Incision-less Repair of Pouch or Stoma Dilation After Gastric Bypass Surgery
Gastric Bypass surgery has evolved over the past forty years and the technique used today is better than ever before. Unfortunately, previous versions of the bypass made it possible for the patient to develop an enlarged pouch or a dilated gastrojejunal anastomosis (connection of the small bowel to the gastric pouch). A dilated pouch allows the patient to eat too much and a dilated stoma removes the restrictive component of the operation also allowing excessive food intake. Both of these conditions lead to weight re-gain after successful gastric bypass surgery. Weight re-gain is terribly demoralizing for the gastric bypass patient and previously available options for treatment of weight re-gain have been invasive and only marginally effective.
I am proud to announce that there is now a non invasive option to repair the dilated gastric pouch and dilated anastomosis. The ROSE procedure is an incision-less endoscopic (through the mouth) option that allows the surgeon to plicate the pouch and or the stoma to aid the patient with losing the re-gained weight. ROSE stands for Revision Obesity Surgery Endoscopic. I was selected to be trained on this new procedure along with a small number of surgeons in the United States. I believe that it provides options not previously present for properly selected patients to help them lose weight.
Weight re-gain can occur for a variety of reasons. Sometimes the patients behavior is the cause. If a patient stops exercising and begins snacking weight re-gain will occur. Food choices and using the tool correctly (not drinking while you eat) are also important. Other causes include overeating causing pouch dilation, formation of a gastro-gastric fistula, and technical errors by the surgeon such as making the pouch too big or the Roux limb too short to begin with. Above are examples of why patients must be properly evaluated before undergoing any form of revision surgery whether it is endoscopic, laparoscopic or open. Evaluation includes:
- Evaluation of Diet
- Evaluation of Exercise Habits
- Upper GI X-ray (can be done in office at the New Life Center)
- Upper Endoscopy
For the properly selected patient, the operation is performed as an outpatient procedure. After undergoing general anesthesia, a transport tube is place through the patients mouth into the gastric pouch. The transport has channels through which an endoscope, graspers, and suturing instruments may be passed. In this way permanent suture anchors are placed to plicate or shrink down the pouch and stoma.
Post operatively, patients return home and can usually return to work the next day. Many patients experience a sore throat that quickly goes away.
Other options for treating weight re-gain exist as well. I routinely perform revision operations on patients from other practices and I know that a thorough evaluation of the patient is necessary in order to tailor the treatment to their needs. Having said that, I am also very excited to have this cutting edge technology available for the properly selected patient!
From the Desk of Dr. Boyce