Bariatric Times - September 2008 - (Page 12)

12 Surgery Perspective FIGURE 1. Animation of pre- and post-ROSE procedure. Bariatric Times • September 2008 FIGURE 2. View of pouch and stoma six years post-gastric bypass prior to ROSE procedure. The pouch measures 10cm and the stoma measures 12mm. FIGURE 3. View of gastric pouch and stoma immediately postROSE procedure, with two anchors placed in the stoma and six placed in the pouch. The pouch now measures 4cm and the stoma measures 8mm. reloaded without removing the TransPort™ or the g-Prox™ from the surgical site. All plications are done under direct visualization, and the system retains the familiar surgical need for tactile feedback, with the operator/clinician controlling tension during the “cinching” process. (The technical aspects of the available incisionless revision options were discussed thoroughly in the article by Dr. Herron et al in the January 2008 issue of Bariatric Times. I strongly encourage those interested to re-read their article.) Briefly, in the procedure, an EOS is inserted through the mouth and into the pouch under direct visualization with a small, attached endoscope (GIFN180, Olympus America, Inc., Center Valley, Pennsylvania). The EOS tools are then used to grasp tissue and deploy tissue anchors to create multiple, circumferential tissue folds around the stoma, reducing the diameter of the opening to more closely match original post-gastric bypass proportions. Additional anchors are then placed in the stomach pouch to reduce its volume capacity (Figure 1). By eliminating skin incisions, this new procedure provides important advantages to patients, including reduced risk of infection and associated complications, less postoperative pain, faster recovery time, and no abdominal scars. After researching the various incisionless options available, we chose to perform the ROSE procedure (Restorative Obesity Surgery, Endoluminal) using the EOS over other available incisionless Roux-en-Y gastric bypass revision options for the following reasons: 1) Other methods use a T-fastener design that concentrates the force on the tissue at a single point, which may limit durability. By using real suture material and mesh basket anchors which more evenly distribute tissue holding forces, the USGI Medical EOS system anchors remain secure over time. 2) Some other devices cannot be used to treat an enlarged stoma, only the pouch. USGI Medical’s EOS addresses both the pouch and the stoma. CONCLUSION Weight regain after successful gastric bypass surgery remains a common and challenging therapeutic dilemma for the practicing surgeon. Endolumenal and incisionless revision of gastric bypass surgery offers an exciting, potentially safer, and effective means to reduce stoma and pouch dimensions. Early results are promising, suggesting that subjective restriction is returned and that the dimensions achieved at the time of the procedure are maintained. Based FIGURE 4. This is a view of the gastric pouch and stoma three months following the ROSE procedure. The pouch measures 4cm and the stoma measures 10mm.

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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