Revisional Bariatric Surgery for a Weight Loss Failure After a Pose Procedure

Jordi Pujol Gebelli, MD, PhD1, Amador Garcia Ruiz de Gordejuela1, Manoel P Galvao Neto, MD, PhD2, Carles Masdevall Noguera, MD, PhD3, Anna Casajoana Badia, MD, PhD1, Almino C Ramos, MD2. 1Hospital Universitari de Bellvitge, 2Gastro Obeso Centre, 3Clinica Diagonal. Barcelona

BACKGROUND. Endoscopic Plication by POSE (Primary Obesity Surgery Endoluminal) procedure is a new endoscopic restrictive procedure. It may be indicated in patients with Grade I or II Obesity. Short term results are promising, but long term results and its efficacy in morbid obese patients it is unknown.

METHODS. This video shows two failure of weight loss after a POSE procedure in morbid obese patients. We show how a revisional bariatric surgery either to Roux-en-Y Gastric Bypass (RYGB) or Sleeve Gastrectomy (SG) are technically feasible.

RESULTS. First case is a 45 y.o. women whio had a POSE procedure 18 months before; after some weight loss she regained up to her original weight. Intraoperatively POSE anchors bytes may be observed over the serosa at fundus and antrum. Working medially to those indentations it is possible to construct a pouch and complete the RYGB as usual. Second case is a 54 y.o male with BMI 39kg/m2 previous to POSE, after 6 months of good weight loss, he recovered all of it and looked for bariatric surgery after 12 months. Patient was planned to SG and as during surgery it was not possible to find properly the anchors, intraoperative endoscopy was required to perform safely the SG. Both patients had an uneventful post operative time and are losing weight the same way other primary SG or RYGB.

CONCLUSIONS. Performing conventional bariatric surgery procedures after a endoscopic POSE it is feasible and can be safely done if the surgical team has appropriate knowledge about both endoscopic and bariatric procedures. The main pitfall is to find and not to cross by the staplers the anchors of the POSE.

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