1. a-00101
Dr. Robert RUTLEDGE
Title of Paper: RESOLUTION OF DIABETES MELLITUS IN
LOWER WEIGHT PATIENTS WITH MINI-GASTRIC BYPASS
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. RESOLUTION OF DIABETES
MELLITUS IN LOWER WEIGHT
PATIENTS WITH MINI-GASTRIC
BYPASS
Robert RUTLEDGE1
1Director, Surgery, Center For Laparoscopic
Obesity Surgery, United States of America

3. Introduction
• Bariatric procedures have been shown to
improve the outcome of Diabetes Mellitus
(DM).

4. Introduction
• The Mini-Gastric Bypass (MGB)
• includes both a
• Gastric component &
• Bypass component
• Which has been shown to be more
effective than either alone.

5. Introduction
• Studies have shown that the MGB leads to
resolution of Type II DM in up to 95% of
morbidly obese patients
• Because of the risks and danger of DM
and the success of the MGB in obese
diabetic the MGB was offered to lower
weight patients.

6. Methods:
• 6,234 patients underwent MGB
including
• 303 DM patients with BMI 21-35.
• The MGB operations were
tailored for lower weight patients
• Shorter bypass length and
Larger gastric pouch

7. Tailored MGB?
• Think as a General Surgeon
NOT as a Bariatric Surgeon
• Antrectomy and Billroth II
Large pouch and 20-50 cm bypass

8. Tailored MGB
• Antrectomy and Billroth II
Large pouch and 20-50 cm bypass
• MGB
Small Pouch and Long (200 cm) Bypass

9. Tailored MGB
For THIN Diabetic
• Antrectomy and Billroth II
Large pouch and 20-50 cm bypass
• MGB
Small Pouch and Long (200 cm) Bypass
• Tailored MGB: For THIN Diabetic
Pouch << than Antrectomy
Pouch >> than “Bariatric” MGB
Bypass >> than Antrectomy
Bypass << than MGB

10. Tailored MGB
For THIN Diabetic
• Antrectomy and Billroth II
Minimal Weight Loss
• MGB
Maximal Weight Loss
• Tailored MGB
Selected for
- Min Weight Loss
+ Foregut Effect

11. Results
• 68.9% of patients were female.
• Average age 48 + 11.
• Follow up 6 to 48 months.
• Mean preop weight
97 kg and post op was 69 kg
• Mean weight loss of 27 kg.

12. Results
• DM resolved in 98% and improved in
the remaining patients.
• 98% of patients were off all oral
medications.
• 15.2% were taking insulin and all were
taken off the insulin by their
physicians.

13. Conclusions:
• The TAILORERD MGB
particularly well suited for Rx of DM in low
weight patients
Gastric pouch = Larger &
Bypass length = Shorter
Weight loss can be customized
• Laparoscopic MGB has a beneficial effect
on glucose metabolism and serum lipid
composition in obese DM patients.

14. Conclusions
• The Mini-Gastric Bypass improves DM
in 95% of obese patients and also leads
to resolution or improvement of DM in
lower weight patients.