Natural Orifice Surgery: Endoluminal Pouch Reduction Following Failed Vertical Banded Gastroplasty

Namdar Manouchehri, Daniel W Birch, Carlos Menezes, Xinzhe Shi, Shahzeer Karmali. University of Alberta, Centre for the Advancement of Minimally Invasive Surgery, Royal Alexandra Hospital, Edmonton, Alberta, Canada

Objectives: To demonstrate the effect of using StomaphyX on patients following failure of vertical banded gastroplasty (VBG).

Background: Patients may develop pouch complications such as dilation and staple line dehiscence following vertical banded gastroplasty (VBG). This may lead to weight regain and if conservative measures are exhausted, traditionally, open revisional surgery of the pouch or conversion of the VBG to Roux-en-Y gastric bypass would be considered. StomaphyX is an endoscopic device used with a conventional gastroscope for the approximation of tissue in gastric pouches or across gastroenteric anastomoses to enhance restriction.

Methods: Fourteen patients with weight gain following VBG had endoluminal pouch reduction performed using the StomaphyX device. Pre and post-operative weights were compared and a regression model was developed to examine for predictors of weight loss following StomaphyX.

Results: Patients had mean age of 47.3±7.9 years, and 13 of 14 were female. Significant reductions were appreciated between pre and postoperative weight and BMI (119.5±25.9 kg vs. 109.6±24.4 kg; 43.4±9.7 kg/m2 vs. 39.8±9.1 kg/m2, respectively). There was no correlation between preoperative pouch status and weight loss. Three patients had two separate StomaphyX procedures performed. Only minor complications (headache, back pain) were identified.

Conclusion: The StomaphyX device may be safely used for reduction of pouch size in patients following VBG. Further studies are required to determine the role of StomaphyX endoluminal pouch reduction in comparison to open or laparoscopic revisional surgery.

Session: Emerging Technology Poster
Program Number: ETP016
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