Endoluminal Gastric Pouch Reduction (StomaphyX)
The number of gastric bypass surgeries being performed each year has rapidly grown over the last several years, and it’s now estimated that over 1 million people in the United States have undergone gastric bypass surgery in the last 15 years. While the majority of primary bariatric procedures are successful, about 10% to 15% of patients who have undergone gastric bypass surgery regain weight 2 -3 years following the primary procedure. Oftentimes, standard diet and exercise programs will help patients get back to their lowest weight after the initial surgery. Unfortunately, a significant number of patients—as many as 200,000 patients—are still unable to return to their ideal weight and/or continue to gain weight over time. These individuals may require a revisional procedure to further weight loss by reducing the size of their gastric pouch after their initial surgery or to treat postoperative bariatric surgery syndromes (eg, dumping).
New Revisional Surgery Offers Substantial Benefits
Several surgical options are available to treat weight gain after gastric bypass surgery when diet and exercise fail, but complication rates with these procedures can be five to 10 times higher than rates associated with the original surgery. At Ohio State University (OSU) Medical Center, we are performing an “incisionless” procedure that helps us avoid the high rates of complications associated with traditional revisional surgeries. This approach uses principles of revisional surgery to help shrink the size of the stomach.
Using the StomaphyX device, a flexible endoscope carrying a fiber-optic camera and a tubular surgical tool is passed through the mouth and advanced to the stomach. Tissue of the stomach is then suctioned into the device and 12 to 20 staple-like fasteners are placed strategically in the stomach to create pleats in the tissue and reduce the volume of the gastric pouch after surgery. The surgery helps recreate the patient’s smaller stomach; this can lead to early satiety and further weight loss. It also decreases the stretch of the stomach (so that it can’t hold as much food) and slows emptying of the stomach. Patients are under general anesthesia during the procedure, but this does not require an overnight hospital stay.
While there are other methods to reduce the size of the gastric anastomosis, the incisionless procedure we’re using at OSU Medical Center is currently the only endoscopic way to reduce the size of the stomach after gastric bypass surgery. There are no incisions or scars, patients have less pain, and the rates of complications are lower, making recovery much quicker.
Patient Selection
Ideal patients for the StomaphyX procedure include those who are between the ages of 18 and 70, had undergone gastric bypass for obesity 2 or more years ago, have regained about 20% of the weight they had lost, are compliant with their diet, continue to exercise regularly, and do not have early satiety during meals.