Aims:
The aim of this study was to evaluate the technical feasibility, and safety and efficacy outcomes, in the short-medium term, of transoral outlet reduction (TORe), by means of an endoscopic suture device in patients with weight regain after Roux-en-Y gastric bypass (RYGB).
Methods:
Bariatric surgery remains the most effective long-term therapeutic option for morbid obesity. Over time, however, many of these patients can regain much of their lost weight.
This was a retrospective, descriptive multicentric analysis of 15 consecutive patients submitted for weight regain after RYGB and with dilated gastro-jejunal anastomosis (> 15 mm). TORe was performed using an endoscopic transmural suture device (OverStitch-Apollo®) which was used to reduce the anastomosis aperture and also to treat the gastric pouch when it was dilated (> 5 cm). We describe intraoperative technical data, and safety and weight loss outcomes with a follow-up at 1, 3 and 6 month.
Results:
After RYGB, there was a mean maximum weight loss of 37.69 kg and a later average regain of 21.62 kg. Mean anastomosis diameter was 36 mm (range 20 – 45) which was reduced to 9 mm (range 5 – 12) (75% reduction) with an average of 2.5 sutures (2 – 3). Mean pouch size was 7.2 cm (range 2 – 10) which decreased to 4.7 cm (range 4 – 5) (34.72% reduction) in 11/13 patients with an average of 2.7 sutures (0 – 4).
Mean weight loss at 1, 3 and 6 months after TORE was 6.19 kg, 10.06 kg and 12.29 kg, representing a weight loss of 28.63%, 46.53% and 56.85% of weight regained after RYGB. The procedure proved safe in all cases.
Conclusions:
Endoscopic suture reduction of the dilated gastro-jejunal anastomosis and the gastric pouch seems a feasible and safe option. Within a multidisciplinary approach and in a short-medium term follow-up, it is presented as a minimally invasive and effective option to control weight regain after RYGB.
