Surgical Endoscopy

, 24:223 | Cite as

Natural orifice surgery: initial US experience utilizing the StomaphyXTM device to reduce gastric pouches after Roux-en-Y gastric bypass

  • Dean Mikami
  • Bradley Needleman
  • Vimal Narula
  • Janice Durant
  • W. Scott Melvin
Endoluminal Surgery



Weight gain after gastric bypass can occur in up to 10% of patients 5 years following and in about 20% of patients 10 years following surgery. The nadir weight is usually reached within the first 2 years after bypass surgery. However, weight may slowly be regained for numerous reasons. This phenomenon has been studied extensively, but there is often no one reason this occurs. Once psychological and dietary reasons have been investigated, revisional surgery may be the only alternative for treatment. Revisional gastric bypass surgery is associated with a much higher morbidity and mortality when compared with a primary gastric bypass procedure.

Patients and methods

Thirty-nine patients underwent endoluminal gastric pouch reduction with the StomaphyXTM device after informed consent. The StomaphyXTM device is a sterile, single-use device for use in endoluminal transoral tissue approximation and ligation in the gastrointestinal (GI) tract.


Average age was 47.8 (29–64) years, and 36/39 (92.3%) patients were female. Average body mass index (BMI) and weight prior to the StomaphyXTM procedure were 39.8 (22.7–63.2) kg/m2 and 108.0 kg (65.90–172.2 kg). The average preprocedure excess body weight was 51.1 kg. Weight loss at 2 weeks (n = 39) was 3.8 kg (7.4% excess body weight loss, EBWL), at 1 month (n = 34) was 5.4 kg (10.6% EBWL), at 2 months (n = 26) was 6.7 kg (13.1% EBWL), at 3 months (n = 15) was 6.7 kg (13.1% EBWL), at 6 months (n = 14) was 8.7 kg (17.0% EBWL), and at 1 year (n = 6) was 10.0 kg (19.5% EBWL). No major complications were observed. The minor complications that were seen included a sore throat lasting less than 48 h in 34/39 patients (87.1%) and epigastric pain that lasted for a few days in 30/39 patients (76.9%). Three patients with chronic diarrhea had their symptoms resolved after the procedure. Eight patients with gastroesophageal reflux disease reported improvement in their symptoms post procedure.


Endoluminal revision of gastric bypass patients with weight gain using the StomaphyXTM procedure may offer an alternative to open or laparoscopic revisional bariatric surgery.


Endoluminal Bariatric Weight gain Revision Gastric bypass Gastric pouch reduction 


  1. 1.
    Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737CrossRefPubMedGoogle Scholar
  2. 2.
    Schauer PR, Ikramuddin S, Gourash W et al (2000) Outcomes after laparoscopic Roux-en-Y gastric bypass for morbid obesity. Ann Surg 232(4):515–529CrossRefPubMedGoogle Scholar
  3. 3.
    Yale CE (1989) Gastric surgery for morbid obesity. Complications and long-term weight control. Arch Surg 124:941–946PubMedGoogle Scholar
  4. 4.
    Sugerman HJ, Kellum JM, Engle KM et al (1992) Gastric bypass for treating server obesity. Am J Clin Nutr 55:560S–566SPubMedGoogle Scholar
  5. 5.
    Christou NV, Look D, Maclean LD (2006) Weight gain after short and long limb gastric bypass in patients followed for longer than 10 years. Ann Surg 244(5):734–740CrossRefPubMedGoogle Scholar
  6. 6.
    Martin MJ, Mullenix PS, Steele SR et al (2004) A case-match analysis of failed prior bariatric procedures converted to resectional gastric bypass. Am J Surg 187:666–671CrossRefPubMedGoogle Scholar
  7. 7.
    Gagner M, Gentileschi P, de Csepel J et al (2002) Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 12:254–260CrossRefPubMedGoogle Scholar
  8. 8.
    Jones KB (2005) Revisional surgery—potential safe and effective. SOARDS 599-603Google Scholar
  9. 9.
    Khaitan L, Van Sickle K, Gonzalez R et al (2005) Laparoscopic revision of bariatric procedures: is it feasible? Am Surg 71(1):6–10PubMedGoogle Scholar
  10. 10.
    Harris PL, Freedman BE, Bland KI et al (1987) Collagen content, histology, and tensile strength determinants of wound repair in various gastric stapling devices in a canine gastric partition model. Surg Res 42(4):411–417CrossRefGoogle Scholar
  11. 11.
    Ethicon Wound Closure Manual (2004) The suture, p 28Google Scholar
  12. 12.
    Dobrin PB (1989) Surgical manipulation and the tensile strength of polypropylene sutures. J Surg Res 124(6):665–668Google Scholar
  13. 13.
    Dobrin PB (1998) Some mechanical properties of polypropylene sutures relationship to the use of polypropylene in vascular surgery. J Surg Res 45(6):568–573CrossRefGoogle Scholar
  14. 14.
    Dobrin PB, Mrkvicka R (1998) Chronic loading and extension increases the acute breaking strength of polypropylene sutures. Ann Vasc Surg 12(5):424–429CrossRefPubMedGoogle Scholar
  15. 15.
    Rothstein RI, Filipi CJ (2003) Endoscopic suturing for gastroesophageal reflux disease: clinical outcome with the Bard EndoCinch. Gastrointest Endosc Clin N Am 13(1):89–101CrossRefPubMedGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2009

Authors and Affiliations

  • Dean Mikami
    • 1
  • Bradley Needleman
    • 1
  • Vimal Narula
    • 1
  • Janice Durant
    • 2
  • W. Scott Melvin
    • 1
  1. 1.The Ohio State University Medical Center for Minimally Invasive SurgeryColumbusUSA
  2. 2.The Ohio State University HospitalColumbusUSA

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