Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results

Horgan, Santiago; Jacobsen, Garth; Weiss, G. Derek; Oldham, John S.; Denk, Peter M.; Borao, Frank; Gorcey, Steven; Watkins, Brad; Mobley, John; Thompson, Kari; Spivack, Adam; Voellinger, Dave; Thompson, Chris; Swanstrom, Lee; Shah, Paresh; Haber, Greg; Brengman, Matthew; Schroder, Gregory

doi:10.1016/j.soard.2009.12.011

« Previous Next »Surgery for Obesity and Related Diseases
Volume 6, Issue 3 , Pages 290-295, May 2010

Incisionless revision of post-Roux-en-Y bypass stomal and pouch dilation: multicenter registry results

Santiago Horgan, M.D.
- Department of Surgery, University of California, San Diego, School of Medicine, San Diego, California
Garth Jacobsen, M.D.
- Department of Surgery, University of California, San Diego, School of Medicine, San Diego, California
G. Derek Weiss, M.D.
- Bluegrass Bariatric Surgical Associates, Lexington, Kentucky
John S. Oldham Jr., M.D.
- Bluegrass Bariatric Surgical Associates, Lexington, Kentucky
Peter M. Denk, M.D.
- Bluegrass Bariatric Surgical Associates, Lexington, Kentucky
Frank Borao, M.D.
- Department of General Surgery, Monmouth Medical Center, Long Branch, New Jersey
Steven Gorcey, M.D.
- Department of Gastroenterology, Monmouth Medical Center, Long Branch, New Jersey
Brad Watkins, M.D.
- Synchrony Health, West Chester, Ohio
John Mobley, M.D.
- Synchrony Health, West Chester, Ohio
Kari Thompson, M.D.
- Department of Surgery, University of California, San Diego, School of Medicine, San Diego, California
Adam Spivack, M.D.
- Department of Surgery, University of California, San Diego, School of Medicine, San Diego, California
- Correspondence: Adam Spivack, M.D., Department of Surgery, University of California, San Diego, School of Medicine, 200 West Arbor Drive, 8402, San Diego, CA 92103
Dave Voellinger, M.D.
- Southeast Bariatrics, Charlotte, North Carolina
Chris Thompson, M.D.
- Department of Gastroenterology, Brigham and Women's Hospital, Boston, Massachusetts
Lee Swanstrom, M.D.
- Department of Minimally Invasive Surgery, Legacy Health System, Portland, Oregon
Paresh Shah, M.D.
- Department of Surgery, Lenox Hill Hospital, New York, New York
Greg Haber, M.D.
- Department of Gastroenterology, Lenox Hill Hospital, New York, New York
Matthew Brengman, M.D.
- Richmond Surgical Group, Richmond, Virginia
Gregory Schroder, M.D.
- Richmond Surgical Group, Richmond, Virginia

Received 21 May 2009; received in revised form 26 October 2009; accepted 16 December 2009. published online 15 February 2010.

Abstract

Background

Surgical revision for weight regain after Roux-en-Y gastric bypass (RYGB) has been tempered by the high complication rates associated with standard approaches. Endoluminal revision of stoma and pouch dilation should intuitively confer a better risk profile. However, questions of clinical safety, durability, and weight loss need to be answered. We report our multicenter intraoperative experience and postoperative follow-up to date using the Incisionless Operating Platform for this patient subset.

Methods

The patients who had regained significant weight ≥2 years after RYGB after losing ≥50% of excess body weight after RYGB were endoscopically screened for stomal and/or pouch dilation. Qualified patients underwent incisionless revision using the Incisionless Operating Platform to reduce the stoma and pouch size by placing anchors to create tissue plications. Data on the safety, intraoperative performance, postoperative weight loss, and anchor durability were recorded to date as a part of 2 years of postoperative follow-up.

Results

A total of 116 consecutive patients were prospectively studied. Anchors were successfully placed in 112 (97%) of 116 patients, with an average intraoperative stoma diameter and pouch length reduction of 50% and 44%, respectively. The operating room time averaged 87 minutes. No significant complications occurred. At 6 months after the procedure (n = 96), an average of 32% of weight regain that had occurred after RYGB had been lost. The percentage of excess weight loss averaged 18%. The 12-month esophagogastroduodenoscopy results confirmed the presence of the anchors and durable tissue folds.

Conclusions

Incisionless revision of stoma and pouch dilation using the Incisionless Operating Platform can be performed safely. The data to date have demonstrated mild-to-moderate weight loss, and the early 12-month endoscopic images have confirmed anchor durability. Patients were actively followed up to document the long-term durability of this intervention in the entire patient subset.

Keywords: Endoluminal surgery, Revisional bariatric surgery, Stoma and pouch dilation, Incisionless surgery