For those still researching ...

[Guest guest]

This statement was posted in MGB Truth and I believe it has some

value for those who are researching WLS.

From: Barry Fisher, MD  <bfisher@m...>

Date: Mon Oct 16, 2000 6:18pm

Subject: My final post

Unfortunately, I have neither the time nor the patience to

read all the activity on this email group.

Sue Widmark received a copy of one of my articles which

documented the association of Gastroesophageal Reflux

Disease and obesity. She has said that I mentioned RNY and

Bile Reflux in that article. This was taken out of

context. I said that I would hypothesize the cause of

relief from acid reflux symptoms might be due to alkaline

reflux, However, this was conjecture, and the facts have

since shown that not to be the case.

I am impressed with the depth of feelings exhibited by

posters to this site. I am also impressed with the effect

these feelings produce which closes peoples minds to other

ideas.

In 1962, the first Loop Gastric Bypass was performed. In

1977, bariatric surgeons observed a 12-20% incidence of

alkaline reflux esophagitis in patients who had undergone

Loop (Billroth II) Gastric Bypass. At the turn of the

century, Dr. Roux, a french surgeon, had introduced the RNY

procedure to treat reflux disease occurring following

Billroth II procedures. He was not aware of the distinction

between acid and alkaline reflux at that time, He only knew

that conversion to the RNY following Billroth II solved the

patients symptoms.

Therefore, in 1977, bariatric surgeons began abandoning Loop

Gastric Bypass procedures in favor of other operations,

including the RNY gastric bypass. This has resulted in the

practical elimination of finding esophagitis following

gastric bypass surgery, as long as the gastric bypass

remained intact. These are the facts, before abandoning

Loop Gastric Bypass a 12-20% incidence of esophagitis,

after, a virtual elimination of this finding. The MGB is a

Loop gastric bypass.

Finally, those who have read the site containing statements

by numerous bariatric surgeons, (including Ed Mason, the

inventor of the gastric bypass procedure) must ask

themselves why these surgeons have made these public

statements in opposition to the MGB. We have nothing to

gain by doing this. I have no ax to grind with anyone. I

simply fear that bariatric surgery will be besmirched by

someone reviving an operation that had been abandoned in the

past, because it produced no better weight control, and

caused more complications that other bariatric surgery

procedures. There is no reason to believe that it should cause any

fewer complications than other laparoscopic gastric bypass

procedures. There is some reason to believe that it will be

responsible for complications not found with other

laparoscopic gastric bypass procedures. Therefore, I will

not be offering MGB, and I recommend against this procedure.

We live in a time when people are encouraged to be involved

in their medical decision making. So be it. There is a

reasonable probability that over time, 10-20% of these

patients will undergo revision to RNY as they develop

symptoms or alkaline reflux esophagitis. There is a

reasonable probability that the weight loss pattern

following this operation will be close to that of other

forms of gastric bypass, There is no reason to believe

otherwise. There is a reasonable probability that the

weight regained 2-10 years following surgery will be

slightly more that following other gastric bypass

procedures, because the stomach pouch is larger than in the

other operations being performed today (if the segment of

intestine being bypassed is the same).

Therefore, if 80% of patients have no alkaline reflux, and

retain 40%? excess weight loss over time, this is not a

disaster. It is just that it is below the present standard

of care to reintroduce an operation that has the proven

potential to cause more problems without the potential to

increase benefit for the patient.

Good luck to you who are in search of reason and a healthy

life.

B Fisher, M