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

  • Endoluminal Surgery
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Abstract

Introduction

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.

Results

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.

Conclusions

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

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References

  1. Buchwald H, Avidor Y, Braunwald E et al (2004) Bariatric surgery: a systematic review and meta-analysis. JAMA 292(14):1724–1737

    Article  CAS  PubMed  Google Scholar 

  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):515–529

    Article  CAS  PubMed  Google Scholar 

  3. Yale CE (1989) Gastric surgery for morbid obesity. Complications and long-term weight control. Arch Surg 124:941–946

    CAS  PubMed  Google Scholar 

  4. Sugerman HJ, Kellum JM, Engle KM et al (1992) Gastric bypass for treating server obesity. Am J Clin Nutr 55:560S–566S

    CAS  PubMed  Google Scholar 

  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):734–740

    Article  PubMed  Google Scholar 

  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 187:666–671

    Article  PubMed  Google Scholar 

  7. Gagner M, Gentileschi P, de Csepel J et al (2002) Laparoscopic reoperative bariatric surgery: experience from 27 consecutive patients. Obes Surg 12:254–260

    Article  PubMed  Google Scholar 

  8. Jones KB (2005) Revisional surgery—potential safe and effective. SOARDS 599-603

  9. Khaitan L, Van Sickle K, Gonzalez R et al (2005) Laparoscopic revision of bariatric procedures: is it feasible? Am Surg 71(1):6–10

    PubMed  Google Scholar 

  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):411–417

    Article  CAS  Google Scholar 

  11. Ethicon Wound Closure Manual (2004) The suture, p 28

  12. Dobrin PB (1989) Surgical manipulation and the tensile strength of polypropylene sutures. J Surg Res 124(6):665–668

    CAS  Google Scholar 

  13. Dobrin PB (1998) Some mechanical properties of polypropylene sutures relationship to the use of polypropylene in vascular surgery. J Surg Res 45(6):568–573

    Article  Google Scholar 

  14. Dobrin PB, Mrkvicka R (1998) Chronic loading and extension increases the acute breaking strength of polypropylene sutures. Ann Vasc Surg 12(5):424–429

    Article  CAS  PubMed  Google Scholar 

  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):89–101

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. The Ohio State University Medical Center for Minimally Invasive Surgery, N717 Doan Hall, 410 West 10th Avenue, Columbus, OH, 43210-1228, USA

    Dean Mikami, Bradley Needleman, Vimal Narula & W. Scott Melvin

  2. The Ohio State University Hospital, Columbus, OH, USA

    Janice Durant

Authors
  1. Dean Mikami
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  2. Bradley Needleman
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  3. Vimal Narula
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  4. Janice Durant
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  5. W. Scott Melvin
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Correspondence to Dean Mikami.

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Mikami, D., Needleman, B., Narula, V. et al. Natural orifice surgery: initial US experience utilizing the StomaphyXTM device to reduce gastric pouches after Roux-en-Y gastric bypass. Surg Endosc 24, 223–228 (2010). https://doi.org/10.1007/s00464-009-0640-y

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  • DOI: https://doi.org/10.1007/s00464-009-0640-y

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