Single Site Series Utilizing the Endosurgical Operating System (eos) for Revision of Post Roux-en-Y Gastric Bypass Stomal and Pouch Dilitation

SINGLE SITE SERIES UTILIZING THE ENDOSURGICAL OPERATING SYSTEM (EOS) FOR REVISION OF POST ROUX-EN-Y GASTRIC BYPASS STOMAL AND POUCH DILITATION. Michael Chaump, M.D., Roy M. Dressner, D.O., Steven A. Gorcey, M.D., Frank J. Borao, M.D., Monmouth Medical Center, Long Branch NJ
Introduction: Interventional therapy for weight regain after Roux-en-Y gastric bypass surgery (RYGB) has been tempered by the higher morbidity and mortality associated with standard revisional surgery. Although endoluminal reduction of post-bypass stomal and pouch dilatation offers the promise of a safer alternative approach, questions still remain regarding safety, durability, and weight loss outcomes with this procedure. We report intra-operative and post-operative results to date utilizing the EndoSurgical Operating System® (EOS), for this challenging patient subset.
Methods: Patients who had regained significant weight 2+ years after RYGB after losing greater than 50% of excess body weight post-RYGB underwent endoluminal stomal and pouch reduction after being endoscopically screened for post-bypass stomal and/or pouch dilatation. The EOS was utilized to endoluminally reduce stoma size by creating circumferential folds with the EOS tissue anchoring system. Anchors were also utilized to approximate gastric pouch tissue and reduce pouch size. Data on safety, intra-operative performance, post-op weight loss, and anchor durability were recorded to date with use of the EOS.
Results: In 20/21 subjects we were able to successfully place anchors (one patient had an occult gastro-gastric fistula impairing pouch distention). Weight regain post-RYGB averaged 59 lbs (N=20). Stomal diameter was reduced on average by 53%, with pouch reduction averaging 41%. O.R. time averaged 91 minutes. There were no significant complications. An average of 36% of weight regain post-RYGB was lost at 3 months post-procedure (N=15). Median weight loss at 3 months was 24 lbs (range 8-40 lbs). 3 month EGD results revealed presence of anchors in their original locations, preservation of most of the intra-operative stoma/pouch reduction, tissue remodeling, and fibrotic tissue folds.
Conclusion: Clinical study of the EOS suggests great potential as a safe, and efficacious method for reducing stoma and pouch dilatation post- RYGB. Weight loss is currently being tracked through ongoing endoscopic and clinical follow-up.


Session: Podium Presentation

Program Number: S009

« Return to SAGES 2009 abstract archive