Issues to be Addressed

Address List:



My Dear Friends and Colleagues


I write to update you on the fact that I have been appointed at the chairman of the new IFSO committee the Varianational Committee which is charged with the evaluation and advising the IFSO on new procedures most particularly the Mini-Gastric Bypass.


I have the responsibility of completing the constitution of the membership of the committee, setting up the goals and purpose of the committee.  The committee must list the goals, make plans to implement the goals.


At present we are going to try address the following topic areas:



We hope to address issues such as:

Discuss Committee membership(maximum 5-6 members)

Discuss the aims of the Committee, what you would like to see

achieved and its role in IFSO

Job description of the Committee

Define a time line

Standard methods of performance of the MGB/OL

Individual and Pooled Research Studies

Encouragement of Controlled Trials

Mentoring programs for new MGB/OL surgeons

Information sharing amoung interested MGB/OL surgeons

National and International recognition of the MGB/OL

Management of complications related to the MGBOL

International and National Referrals to Qualified MGB/OL surgeons

Medical Tourism (Referral of MGB patients from one country to

another qualified MGB/OL surgeon)

Renaming the MGB

Other Topics (Your suggestions)

Capsule CRM


Naming/Renaming the Committee

Naming/Renaming the Mini-Gastric Bypass

Review of the Mini-Gastric Bypass:

IFSO Survey

Who is doing it?

How many?

If not why?

What are you doing now? Band/VBG/RNY/BPD/Sleeve/Other – List

Other new surgery: placation, ileal interposition


PreOp Management


Anesthesia Management


How is the MGB Done?

Surgeon/Patient Position/Placement

Ports Position/Placement

Location of pouch initiation

Skeletonization of lesser curve

Creation of the pouch

Use of the staple gun

Covidien: Pros & Cons

Ethicon: Pros & Cons

Location and angle of first staple cartridge

Staple cartridge selection: White/Blue/Gold/Green

Fear The Tube/Bougie/NC tube

Delays: Before and During Staple Gun Firing

Fear “Thickness”

Management of the angle of His

End of part 1

View Left gutter

Open left para-coloic gutter and identification of the small bowel

Identification of the ligament of Trietz

Running the Bowel

Distance of the bypass

Tailoring the bypass

Mobilizing the bowel


Camera port change


Staple gun for G-J passed from the middle lower epigastric port (parallel to the long axsis of the esophagus and the neo-gastric pouch.)

Placing the small bowel on the cartridge jaw (not the anvil jaw) of the staple gun

Prepare for the gj

Advance the bougie/tube out of the gastric pouch through the gastrostomy

Grasp the gastric pouch via the two mid working ports, medial and lateral sides of the gastrotomy with downward tension immobilizing the gastric pouch

Advance the staple anvil into the gastric pouch

Confirm that the GJ staple when closed:

Does Not override the staple line of the gastric pouch



Delay staple gun firing (Ethicon) or Fire the staple gun slowly with delays to compress as the staples are fired

Examination of the gastro-jejunostomy staple line

Advance Tube/Bougie across the Gastro-jejunostomy

Closure of the G-J defect

Place two Corner stitches

Interrupted sutures

Running suture closure

NO ?Reinforcement stitch?

NO Drain?

NO Leak tests?

NO Post gastrograffin swallow?

Port closure

Skin closure


Post Op Care

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