The ROSE Procedure (Restorative Obesity Surgery, Endolumenal)

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The ROSE Procedure
Restorative Obesity Surgery, Endolumenal (or Endoscopic)

The ROSE procedure is a safer, incisionless revision that reduces the stomach volume and stoma diameter in order to increase restriction and encourage weight loss in gastric bypass patients.

A gastric bypass revision, The ROSE procedure (which stands for Restorative Obesity Surgery, Endolumenal) is an incision-free procedure that reduces the size of a patient's stomach pouch and stoma to the original post-gastric bypass size to help them back onto the path of weight loss. It is not a primary method of weight loss surgery, but a follow-up procedure that is specifically designed for gastric bypass patients with weight regain.

The ROSE procedure is indicated for gastric bypass patients who were initially successful in losing the excess weight but are now regaining some of the lost weight because the stomach and stoma have stretched out and no longer effectively control hunger and food intake.

Why is the ROSE procedure performed?

The purpose of the ROSE procedure is to reduce the size of the stomach and stoma to recreate the restriction of the original gastric bypass.

Most gastric bypass patients are able to lose a significant amount of excess weight following surgery and keep it off long-term. While slight weight regain after the first 18 to 24 months is common, some patients gain back more weight than desired.

In many cases of failed gastric bypass, weight regain is due to the stomach pouch and stomach outlet (stoma) stretching out over time. Stretching often occurs from poor portion control. When the stomach and stoma become enlarged, they no longer effectively restrict food intake or reduce hunger sensations.

How is the ROSE procedure performed?

The ROSE procedure is performed endoscopically and does not require external cuts or incisions.

With endoscopic procedures, such as the ROSE, the doctor operates via a natural body opening using small, flexible surgical tools. To reach the surgical area, a special FDA-approved medical device is inserted through the mouth, down the esophagus, and into the stomach pouch. The tool gathers together sections of stomach tissue to create a pleat which is then sutured together. With this process, the stomach volume and stoma diameter can be reduced to increase restriction and encourage weight loss.

Patients will be put under general anesthesia. It takes about one hour to complete the operation, which is often performed on an out-patient basis. Most patients will feel little or no discomfort.

What is the expected recovery?

Most patients are able to go home within 24 hours and can resume a normal schedule within a few days. Post-operative symptoms are minimal. Most patients experience little more than a few days with a mild sore throat, hoarseness, swollen lip, and lip pain due to the endoscopic instruments that were inserted into the mouth. Most patients don’t experience stomach pain as they did with gastric bypass surgery. Since no incisions are made into the skin, the risk of infection and associated complications is low, recovery time is faster, post-operative pain and discomfort is minimal, and there are no visible scars.

What is the post-operative diet?

To give the stomach sutures time to heal, the diet will be similar to the post-op gastric bypass diet. The first week is full liquids, followed by two weeks of soft foods. Solid foods will slowly be reintroduced back into the diet after healing. Portion control will help to reduce the risk of restretching the stomach and stoma.

What are the advantages of the ROSE procedure?

The ROSE procedure is performed endoscopically and does not require cuts or incisions. This offers many gastric bypass patients a safer option than most of the other revision options currently available. Most other revision options require open or laparoscopic surgery which is very challenging because of the scar tissue and adhesions that develop after the initial gastric bypass; they typically take longer and are more likely to cause complications than the original procedure. Because the risks tend to outweigh the benefits, many patients decide not to undergo an open or laparoscopic surgical revision.

Benefits of the ROSE procedure include:

• Endoscopic procedure, therefore no external cuts or incisions
• Quick procedure (1 hour)
• Usually performed on an outpatient basis
• Quick recovery time, resume normal activities within a few days
• Overall risks much lower than with open or laparoscopic surgical revision
• No visible scars
• Low risk of infection
• Minimal pain and discomfort
• Reduces size of stomach pouch, thus limiting food intake
• Reduces stoma diameter to slow digestion, thus increasing satiety

What is the cost of the ROSE procedure?

The cost for the ROSE procedure will vary, but is approximately $10,000. What you pay will depend on where the procedure is performed, how long you stay in the facility, surgeon fee, and other associated surgical factors. Your doctor will be able to give you an estimate of the total cost during your consultation.

Is it covered by insurance?

Revisional bariatric surgery, just like gastric bypass, may or may not be covered by insurance. As with all weight loss procedures, coverage will depend on insurer, policy, and patient criteria.

How do I choose a doctor for the ROSE procedure?

Select a bariatric surgeon who has experience doing revisions, rather than just general bariatric surgery. As many bariatric surgeons do not perform revisions or have minimal experience in revisional procedures, you will want to find a bariatric center that offers the new ROSE procedure as well as having significant experience with gastric bypass revisions.

