible to see - like projectile vomiting squared.  Basically, when the alkaline bile meets the stomach acid, the same thing happens as when you pour vinegar on baking soda to make a volcano for your kid's science fair project.  Many people back then were complaining that they had to sleep in a recliner, but it seemed to get better for most of them further post-op.  Obviously, the vast majority of people must be satisfied, and have no problems with their surgery.  Since bile and acid will ultimately neutralize each other, I imagine that's what usually happens.  The thing that actually put me off the most was research I did on Medline.  The old Bilroth II was not abandoned due to bile reflux causing indigestion - it was a surgery to treat ulcers and acid reflus problems, so whatever complications there were couldn't have been very widespread.  But Medline reported several studies linking the Bilroth II to a scary increase in stomach cancer - with an average onset of 22 years.  Dr. Rutledge seems like a very sincere man, and he is absolutely convinced that his modification to the stomach - the vertical, rather than horizontal design, will solve all the problems.  He may be right in most cases, but just because the bile is mixing with the acid way down in your stomach, where you don't feel pain, as opposed to up in your esophagus, this doesn't necessarily eliminate the cancer issue.  Dr. Rutledge sincerely believes in his surgery, and I don't think he'd continue doing it if he was seeing a lot of complications, but in talking to him, I discovered that the figures for complication rates on his website were somewhat misleading - at least to me.  He only reports surgical complications that occur within 30 days - things like a hernia, which would be very unlikely with any lap surgery, or internal bleeding, an infection - things like that.  He never reported the complaints that people had post-op as a result of his procedure.  He didn't believe the MGB caused it, he blamed the patients for not eating right - which may have been a contributing factor, for all I know.  He said intestinal bile in the stomach was not a problem.  It seems that most other surgeons, including those at Mayo and Johns-Hopkins, disagree.  Dr. Rutledge says it's just professional jealousy, or stodgy old doctors wanting to do the same old thing, but the MGB is a Bilroth II, despite his minor modifications - if it weren't he'd have had to test it on animals or something besides human guinea pigs.  His insurance code - which may have changed since then - was the standard code for a Bilroth II.  Back in 2001, when I had my RNY, insurance companies generally wouldn't pay for the MGB because a Bilroth II wasn't an approved weight loss surgery - although they would have covered it for other reasons.  I don't know what the status is now, but the insurance companies refusal to cover it had nothing to do with any complications or complaints about the surgery.  The comment about Dr. Rutledge not having insurance was probably a misunderstanding.  I don't know how he does it now, but back then, he wouldn't process insurance claims, even if your insurance company might pay for all or part of the surgery.  You had to pay him up front, and then do your own insurance filing to get reimbursed.  I imagine that was what the poster was referring to.  I just have to say one thing in defense of the RNY -  It is also done in slightly different ways, with different results, so i would encourage anyone who's considering it to check with their doctor, and see exactly how they do it, and read up on the differences.  But, it's not fair to compare complication rates or death rates for the MGB to an RNY straight across the board.  The MGB is only done on relative lightweights, and those people are typically better candidates for any type of surgery - the heavier the person, the more likely it is there will be complications.  My doctor performed a successful RNY on an 800 pound man, and that happens every day around the country.  Also, until recently, almost all RNY's were done open - I don't know what the percentage is now, but really heavy people can't have the lap surgery, and complication rates will always be much higher for an open surgery.  MGB's are never done open - a patient who weighs too much just can't get one.  Also, the relative lightweights - people with only 100 pounds or so to lose, always have better results with any type of WLS.  The heavier people are fighting a bigger genetic battle.  I eat anything i want - seiously, anything - but I just can't eat too much.  It doesn't take much to fill me up, but I often feel like I overeat, so I honestly can't see how people stretch out their pouches - it's just too painful to overeat, even a little bit.  But, I don't see why the MGB would be any better than an RNY in that respect.  The muscles that must contract in order to let your brain know you're full are at the very top of the stomach.  The pouch is a lot larger on the MGB, and I honestly think RNY surgeons and patients take the wrong approach, making the pouch so small that the patient is so limited in eating.  From the post-op discussions I've had, it seems that the biggest problem with RNY patients is that they starve themselves, instead of eating a lot of little meals, and they wind up skipping meals, getting very few calories, and shutting down their metabolism and gaining weight on 600 calories a day!  The last thing I'd like to say is I don't think anyone should rely too heavily on CLOS.net, or any other surgeon's website, when trying to get the facts about any surgery.  Those web pages are there to sell surgeries, and the information is certainly slanted to make their own surgery look the best, and make all the others look as bad as possible.  It's much better to get MGB info from an RNY doctor, and RNY info from an MGB doctor, etc., because you'll certainly get a more honest view of the downside that way.  