Restorative “Incisionless” Obesity Surgery

Even the most successful gastric bypass patients occasionally regain weight

New surgical technology now allows surgeons to treat one of the potential sources of this weight regain. The ROSE procedure (Restorative Obesity Surgery, Endolumenal) provides an incisionless surgical option to restore gastric bypass patients’ anatomy to closely match original post-surgery sizes

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Dr. Bagnato performs the scar-free ROSE Surgery (Restorative Obesity Surgery, Endolumenal) entirely through the mouth without making any external incisions into the body. Eliminating incisions means less risk than traditional open or laparoscopic surgery, minimal post operative pain, fast recovery time and no scarring. Patients generally report minimal or no pain after the procedure and many of them return to work and normal activities the next day.

Who is eligible?

Patients who originally lost significant weight following gastric bypass but who now find themselves regaining weight may be ideal candidates for this procedure. After an initial screening, you will undergo a series of evaluations including nutritional and dietary counseling, a full medical exam, and endoscopy to determine if you are a good candidate for ROSE Surgery.

What does the ROSE procedure entail?

ROSE surgery is performed with the patient under anesthesia using a four-channel tube and special Incisionless Surgery tools. The bariatric surgeon advances the flexible tube and a small endoscope through the patient’s mouth, into the stomach pouch. The surgeon will then insert the surgical tools through the channels of the tube. Tissue anchors are used to create multiple tissue folds around the stoma to reduce the diameter. The surgeon will then use the same technique to place anchors in the stomach pouch to reduce its volume.

Are there other treatment options available?

To perform the initial gastric bypass, the bariatric surgeon creates smaller stomach “pouch” and then bypasses the top portion of the small intestine. The procedure leaves a significant amount of scar tissue behind.

This scar tissue makes traditional or “open” revision (performed through an abdominal incision) surgery far riskier than the original surgery. The most feared complication of gastric bypass – a leak, an incomplete tissue connection that allows the stomach contents to spill into the body – is four times more common in revision procedures than in the original bypass. Most surgeons don’t perform open revisions today because of the risks.

In recent years, many medical device companies have developed new tools that allow surgeons to operate through the mouth. We’ve chosen a set of tools known as the EndoSurgical Operating System (EOS) because the system’s sutures and tissue anchors distribute holding force across tissue, leading us to believe that they will hold longer than other tissue fasteners. The EOS is also unique because it allows us to reduce the size of both the pouch and the stoma.

How long will you need to stay in the hospital?

Hospital stay is determined on a case-by-case basis. You may be discharged the same day if the procedure was done early in the morning or Dr. Bagnato may want you to stay overnight. He will make the determination following your ROSE surgery.

What are the benefits of an Incisionless procedure?

By eliminating skin incisions, the new procedure may provide important advantages to patients, including reduced risk of infection and associated complications, less post-operative pain, faster recovery time and no abdominal scars.

What type of side effects can I expect?

It is anticipated that patients will feel little or no discomfort from the procedure. To date, the only noted side effects have been short-term sore throat, swelling of the tongue or lip discomfort from the insertion of the instruments into the mouth. These issues usually go away in one or two days.

Is it safe?

As with any surgery there is risk involved. This less invasive approach should reduce the likelihood of many of the complications associated with the other open or laparoscopic revision procedures. ROSE surgery is a new procedure, however, and long term outcomes are unknown.

What is the success rate?

As with any weight loss procedure, results vary with each patient. The ROSE procedure has been well tolerated and most patients immediately lose weight as they eat less – with the return of the early feeling of “fullness” due to the restriction of the new, smaller pouch. The ROSE procedure is new and long-term data are not yet available.

What is the recovery process?

Typically, patients return to normal activity within a few days of their procedure. Dr. Bagnato will give you specific instructions. In addition, you will be required to follow a post-procedure diet and exercise plan, similar to the regimen prescribed following your initial bypass surgery. This generally means that patients will need to consume only liquids for a day or two after the surgery, and then slowly add soft, pureed foods for about two weeks before resuming a regular diet. To help you on your journey, follow-up appointments with Dr. Bagnato and regular visits with our bariatric support staff will be required.