Bariatric Surgeons vs.General Surgeons;Confusion About

General Surgery Basics

What Happens When Bariatric Surgeons Forget General Surgery Basics

What Happens When Bariatric Surgeons Forget General Surgery

Numerous Examples Where Bariatric Surgeons Make Decisions Based Upon

Errors and Misunderstandings of General Surgery Basics

Fear of Cancer

• Numerous Critics Bariatric Surgeons have raised Fears of Gastric Cancer after the Mini-Gastric Bypass

• ERRORS in Understanding Basic General Surgery

Misplaced Understanding Magnitude

• Most Bariatric Surgeons Do Not Know:

• General Surgery Basics

• Rate of Gastric Cancer

• Lifetime Risk of Gastric Cancer

Lifetime Risk Gastric Cancer

• The projected cumulative lifetime incidence of gastric cancer in

• H. pylori-infected males is 2.2% and 0.9% for females;

• This contrasts with

• 0.4 Males & 0.2%, Females, for those never infected.

• 2 - 4 / 1,000 patients Lifetime Risk

Lifetime Risk Gastric Cancer

• Lifetime Risk gastric cancer 2-4%2 - 4 / 1,000

• Compared to:

• Lifetime risk breast cancer 12%120 / 1,000

• Prostate cancer risk 16 %160 / 1,000

Most Bariatric Surgeons Do Not Know:

• Risk of Cancer from CAT Scans

• Computed Tomography (CT)-Abdomen and Pelvis, repeated with and without contrast material

• 20 mSv

Most Bariatric Surgeons Do Not Know:

• Risk of Cancer from 1 CAT Scan

• 2006 report from the National Research Council has estimated that 20 mSv

• The approximate dose from 1 CT Abd+Pelvis w/wo contrast = 20 mSv => Inc Cancer Risk 0.2%

• 2 / 1000

Now Having ReviewedMost Bariatric Surgeons

Do Not Know:Magnitude of Gastric and Other

Cancers

Risk of Cancer from CT Scan

Most Bariatric Surgeons Do Not Know:

• Bariatric Surgeons

• Fear of Mice & Bile

• Critics of the Billroth II have referred to mouse studies showing increased risk of gastric cancer from "Bile"

Fear of Mice & Bile

• Similarly Mouse/Rat Studies have shown

• Artificial Sweetener cause cancer• Cell phones cause brain cancer• Mouse virus causes breast cancer• Gingko biloba caused thyroid

cancer in mice• Power Lines

Fear of Mice & Bile

• Similarly Mouse/Rat Studies have shown

• RFID Chips• Genetically Modified corn• Fluoride osteosarcoma • Soy Beans cause Breast Cancer • Bisphenol A Increases Mammary

Cancer Risk

Fear of Mice & Bile

• Mouse/Rat Studies have that there may be a relation between

• Hundreds of things and cancer• RFID Chips, Corn, Fluoride, Soy Beans,

plastic, Artificial Sweeteners, Cell phones, Gingko, Power Lines and many more...

• and Bile

• Bariatric Surgeons Fear Bile(?)

Review of the Basics General GI Surgery and

Gastric Cancer

What happens when Bariatric Surgeons Forget

their General Surgery

GASTRIC CANCER RAPIDLY DECLINING

Bariatric Surgeons Do Not Know

*1* GASTRIC CANCER RAPIDLY DECLINING

• The incidence of gastric cancer in the United States has

• Decreased four-fold since 1930

• Approximately 7 cases per 100,000 people. 

*2* WHAT CAUSES GASTRIC CANCER?ITS NOT BILLROTH II

• Diets rich in fried, salted, smoked or preserved foods increased cancer risk in many studies. 

• Foods contain nitrites and these chemicals can be converted to more harmful compounds (carcinogens) by bacteria in the stomach. 

• Diets high in fruit and vegetables protects against Cancer

• Stomach cancer is much more common in smokers and in those with heavy alcohol intake.