And, it's very important to do your research, and know aht surgery will fit your post-op lifestyle - and what sort of risks you're willing to take.  Forums like this are great places to find information.  Since I just joined, I don't know what all the forums are, but before my surgery decision, I lurked for about a year on several sites, particularly the Graduates site for people at least one year post-op, where I could really get a feel for what life was like, what problems people had, a year or two, or five post-op.  You also have to remember, for the most part, the only old timers you'll see online are the people who are having problems of some sort.  People like me, who have no problems, lose interest after a while - once your surgery just becomes a part of your past.  Anyway, sorry for being so long-winded.  I wanted to add my two cents about the MGB, but I guess I put in more like a few dollars!  What I'm really trying to find out now - and all you newbies who have been researching this stuff probably know - what's the trend now?  Other than the MGB, are things shifting to any of the newer surgeries?  There was a lot of talk back when about DS and BPD(?) - I can't remember if that's right.  My friend's daughter is very young - 20 years old and in college in Texas.  She has always had a weight problem, and she got a lap band a few years ago, when she was 16.  She weighed over 300 pounds at the time, and she should probably weigh around 150.  She has probably lost about 50-60 pounds, but she's still very heavy - definitely over 40 BMI - probably still weighs in the upper 200's.  Of course, who knows how heavy she would be if she hadn't had the band?  She says she feels hungry all the time, and just eats really slow and drinks lots of water, and outeats her band.  I think she's either got an eating disorder, or it may be head hunger, or maybe 16 year old kids just aren't mature enough to have any WLS.  Any RNY like mine, where the stomach is completely severed into two pieces, doesn't produce an enzyme that creates that hungry feeling, but she insists that she's hungry all the time.  So, now, they think it's time to do something more serious.  I am very happy with my RNY, but I was wondering if a DS would be better for her, since you can eat more?  But, I saw some negative comments here about the DS - what's the deal with that?    And, whatever happened to the BPD?  And the gastric pacemaker?  And what in the heck is a gastric sleeve?  And, is insurance still pretty much only paying for the RNY?   Are people having problems getting insurance to pay?  Back when I had my surgery, one reason I didn't wait an extra few months to have it done lap was that I was getting nervous - it seemed like the insurance companies were trying to pull the plug on WLS.  If anyone can kind of give me an overview of what's going on now, it would save me a lot of time researching!  Thanks bunches! Lily

A gastric sleeve is where they make your stomach into a vertical sleeve. There is no bypass of intestines.  The pyloric valve is kept to regulate food flow to the intestines.   I am one of the people who had a revision from an MGB to a gastric sleeve.  Dr. Rutledge bypassed way too much intestine for my needed weight loss. I had my MGB in Nov. of 2006, and  my revision in Nov. of 2007.  I lost way too much weight with it and ended up down to 90 lbs.  When my new surgeon did my revision, he told me that MORE than 6 feet had been bypassed, and what I had was the equivalent of a DS!  I never considered the DS because it was too drastic for me and the amount of weight I wanted to lose (80-85 lbs.). My new surgeon re-hooked up all my intestines and moved my pyloric valve with it, to the base of my stomach sleeve.  The sleeve portion I had with the MGB was larger than a standard gastric sleeve, so he made my sleeve smaller, in an effort to help me not to regain too much.   So far, I am having success.  I've gained 21 lbs. since my revision to the sleeve and it is slowing down as I approach my goal weight. When I had my MGB, I was told that Dr. R. is using a 6 foot bypass as a standard starting point to consider due to the fact that so many earlier patients who had less have been coming back for revisions to have more bypassed.  In my case, as a lightweight, I feel he made a huge error in judgment when choosing a 6 foot bypass for me.  I lost 112 lbs. at my most, and that was with eating 3,500 to 4,000 calories a day to try not to lose ground as I waited for my revision. For anyone considering the MGB, especially if you need to lose 100 lbs. or less, I would caution you to get a commitment from Dr. R. the length of bypass he will do.  I would have done better, probably, with only a 3 foot bypass.  Yes, there are people out there who have had a 6 foot bypass and only lost 32 lbs. But, I would have rather had to work to get the last 20 lbs. off, than to have  my life threatened with malnourishment and a BMI of 15.8 and need a revision to save my life. My insurance did not cover MGB.  It does not cover any WLS,  But my revision was covered for the most part.  Although, they called the night before the surgery and said they would not automatically cover it, but would wait to see what was done with me after my surgery and then decide.  This whole experience has taken a huge emotional toll on me.  From going from elation at the original weight loss, to dread as I started losing too much, to anger as Dr. R. essentially brushed me off, in person and long distance, and would not cooperate with releasing my medical records until I reported him to the Nevada State Board of Medical Examiners.  To now, I feel relief that I actually did not die and I can look forward to getting back to a healthy weight and get back to living life. If anyone wants additional information on my story, you can check out my profile or contact me here at OH.