Dr. R.'s response

July 15, 2000

In a message dated 7/15/2000 11:33:27 PM Eastern Daylight Time,

Dr_Rutledge@... writes:

<<

Funny business.

RR >>

It Truly is!!!

TL

July 15, 2000

Hi Dr. Rutledge,

I wanted to thank you personally for responding to my post. I was

thrilled to see your response and appreciated the info. I now know

that the old mason loop patients had bile reflux soon after surgery (

40%). Was that the gastritis type only? Any stats on that longterm

Bile Esophagitis or cancer with those patients? Also thanks for

clearing up that none of your patients have had anything but bile

reflux gastritis symptom in the early months.

Thanks again,

laurie in Ohio

July 15, 2000

Any stats on that long-term

> Bile Esophagitis or cancer with those patients? Also thanks for

> clearing up that none of your patients have had anything but bile

> reflux gastritis symptom in the early months.

>

Yes.

Never, ever been reported.

That is why no Dr. has ever referred to a paper on the subject.

You have never for example heard " In the series by Dr X, XX patients

developed esophageal cancer after loop gastric bypass "

Never ever been reported.

It is only a " Theoretical " concern.

Now here is another kicker.

The real cause of esophageal cancer is ACID reflux.

Guess what. Some type of weight loss surgery cause severe ACID reflux in

greater than 15% of patients (Lap Band, Gastric Band, Vertical Banded

Gastroplasty etc.)

Are the surgeons who seem so very concerned about the MGB reflux as

concerned about the high rates of ACID reflux from the banded procedures?

Answer: Nope.

Hmmm...

I guess they are so busy worrying about the MGB that they don't have time to

worry about the thousands and thousands of cases of esophagitis caused by

other types of weight loss surgery.

But there are no cases of esophagitis after MGB.

Esophagitis

Esophagitis is a well described complication of several types of weight loss

surgery. In a study by Westling[32] of 90 patients undergoing

Silicone-adjustable Gastric band 32 patients (35%) were re-operated upon.

Erosive esophagitis was the cause requiring reoperation in 14 patients

(16%). In a study by Ovrebo[33] of gastric banding with respect to

postsurgical gastroesophageal reflux. The prevalence of acid regurgitation

among patients treated with gastric banding increased from 13%

preoperatively to 69% following surgery. Acid inhibitors were needed in 81%

of patients. The incidence of gastroesophageal reflux increased markedly

after gastric banding. In a study of 159 patients after vertical banded

gastroplasty 55 of the 159 patients complained of upper gastrointestinal

symptoms such as vomiting (72%), esophageal reflux (17%), and epigastric

pain (3%). Stenosis of the outlet of the gastric pouch was described in 40

of the 55 symptomatic patients. Esophagitis was observed in 60% of these

patients[34]. In a study of 185 laparoscopic adjustable silicone gastric

banding cases there were eight cases (4%) of esophagitis[35]. These and

other studies show that esophagitis is a significant risk in many types of

weight loss surgery. In this series of 667 Mini-Gastric Bypass patients,

there were no cases of esophagitis.

Funny business.

RR

Rutledge, M.D., F.A.C.S.

The Center for Laparoscopic Obesity Surgery

4301 Ben lin Blvd.

Durham, N.C. 27704

Telephone #:

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Email: DrR@...

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Dr. R.'s response

> Hi Dr. Rutledge,

>

> I wanted to thank you personally for responding to my post. I was

> thrilled to see your response and appreciated the info. I now know

> that the old mason loop patients had bile reflux soon after surgery

> 40%). Was that the gastritis type only? Any stats on that longterm

> Bile Esophagitis or cancer with those patients? Also thanks for

> clearing up that none of your patients have had anything but bile

> reflux gastritis symptom in the early months.

>

> Thanks again,

> laurie in Ohio

>

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>

July 15, 2000

Ok one more thing and I am off to bed.

Go to the National Library of Medicine Medline Search of the Medical

Literature

http://clos.net/medline_search.htm

Search for all the articles in the world ever written about " esophageal

cancer reflux bile "

Results: 31 articles!!!

Now...

Search for all the articles in the world ever written about " esophageal

cancer acid "

Results: 525 articles!!!

In a nice study the Billroth II has been shown to Cure Reflux!!!

Minerva Chir 1995 May;50(5):493-6

[Effects of gastric resection by the Billroth II technic on reflux

esophagitis associated with duodenal or pyloric ulcer].

Lorusso D, Pezzolla F, Guerra V, Giorgio I

Divisione di Chirurgia, Istituto Scientifico Gastroenterologico S. De

Bellis.

The authors report a retrospective evaluation of the prevalence of reflux

esophagitis (endoscopic diagnosis) in a consecutive series of 633 patients

undergoing elective gastric resection according to Billroth II for duodenal

or pyloric ulcer during the period 1974-1992 and assess the effects of

surgery on co-existent esophagitis.

The prevalence of reflux esophagitis associated with ulcer was 12.3%.

****************************************************************************

*****

In 95% of patients Billroth II gastric resection led to the resolution or

improvement of associated esophagitis.

****************************************************************************

*****

The authors conclude that by eliminating the main pathological factors of

reflux esophagitis associated with duodenal ulcer

****************************************************************************

*****

(hypersecretion of gastric acid, impeded gastric emptying)

****************************************************************************

*****

gastric resection is sufficient to achieve the resolution of esophagitis.

If the Bariatric Surgeons of the world were really and honestly concerned

about weight loss surgery patients developing esophageal cancer then why

don't they get excited about the LapBand, the Silicone Adjustable Gastric

Band, Gastric Banding and the Vertical Banded Gastroplasty????

See http://www.clos.net/mgb-paper/MGB-Paper061300.htm search for

esophagitis