Endoscopic Surgery

Transoral obesity surgery
– no incision required

A new type of surgery for obese patients is being tested in the United States and it promises quicker recovery and fewer complications compared to traditional lap band or Rouxen- Y gastric bypass surgery.

The primary obesity procedure, which involves suturing the stomach, is performed endoscopically through the oral cavity. No incision is necessary.

The procedure, termed transoral obesity surgery, is part of an FDA-approved clinical trial for primary obesity surgery at Brigham and Women’s Hospital (BWH) in Boston and the Cleveland Clinic.

In the endoscopic procedure the front and back of the stomach are sewn together with multiple stitches. This prevents it expanding with a meal and leads to the patient feeling satiated earlier and with less food. A similar endoscopic primary obesity procedure was carried out several years ago by a Venezuelan doctor, Dr Roberto Fogel, although he used an older device and a different stitch pattern.

Christopher Thompson, MD, BWH’s director of Developmental and Bariatric Endoscopy and the surgeon who is performing the procedure, said: “Our goal is to give patients an alternative to traditional obesity surgery, one with a faster and less painful recovery time and a reduced risk for infections and other complications.”

He told Middle East Health that the trial is the first prospective evaluation of endoscopic suturing for primary obesity in the world. Dr Thompson performed the first per-oral endoscopic bariatric revision procedure in the world in 2003.

The stitch pattern that Dr Thompson uses creates 2 to 3 stitch plications and each plication is fastened individually. Typically this will result in 6 to 8 plications throughout the stomach, each fastened with a fastening plug. Dr Fogel created a running stitch – or continuous suture pattern – all the way down the stomach with one fastening plug. If one plication broke the entire procedure would come apart. The procedure Dr Thompson is using aims to ensure this does not happen by fastening each plication separately.

Dr Thompson said he was pleased with the results so far. “All of the patients are doing very well,” he said, adding that the first patient, after nearly three months post-surgery, had lost more than 18 kilogrammes.

“This procedure is extremely promising for patients struggling to lose a lot of weight and who face the greatest risk with traditional bariatric surgery.”

ate of upload: 25th January 2009

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