Gastric Pouch Reduction
Laparoscopy or Minimally Invasive Bariatric Weight-Loss Surgery
Laparoscopic procedures for weight loss surgery employ the same principles as their “open” counterparts and produce similar excess weight loss. Not all patients are candidates for this approach, just as all bariatric surgeons are not trained in the advanced techniques required to perform this less invasive method. The American Society for Metabolic and Bariatric Surgery recommends that laparoscopic weight loss surgery should only be performed by surgeons who are experienced in both laparoscopic and open bariatric procedures.
Gastric Pouch Reduction
We at Wittgrrove Bariatric Center now offer the “ROSE” procedure for pouch reduction and reduction of the anastomosis size for gastric bypass patients. Please read on to fully understand the rational
Let us say at the outset that we are dedicated to the treatment of morbid obesity and we perform several operations to treat that disease. Dr. Wittgrove has performed literally thousands of gastric bypass operations, both open and laparoscopically. Our program also sees many patients, from all over the country, who have not done as well as they would have liked. Our feeling is that most of these “failures” come from operations where the original operation created a gastric pouch which was “too big”. In laparoscopic gastric bypass surgery that is usually because it can be quite difficult to create a small enough pouch. This is why Dr. Wittgrove continues to measure his gastric pouches with a balloon. The size of the gastric pouch seems to be important in overall success when looking at the gastric bypass. Because we measure the pouch every time, we rarely see pouch dilatation in our program patients but we have seen this phenomenon in patient refered to us.
When talking about bariatric operations, both primary and revisions, we must also discuss what is available by way of “new technology”. As we outlined in the section on Revisional Surgery, trying to determine what secondary procedures may help patients obtain the maxamum success can be a difficult and sometimes risky proposition. Because there is significant risk, new technology has developed to try to answer some of the questions, and attempt to do so more safely.
The main techniques we see today are the ones that reduce the size of the gastric pouch and / or reduce the size of the anastomosis, endoscopically. Endoscopic means the procedure is performed through an endoscope, without abdominal incisions. There are several different devices now available to sort of take “pleats” in the gastric pouch and therefore reduce the size. The claims from some of the companies or programs doing such procedures are at times outlandish and contains some misstatements of the facts. WBC offers technology based only on the data. WBC is conservative about this approach and we offer this technology only in the framework of a very experienced program with significant revisional bariatric surgery practice.
(See Revision Surgery Discussion Here) We offer the ROSE procedure by USGI.
The fact is that at several national and international meetings, recently, this topic was discussed in depth by very well known bariatric surgeons throughout the world. The general feeling is that these procedures should still be investigated by very well controlled studies because many types of techniques do not offer the majority of patients much benefit at all. When evaluating the data on such procedures one must understand several facts. First of all, the majority of Gastric Bypass patients do very well. Next, it is important to understand that if a particular patient didn’t do as well as they would have liked, there are many issues that need to be addressed to try to understand “why”. Our philosophy regarding this topic is outlined under revisions so we will not discuss it here. All revisions should be evaluated in a program with significant experience; not only with primary cases but with all types of difficult cases as well.
USGI was not the first company to put this endoscopic type of procedure out there in the market place. They actually waited till they had a registry of patients to follow so we could better understand the probability of success. It is based on this DATA that we decided to offer this procedure. An animation can be seen to better understand how the procedure works.
What makes this different? Once a full evaluation has been done and the patient and the surgeon believe an endoscopic proceudre should be done to try to reduce the size of the pouch or anastomosis, what do we want to achieve? We want some type of material which will reduce the size and stay in place long enough for scarring to occur at the right layer of the stomach wall. It gets rather technical at this point but the stomach is made of several layers and if you don’t bring the right layers together you can not reduce the size. If the suture and “tackers” don’t stay around long enough, you can not get scarring. And one of the most important issues to be concerned about is the fact that the stomach tries to push out or get rid of most “tackers”. That is exactally the reason we use the ROSE procedure; their type of tacking devices have been show to last where others have not!
For the stomach to heal from the pleating procedure, we have the patient avoid solid foods for a time. After the procedure, most patients have a weight loss of about 3 to 5 kg within the first 30 to 45 days, but compliance is very important. At three to six months out, the data is less than impressive for many of these new technologies. This is where patients need to do their homework with regards to the type of technology used.
Dr. Wittgrove’s personal and professional opinion in a message to you:
“Though the results are not impressive at this point for some of the techniques, I still think it is important to keep pushing for advancements in technology. How could I say anything else? After all I was the first to perform a laparoscopic gastric bypass! I believe in advancement and new technology. That being said, I think industry needs to maintain high ethical standards and promote the right investigations. That is why we offer the endoscopic platform we do. We can and will explain the differences in the various techniques and the outcomes as they are available, currently.
The endoscopic approach may be appropriate for some patients but it is the overall approach to less than expected results that makes our program special. Dr. Wittgrove has over 20 years of experience with all sorts of operations and complications referred to him from literally all over the world. That fact makes our program different from most and able to understand nearly every problem that is presented.”
