Bariatric Times - September 2008 - (Page 10)

10 Surgery Perspective Bariatric Times • September 2008 Revisional Gastric Pouch and Stoma Reduction Surgery for Weight Regain: Gastric Bypass via an Endolumenal Approach A Case Report by G. Derek Weiss, MD, FACS, FASMBS Dr. Weiss is with Bluegrass Bariatric Surgical Associates, PLLC, with locations in Lexington, Georgetown, Louisville, Hazard, and Mayfield, Kentucky. Continued from Page 1 Many have speculated that postoperative gastric bypass weight gain is related to gastric pouch and/or stomal dilatation as a result of surgical technique or dilatation over time post-surgery. This speculation has been driven in part by the long-accepted surgical principle of reducing gastric pouch and outlet size as an important component of weight loss for primary Roux-en-Y surgical patients. Many patients report they lose the early satiety feeling they feel early on after the primary bypass surgery. Roberts et al revealed data that show pouch size correlated with weight loss in regard to laparoscopic Roux-en-Y.5 The surgical treatment options offered for these patients are tempered by the well-documented, significant incidence of morbidity and mortality rates associated with revisional gastric bypass surgery. Revisional bypass surgery has a significantly higher morbidity rate (15%) and mortality rate (1%) than the primary surgery.6, 7 These sobering statistics have prompted many clinicians and those in industry to consider less invasive, safer alternatives to the lifethreatening ramifications of WLS patients’ recurrent, excess weight. These approaches have included band placement over the bypass, as well as other endoscopic/ endolumenal approaches to reduce the stoma and/or pouch size to more closely approximate immediate post- Roux-en-Y results. These “incisionless” options have included sclerotherapy of the stoma and various plicating devices that address either stoma or pouch dilatation. I report on one of my initial cases with the Endoscopic Operating System™ (EOS) from USGI Medical (San Clemente, California) to reduce stoma and pouch dilatation post-bypass in a patient who was beginning to regain her lost weight. CASE PRESENTATION Miss P was a 34-year-old woman who presented with concern about weight regain of approximately 50 pounds over several years, after a “successful” open Roux-en-Y gastric bypass in 2002 by another surgeon. At the time of surgery in 2002, she weighed 328 pounds and had a BMI of 43.3. She had previously plateaued on a weight loss program that helped her lose 40 pounds of her excess weight preoperatively. Miss P proceeded to lose 99 pounds over the next few years following open Roux-en-Y gastric bypass. She was very happy with the surgical results, which greatly improved her quality of life. However, over the last couple years, she noticed less satiety and found she was able to eat larger and larger meals without much restriction. After we discussed all of the surgical options, Miss P agreed to endoscopic evaluation to see if she might be a candidate for an endolumenal revision of her gastric pouch and stoma with the USGI EOS. Subsequent endoscopic evaluation revealed an enlarged gastric pouch at 10cm (distance between lower esophageal sphincter [LES] and gastrojejunal [G-J] stoma), and a marginally dilated stoma at 1.2cm (Figure 2). We conducted nutritional and medical evaluations to confirm she would be an appropriate surgical candidate for this procedure. She underwent stoma and gastric pouch reduction with the EOS. During the procedure, which was done under general anesthesia, she had two anchor pairs placed in the stoma and six anchors placed in the pouch, which reduced the stoma from 12mm to 8mm, and the pouch was reduced to 4cm (Figure 3). She was discharged the same day uneventfully, and continues to follow up with our group closely. At

Table of Contents Feed for the Digital Edition of Bariatric Times - September 2008

Bariatric Times - September 2008 Emerging Technologies Case Report Sleeve Gastrectomy after a Jejunoileal Bypass Reversal Editorial Message Contents Editorial Board Walk from Obesity The Latest on Nutrition and Hair Loss in the Bariatric Patient Consultant’s Corner Journal Watch Calendar of Events Advertiser Index

Bariatric Times - September 2008

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