Revision Surgery

Some patients have had previous bariatric surgeries that may have included vertical banded gastroplasty, intestinal bypass, or stomach stapling. Although our surgeons do not perform these procedures, we may be able to assist in the revision of these procedures. In the past, stomach pouches were typically made larger and were more prone to stretching. Patients having these procedures would lose only about one-half of their extra weight.

Often, little instruction was given to patients to optimize the use of their pouches. Many times proper instruction in the correct use of the pouch can improve weight loss. In addition, poor portion control in the immediate post-operative time period can lead to some stretching and less than ideal weight loss. Sometimes, if the pouch is too large, revision surgery needs to be considered.

Some bariatric surgeons refuse to see patients when they fail with an original bariatric procedure. Other surgeons have minimal experience with revisional surgery. Our surgeons, on the other hand, regularly see patients from miles around who need revisional surgery, as we have significant experience with these procedures. We offer a comprehensive, multidisciplinary program to help patients achieve the best results possible.

ROSE PROCEDURE

Most gastric bypass patients obtain excellent weight loss after surgery. Some patients however, experience weight regain years after their original bypass surgery. This weight regain may be caused by a gradual enlargement of the stomach pouch or stoma (the connection between the stomach pouch and small intestine). We recognize this is a source of frustration and health concern and it has motivated us to pursue new options and potential solutions for our patients.

The ROSE Procedure (Revision Obesity Surgery, Endoscopic) is one of those options.The procedure uses FDA-cleared endoscopic instruments to decrease pouch and stoma size to recreate a restriction to encourage weight loss. This technique does not require surgical incisions. Rather, an endoscopic suturing device is introduced through the mouth like an upper endoscopy.

Sutures are placed in the stomach pouch to reduce its size and around the stoma to reduce its diameter. By eliminating outside incisions, the ROSE procedure is expected to provide important advantages to patients, including, reduced risk of infection and associated complications, less post-operative pain, faster recovery time, and no scarring.

The ROSE procedure is one of the first of many potential applications for Incisionless Surgery. Incisionless Surgery is considered the next wave in minimally invasive procedures and, in addition to obesity, it has generated interest among physicians in areas such as GERD, GI cancer and NOTES (Natural Orifice Translumenal Endoscopic Surgery).

(ROSE is a registered trademark of USGI Medical, Inc., San Clemente, CA.)

SCLEROTHERAPY

The gastric bypass pouch works optimally when a small opening keeps food in the pouch for a longer period of time. However, in some patients, with the passage of time, the opening can enlarge slightly. Until recently, there was no procedure available to address this situation. However, a study published in the Obesity Surgery Journal demonstrated that when a procedure known as sclerotherapy (pronounced: sklare-o-therapy) is performed in conjunction with a consultation with a registered dietitian, the best weight loss results are obtained.

How Sclerotherapy Works
Sclerotherapy is an outpatient procedure available for gastric bypass patients who have a dilated (enlarged) opening in their pouch. The procedure may be helpful in preventing additional surgery and may assist the patient with continued weight loss. It involves injecting an irritant around the opening from the pouch to the intestines. The body then reacts to the irritant by constricting (decreasing) the opening.

Who is Helped by Sclerotherapy?
This procedure can be very helpful for patients who are 2 – 5 years post surgery and have lost a fair amount of weight, but continue to struggle with the sensation that they can eat more than they could immediately following surgery. The procedure involves having an esophagogastroduodenoscopy (EGD) to evaluate the size of the pouch opening. If the opening is deemed large, then the irritant can be applied to decrease its size. In some cases, it may take more than one application to get the opening to constrict to the desired size.

If you have questions please call mmpc Michigan Weight Loss Specialists at 877-877-6672