StomaphyX and ROSE:
Incisionless Operations to Tighten a Gastric Bypass
T he StomaphyX and ROSE procedures are two remarkable new techniques that are used to re-tighten a gastric bypass through the mouth, without any incisions. This tightening helps patients get back on track with their eating behaviors and lose re-gained weight. These procedures must be accompanied by a team approach between the surgeon and patient, to ensure that the patient is making the best use of their tool and receiving full benefit. It is this close personal follow-up that has helped patients in the Ellner Bariatric Incisionless Revision Program achieve outstanding success with losing re-gained weight.
If a patient has undergone gastric bypass surgery and either their stomach pouch or their stoma (this is the connection between the stomach and the small intestine) has stretched, the patient has a stronger tendency to re-gain weight. This weight re-gain can lead to recurrence of dangerous weight related medical problems like diabetes, hypertension and sleep apnea, as well as low back pain, hip and knee pain. It is also believed that stoma stretch leads to increased dumping syndrome, by means of the rapid transit of food from the stomach pouch to the small intestine. Stoma stretch also predisposes patients to reflux of intestinal contents, which can be irritating to the stomach lining.
However, what people worry about most is weight re-gain. It's impossible to say how many people re-gain weight after gastric bypass, because it's almost always associated with a lack of follow-up with the surgeon - so we really don't know how many people are struggling with weight gain, because they haven't been in to see their surgeons about it.
One of the eye-opening things about my Incisionless Revision practice is that while patients are coming to me from all over the nation, from many different programs, with a wide variation in the level of post-operative education, they all have one thing in common - a lack of follow-up. They haven't been seeing the surgeon who performed their gastric bypass. Many didn't do monthly follow-up for the first year, and they certainly didn't have yearly visits thereafter. They haven't had regular lab testing by their bariatric surgeon, and I have discovered moderate to severe vitamin deficiencies in nearly everyone... all of which could have been avoided if they had been tested and had been taking the appropriate vitamin supplementation as part of a standard follow-up program.
Most patients in my revision practice hadn't been making regular appearances at educational support groups. They have found, though extensive discussion with me, that they have never known how to use their bypass surgery effectively. They have perhaps unknowingly stretched their stomach and pouch and have regained weight in the process. Many have told me that they simply felt so good after the gastric bypass that they didn't see the need to follow up with their surgeon. They thought that the weight would never come back. They were devastated when, after years of unintentionally misusing the surgery, it did come back.
The StomaphyX and ROSE procedures are very low risk, straightforward, outpatient procedures that allow the surgeon to shrink the stomach and stoma from the inside, like taking darts or tucks in a waistband that is too large. The ROSE procedure focuses on re-cinching the stoma, while the StomaphyX does its best work on the pouch itself. The internal volume of the stomach can be reduced by up to 80%, which gives the patient a small stomach that fills quickly. The tucks, or "plications" can also reduce the "stretchability" of the stomach pouch. Patients have reported that it gives them a fresh tight feeling with smaller meals, similar to having had a new gastric bypass, without the nausea the commonly accompanies the initial bypass. The ROSE procedure, by way of tightening the stoma, makes the stomach empty more slowly. This is intended to prolong the full feeling. These re-tightening procedures have been referred to by my patients as a "tune-up" of their gastric bypass. The patients are able to use the tool of the surgery better by getting a full feeling sooner. The patient then responds to that full feeling and stops eating sooner, which reduces the total amount of calories they consume.
There are a couple of surgically correctable reasons why weight re-gain occurs:
- Pouch too large
If a patient has a pouch that is too large or has stretched over time, he/she will require more food intake in a given sitting before feeling physically full. If the patient relies solely on this "full feeling" as their signal to stop eating, the food intake will increase as the size of the pouch increases, leading to weight re-gain over time. - Stoma too large
If a patient has a stoma that has stretched over time (generally from inappropriate eating habits), the food that he/she eats will not stay in the stomach very long. It will tend to pass out of the stomach and into the small intestine rather quickly. This will result in the patient feeling empty again soon after a meal and the resultant increase in the number of meals will lead to weight re-gain. Some doctors believe that this rapid emptying of food into the small intestine also creates more severe dumping symptoms than would otherwise be present if the food passed more slowly.
The traditional method of repairing a pouch or stoma that is too large is a very high risk "revisional" operation, performed through a large incision in the abdomen. This is a long, difficult procedure and is fraught with complications, risk, and failure. Many surgeons quote up to 25-30% complication rate with traditional revisional surgery. Because of this, many patients just haven’t wanted to undergo a revision and they have just lived with the added weight and the medical problems that go with it. Now that StomaphyX and ROSE are available, patients can undergo a “tightening” procedure without having to undertake the risk of a traditional major operation.
It's important to understand that there are reasons for weight re-gain that aren't surgically correctable - like snacking, not exercising, eating inappropriate foods, etc. These behaviors need to be corrected in order to maximize the success of any revisional procedure. That's why I ensure that all of my StomaphyX and ROSE patients receive a full and ongoing education on how to make the most of the surgery, including changing lifestyle and eating behaviors. I personally perform the follow-up on my patients, because I feel that this gives my patients the best opportunity to understand how their gastric bypass surgery is meant to work and to make the necessary changes to use their tool effectively.
If you would like to learn more about these procedures, please attend one of my free educational seminars. The seminar is designed to answer most, if not all of your questions. You can register by pressing the "Free Seminars - Schedule" button at the top left of this page. It will take you to the calendar of events - you simply choose a Revision/StomaphyX/ROSE seminar date, and register for it online. If you have additional questions, please call me at 619-286-STOMA (7866). I will be happy to discuss your situation with you by phone or in office consultation.
My Incisionless Revision patients are enjoying immense success. I look forward to answering your questions and helping you get back on track!
Julie Ellner, M.D.