• H. Pylori, No H. Pylori No Cancer

DIET CAN PREVENT GASTRIC CANCER

• Avoid ETOH, Tobacco, Processed & Preserved Meats, Salt

• RX H. Pylori, • Eat Fruits and Veggies,

Yogurt and • Drink Green Tea

•Gonzalez CA, Cancer Research, Institut Català d'Oncologia, Av. Gran Via s/n, km 2.7, 08907 L'Hospitalet, Barcelona, Spain.

CANCER QUIZ: MORE DEADLY CANCER CAUSING AGENT? A OR B

AA BB

CANCER QUIZ: MORE DEADLY Hot Dog or Mini-Gastric Bypass

AA

• American Institute for Cancer Research

• Hot Dog / day • Increase the

risk cancer 21%

Many Large Studies: No Increased RiskThousands of patients followed for Decades

Many Large Studies: No Increased Risk

• Mayo Clinic Study (Example)

• 338 Billroth II patients

• Followed 25-years

• 5,635 person-years

• Only 2 Cancers in 5,000+ pt years of Follow Up

• Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309

BARIATRIC SURGEONS FEAR BILLROTH IIMAGNITUDE OF THE PROBLEM

• Population based study, 338 Billroth II pts

• Followed 25-years

• 5,635 person-years

• Only 2 Cancers Found in 5,000 years• Predicted 2.6 cancers (relative risk 0.8)

Schafer et al, Risk of gastric carcinoma after treatment for benign ulcer disease. N Engl J Med. 1983 Nov 17;309

BARIATRIC SURGEONS FEAR BILLROTH IIMAGNITUDE OF THE PROBLEM

• 338 Billroth II pts, Followed 25-years

• 5,635 person-years

• Only 2 Cancers in 5,000 pt years follow up

• RATE of Gastric Cancer is Declining

• 24 - 50% Expected Decrease from 1983

• Future risk ~1 patient / 5,000 pt years

There are some HUMAN studies that show an increased risk of Gastric Cancer after Billroth II

Bariatric Surgeons Forget:

These Billroth II operations were done for ULCERS!

Ulcers => Increased Risk of Gastric Ca!

Both Related to H. Pylori

ULCERS INCREASE RISK CANCER

• Meta-analysis: 7 studies Small increased risk 5 studies No Increased Risk

• Studies with increased Risk; Flawed

• Billroth II = Surgery Rx Ulcers

• ULCERS increase risk of Gastric Cancer!

• Ulcers and Gastric Cancer Common Etiology =H. Pylori=

ULCERS INCREASE RISK CANCER

•3,078 gastric cancer vs. 89,082 controls•Ulcer increases risk gastric cancer =(relative risk 1.53)=•Same as Increased Risk reported Billroth II •Many other studies confirm these findings: •Ulcer Increases Risk Gastric Cancer•Ulcers & Gastric Cancer:•Common Etiology = H. Pylori

General, Trauma and Oncologic surgeons routinely use the Billroth II (Thousands of publications)

UNINFORMED FEAR BILLROTH IIEDUCATED USE BILLROTH II

UNINFORMED FEAR BILLROTH IIEDUCATED USE BILLROTH II

• Billroth II and the Mini-Gastric BypassExcellent, Safe and Effective

• Fear Cancer? CAT Scan much more likely to cause cancer!

• FEAR Gastric Cancer? Avoid ETOH, Tobacco, Processed & Preserved Meats, Rx H. Pylori, Eat Fruits and Veggies, Yogurt

• A Billroth II probably makes NO difference

Rational Data Analysis vs.Irrational FEAR Gastric Cancer

• 1. Gastric Cancer Declining Rapidly

• 2. GC Environmental Causes; Easily Prevented

• 3. Some studies show Small Increased Risk Probably from Ulcers / H. Pylori

• 4. Many large studies: NO increased risk

• 5. Endoscopic Screening: Not Recommended

• 6. General, Trauma & Oncologic Surgeons Use Billroth II

Bariatric Surgeons Fear of Cancer after MGB Misplaced!

Fear Cancer After Bariatric Surgery

Fear Esophageal Cancer After

Sleeve, Band and Plication