What other revision options do gastric bypass patients have if they regain weight?
Revision options for gastric bypass include:

• Revision surgery to restore the original gastric bypass anatomy
• Conversion to Vertical Sleeve Gastrectomy (Gastric Sleeve)
• Conversion to Duodenal Switch
• Conversion to Bilio-Pancreatic Diversion (Scopinaro-type)
• Adjustable Gastric Banding (LAP-BAND or REALIZE Band)
• Gastric bypass revision with StomaphyX

Are you a candidate for the ROSE Procedure?

The ROSE procedure is designed for patients who previously had a Roux-en-Y gastric bypass and were successful in losing over 50% of their excess weight but are now gaining back weight. Typically, the original procedure must have been performed more than 2 years ago and weight regain has reached 15% or more of the lost weight. In some cases, patients may also be a candidate if they underwent gastric bypass surgery but failed to lose weight.

Patients will first be screened by a bariatric surgeon to determine if they meet the criteria for ROSE. Then, patients must undergo a series of evaluations including nutritional and dietary counseling, a full medical exam, and endoscopy (EGD and Upper GI series). During the endoscopy, measurements will be taken of the stomach size and stoma diameter to determine whether or not there is sufficient enlargement to qualify.

How will it help with weight loss?

The ROSE procedure will help a person eat less by recreating the restriction of the initial gastric bypass surgery. By reducing the stomach volume, it will help limit meal portions and food intake. By making the stoma diameter smaller, it will slow down the movement of food out of the stomach pouch. This will prolong the feeling of fullness after a meal and lessen hunger sensations between meals.

The procedure is new, but early weight loss results have been positive. Patients can expect immediate results, at a weight loss rate of one to two pounds per week.

The Rose Procedure Video:

Bariatrics The branch of medicine that deals with the causes, prevention, and treatment of obesity. The term bariatrics was created around 1965, from the Greek root baro ("weight," as in barometer), suffix -iatr ("treatment," as in pediatrics), and suffix -ic ("pertaining to"). Besides the pharmacotherapy of obesity, it is concerned with obesity surgery.

Roux-en-Y Gastric Bypass A type of gastric bypass procedure which combines restrictive and malabsorption techniques - meaning, it reduces the amount of food a patient can comfortably eat (restriction), and also reduces the amount of calories that can be digested in the small intestine (malabsorption). This combination of bariatric methods leads to greater weight loss and the roux-en-y procedure is seen as one of the best ways to treat clinically severe obesity. See WLS Videos for animated surgery technique.

Laparoscopy Laparoscopic surgery, also called minimally invasive surgery is a modern surgical technique in which operations in the abdomen are performed through small incisions as compared to larger incisions needed in open surgical procedures. Laparoscopic surgery belongs to the broader field of endoscopy. The key element in laparoscopic surgery is the use of a laparoscope: a telescopic rod lens system, that is usually connected to a video camera. Also attached is a fiber optic cable system connected to a 'cold' light source (halogen or xenon), to illuminate the operative field, inserted through a 5 mm or 10 mm Trocar to view the operative field. The abdomen is usually insufflated with carbon dioxide gas to create a working and viewing space. The abdomen is essentially blown up like a balloon (insufflated), elevating the abdominal wall above the internal organs like a dome. The gas used is CO2, which is common to the human body and can be absorbed by tissue and removed by the respiratory system.

Obesity Obesity results from the excessive accumulation of fat that exceeds the body's skeletal and physical standards. Obesity has been defined as a weight more than 20% above what is considered normal according to standard age, height, and weight tables, or by a complex formula known as the body mass index. According to the National Institutes of Health (NIH), an increase in 20 percent or more above your ideal body weight is the point at which excess weight becomes a health risk. CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

Stoma Opening to stomach created by stapling or placing an adjustable band around the upper part of the stomach during surgery.

Endoscopy Endoscopy is a minimally invasive medical procedure that is used to assess the interior surfaces of an organ by inserting a tube (generally a medical instrument known as an endoscope) into the body. Many endoscopic procedures are considered to be relatively painless and, at worst, associated with mild discomfort. Eliminating incisions means less risk than traditional open or laparoscopic surgery, minimal post operative pain, fast recovery time and no scarring. The Restorative Obesity Surgery, Endolumenal Procedure better known as The ROSE Procedure is performed endoscopically, as is the StomaphyX gastric bypass revision. Patients generally report minimal or no pain after the procedures and many of them return to work and normal activities the next day.

Pouch Most bariatric surgeries restricts the amount of food a patient can eat by reducing the size of the stomach by gastric banding, stapling or removal. What results is known as the gastric pouch.