Endoluminal bariatric surgery grand rounds

The Shrinking World of Bariatric Surgery – new endoscopic

solutions to old surgical problems:

The Shrinking World of Bariatric Surgery – new endoscopic

solutions to old surgical problems:

Elliot R Goodman MD

Bariatric Surgery Service

Beth Israel Medical Center

New York, NY

Elliot R Goodman MD

Bariatric Surgery Service

Beth Israel Medical Center

New York, NY

BackgroundBackground

150,000-200,000 bariatric operations done a year

Weight loss of 67-75% EBWL in 80% of patients in 2 years

14 year follow up study: 95% of patients maintained at least 50% EBWL

150,000-200,000 bariatric operations done a year

Weight loss of 67-75% EBWL in 80% of patients in 2 years

14 year follow up study: 95% of patients maintained at least 50% EBWL

Pories WJ, Swanson MS, MacDonald KG. Who would have thought it? An operation proves to be the most effective therapy for adult-onset diabetes mellitus. Ann Surg 1995;222:339-350.

BackgroundBackground Estimated 10% - 20% will regain some weight at 5 and 10 years

Usually a nadir weight is reached at 2 years

Weight regain = ????? 20% of weight gain above nadir weight Dropping below 50% of % EBWL after primary surgery

12% incidence of revision after gastric bypass surgery

Estimated 10% - 20% will regain some weight at 5 and 10 years

Usually a nadir weight is reached at 2 years

Weight regain = ????? 20% of weight gain above nadir weight Dropping below 50% of % EBWL after primary surgery

12% incidence of revision after gastric bypass surgery

Gagner M., et al. Laparoscopic Reoperative Bariatric Surgery : Experience from 27 consecutive patients. Obes Surg, (12) 254-260, 2002.

BackgroundBackground

Review of Literature on Reoperative Bariatric Surgery 17 open papers (838 patients)

118 major complications (14%) 11 deaths (1.3%)

64 patients - laparoscopic reoperation 6 major complications (9%) Average OR time 4.5 hours

Review of Literature on Reoperative Bariatric Surgery 17 open papers (838 patients)

118 major complications (14%) 11 deaths (1.3%)

64 patients - laparoscopic reoperation 6 major complications (9%) Average OR time 4.5 hours

Jones KB. Revisional bariatric Surgery-potentially safe and effective. SOARDS 1 (2005) 599-603

Endoluminal Gastric Pouch ReductionEndoluminal Gastric Pouch Reduction

StomaphyXTM


StomaphyXTM (EndoGastric Solutions, Redmond Washington)

Cleared in the United States and Europe for endoluminal tissue approximation

Patients who want further weight loss

Patients with rapid gastric gastric emptying or dumping syndrome associated with diarrhea

StomaphyXTM (EndoGastric Solutions, Redmond Washington)

Cleared in the United States and Europe for endoluminal tissue approximation

Patients who want further weight loss

Patients with rapid gastric gastric emptying or dumping syndrome associated with diarrhea


Procedure

12-20 fasteners per case

Start 1 cm proximal to stoma- 6 fasteners

1-2 cm proximal to first row- 6 fasteners

Additional fasteners

Procedure

12-20 fasteners per case

Start 1 cm proximal to stoma- 6 fasteners

1-2 cm proximal to first row- 6 fasteners

Additional fasteners

Diagram for fastenersDiagram for fasteners

H

H H

HH

H


Pre anastomosis Post anastomosis


Gastro-esophageal Junction


26 patients have undergone the endoluminal pouch reduction since April 12, 2007 at The Ohio State University (Columbus, Ohio)

200 other patients have undergone the endoluminal pouch reduction procedure in the US

26 patients have undergone the endoluminal pouch reduction since April 12, 2007 at The Ohio State University (Columbus, Ohio)

200 other patients have undergone the endoluminal pouch reduction procedure in the US

Endoluminal Gastric Pouch Reduction The Ohio State University Data


AGE 47 (29-57)

Pre StomaphyX Weight (kg) 107.7 (75-172.2)

BMI 40.4 (32.6-63.2)

Height (inches) 64.3

Female / Male 96% female

Ave. wt. loss- gastric bypass (kg)

31.8

% EBWL- gastric bypass 54.9 %



2 week weight loss (kg) 4.1 (1.2-17.7)

4 week weight loss (kg) 4.9 (1.3-19)

8 week weight loss (kg) 6.6 (2.3-15)





2 week % EBWL 8.4 (2.5-26.8)

4 week % EBWL 11.3 (3.0-41.5)

8 week % EBWL 16.8 (5.1-51)

12 week % EBWL 20.8 (7.9-30.9)

16 week % EBWL 29.5 (21-38)


Unexpected Results

Postprandial diarrhea resolved in 3 patients. Slowed gastric emptying Obliteration of the gastric colic reflex

GERD completely resolved in 2 patient. New valve created just distal to GE junction

Unexpected Results

Postprandial diarrhea resolved in 3 patients. Slowed gastric emptying Obliteration of the gastric colic reflex

GERD completely resolved in 2 patient. New valve created just distal to GE junction


Mechanism of Weight loss

Reduce size of gastric pouch

Possible to reduce size of stoma

Reduce compliance in the gastric pouch

Slows gastric emptying

Mechanism of Weight loss

Reduce size of gastric pouch

Possible to reduce size of stoma

Reduce compliance in the gastric pouch

Slows gastric emptying

On The Drawing BoardOn The Drawing Board

TOGA gastroplasty:TOGA gastroplasty:

Endoluminal bariatric surgery grand rounds

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