Expert: John Pilcher, MD - 11/24/2008

Question
QUESTION: Do you think the surgeons who perform the MGB with clos, Drs. Rutledge and
Peraglie are reputable?  Do you know if the complication risk with this procedure
is any higher than with any other WLS except the lapband?

ANSWER: Ms. Coon,
Dr. Rutledge has long performed surgery and follow up in a way that is outside the accepted standards of our professional society (American Society for Metabolic and Bariatric Surgery).  Speaking personally, I have cared for one of his patients who has suffered devastating neurologic damage from a procedure done by him, who reports that she called him repeatedly at the beginning of her problems and was put off, his staff instructing her to see her primary physician.

I have a hard time commenting on the complication rates of the MGB, since it has been changed very frequently and since I do not have access to the large population of patents who have gone through surgery with Dr. Rutledge.  What I can say is that the key part of the procedure, which is to use a LOOP of jejunum to the stomach (not a Roux limb) is known to be associated with a high rate of a problem called bile reflux esophagitis.

Although I will not claim full knowledge of Dr. Rutledge and his outcomes, I recommend you carefully evaluate your other options before choosing to undergo the MGB.

Best of luck,
Dr JP

---------- FOLLOW-UP ----------

QUESTION: Thank you for your response.  Can I please ask what sort of neurologic problems
can you get after the MGB surgery?  I do appreciate your taking the time to
answer this.

Answer
The patient I encountered suffered from thiamine deficiency, leading to a condition called Wernicke-Korsakoff syndrome.  Her primary problems are memory loss, inability to concentrate, and deficiency of sensation and coordination in her arms and legs.  She is not able to write normally and is not able to walk without a walker.  She is a 42 year old who was a RN.  She is not able to work in any capacity now and I doubt she will in the future.

In fairness, this problem can happen with several of the accepted bariatric procedures if proper follow up is not provided.  What I found bothersome in this case is that the patient recognized she was having a problem of some type, but she reports that she was not able to get help in spite of making calls to Dr. Rutledge.

Dr JP