The Old Mason Loop

September 9, 2000

Dear :

Congratulations on your thorough research. Most of us (I am pre-op) on the MGB

boards have a similar commitment to choosing the surgery best suited to our

particular situation, we have reviewed the MGB website and are also impressed

with the contents, and we are familiar with the questions you have raised.

Change has to start somewhere. Dr. R developed and has been using the MGB

technique since 1998, he has performed almost 840 MGB operations. His carefully

kept statistics are reported on the MGB website. Dr. R also provides pre-op

patients with access to post-op so that additional questions may be explored.

Furthermore, this past June Dr. R presented an MGB seminar at the ASBS

convention.

I'm not a medical person, but this is how I understand these issues: the two

operations are not the same. In the now defunct " Mason " Loop Gastric Bypass,

procedure, a horizontal pouch was formed from the upper most portion of the

stomach by laterally sectioning along the greater stomach curve (which gave the

pouch a 'weak' wall vulnerable to stretching) just below where the esophagus

empties into the stomach. Positioning the pouch high up in the abdomen in this

manner caused the flow of liver and pancreatic secretions to approach the

esophagus and frequently led to high rates of esophagitis. The stretching of

the intestine also caused pressure on the loop and stress on the attaching

sutures.

The Standard Billroth II Gastrojejunostomy is currently used to treat ulcer

disease, stomach cancer, injury, and other diseases of the stomach. This

procedure connects the middle portion of the small intestine (the jejunum)

directly to the main portion of the stomach, bypassing the pyloric valve and

duodenum. An international consensus conference of gastric cancer specialists

express consensus about the use of the Billroth II for the TREATMENT of Gastric

Cancer.

The modern Mini--Gastric Bypass (MGB) sections off a vertical pouch along the

lesser curve of the stomach (providing a 'strong' wall, minimizing stretching,

and reducing incidence of pouch failure.) The MGB does have a loop like the old

" Mason " Loop Gastric Bypass, but the loop in the MGB is placed low on the

stomach pouch, far away from the esophagus. This lower positioning of the pouch

directs liver and pancreatic secretions away from the esophagus, thereby greatly

reducing incidence of esophagitis and eliminating the stress on the loop and

sutures. This technique was adapted from the common Billroth II

gastrojejuostomy currently performed for ulcers, cancer, trauma, and other

diseases.

In summary, the modern MGB is descended from the Standard Billroth II procedure,

and is quite distinct form the old " Mason " Loop Gastric Bypass. The MGB

provides a stronger and more strategically placed pouch, which results in

greatly reduced pouch distension and resultant failure, less intestinal and

suture stress, and provides a significant reduction of esophagitis by directing

liver and pancreatic secretions away from the esophagus.

Laparascopic surgery is in it's infancy and most of us feel fortunate that it is

currently available and that Dr. R has developed it to suit the MGB.

I guess this is a decision we each have to make individually. Good luck.

Judith in Seattle

P.S. Please note, Dr. R has performed 840 MGB operations HIMSELF. I suggest

you inquire of the Alvarado surgeons how many of their favored

operation (RNY) EACH of them have performed, before you make your decision.

September 9, 2000

Judith,

Thank you so much for your post and email. I appreciate your detailed answers.

I thought oh god after all this work making my decision here comes another issue

I as a non medical professional have to make.

Again, many thank!

Elliott Stern

Las Vegas

judith wrote:

> Dear :

>

> Congratulations on your thorough research. Most of us (I am pre-op) on the

MGB boards have a similar commitment to choosing the surgery best suited to our