New surgery targets weight loss (ROSE Procedure)

[MsJacquiiC]

A new incision-free procedure offers a less invasive option for gastric bypass patients who need surgery to "tighten up" their stomach pouches and get back on track with weight loss.

In traditional approaches, surgeons make an incision in the abdomen and repair the stomach pouch. They often also tighten the stoma.

The ROSE (Restorative Obesity Surgery, Endoluminal) procedure means less pain and a quicker recovery than traditional surgeries, said Elliott Fegelman, the surgeon who performs the procedure at Kenwood's Jewish Hospital.

But it's also a reminder that gastric bypass surgery, often the option of last resort, isn't always a permanent fix for obesity.

Weight-loss surgeries have grown in popularity since the early 1990s, reflecting both the increase in obesity and improved surgical technique. In recent years, newer, less invasive procedures have fueled some of that growth, but gastric bypass remains the gold standard for morbidly obese patients.

In gastric bypass surgery, doctors reduce the size of the stomach with sutures or staples, which limits the amount of food a patient can eat, and re-route a portion of the intestine to restrict the number of calories a patient absorbs from digesting food.

It's a drastic surgery, and patients have to follow strict post-surgical diets and start exercise routines to maintain the weight loss. But it lets morbidly obese patients lose more than half of their excess weight and it has been shown to cure type 2 diabetes in adults and teens.

But gastric bypass surgery isn't a sure-cure for obesity. About 12 percent to 15 percent of people who have the surgery gain back some of the weight. In most cases, experts say, it's because they didn't follow the post-surgery plan.

A small percentage of people who regain weight - no firm data is available - undergo corrective surgery to restore their stomach pouches to the size they were immediately after the gastric bypass.

The ROSE procedure is the latest surgery option, Fegelman said. It's been available for about two years nationally, but Fegelman performed the first procedure at Jewish in December.

In traditional approaches, surgeons make an incision in the abdomen and repair the stomach pouch. They often also tighten the stoma, or connection between the intestine and stomach. In some cases, the surgery can be done laparoscopically, using a small incision and tiny surgical tools.

Click the "Play Video" button to view procedure animation. Learn more about The ROSE Procedure in our community forums.

In the ROSE procedure, a surgeon threads an endoscope down a patient's throat and esophagus into the stomach, then uses specially designed tools to suture up the stomach pouch and stomach.

The procedure takes about an hour and a half, Fegelman said, and requires general anesthesia.

Patients can go home the same day, he said. "They have a sore throat, and that's about it," he said.

The procedure costs about $12,000, and it isn't covered by insurance.

Cost for a gastric bypass averages about $15,000 to $16,000. Some insurers cover it, but they don't usually cover any corrective procedures.

Diana Schwallie, 61, of Sardinia underwent the ROSE procedure Dec. 17. She had gastric bypass surgery five years ago, and lost about 100 pounds.

Her extra pounds caused several health problems, including high blood pressure and type 2 diabetes. After the gastric bypass surgery, they went away.

"The diabetes disappeared. I went down to minimal blood pressure medicine. I was able to get rid of several medications," Schwallie said.

The weight loss lasted for a few years, then the pounds creeped back - about 40 of them.

Since the ROSE procedure, Schwallie has lost about 15 pounds.

In some cases - about 5 percent of the time - gastric bypass surgery stops working because the stomach pouch or stoma wasn't constructed properly in the first place, said George Kerlakian, medical director of the Weight Management Center at Good Samaritan Hospital.

The rest of the time, the pounds reappear because patients aren't following the strict regimen of diet and exercise recommended following the surgery, experts say.

"The key thing is aftercare," said John Baker, a Little Rock, Ark., bariatric surgeon and president of the American Society for Metabolic and Bariatric Surgeon. "We need patients to come in for follow-up. We encourage them to come in for support groups, and to lets us monitor what they're doing in terms of weight-loss, their meal plans and their exercise."

Schwallie realized she was eating more than she should have after her original surgery without really noticing it. "When I first had the surgery, if I ate one bite over , I would get this nauseated feeling. That just kept getting less and less, and I could eat more.''

She learned the small stomach "pouch" created during the bypass surgery had stretched, letting her stomach hold more food, and letting the weight come back.

There are risks with any surgery, but the ROSE procedure is generally safer than traditional corrective surgeries, Fegelman said.

Since her follow-up surgery, Schwallie is on a mostly liquid diet her surgeon prescribed. It's pretty close to the plan she followed immediately after her initial gastric bypass.

"It's almost like starting over," she said.



Learn more about The ROSE Procedure in our community forums.
Source

Morbid Obesity A condition in which the Body Mass Index is 40.0–49.9, which is roughly equal to 100 pounds or more over ideal body weight; a weight level that is life-threatening. A BMI greater than 50 is termed as "super obese." CLICK HERE TO OPEN THE JOURNEY BMI CALCULATOR!

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.

Hypertension Also referred to as high blood pressure, HTH, HTN or HPN, hypertension is a medical condition in which the blood pressure is chronically elevated. In current usage, the word "hypertension" without a qualifier normally refers to arterial hypertension. The Mayo Clinic specifies blood pressure is "normal if it's below 120/80".

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.

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!

Diabetes Mellitus A disease that occurs when the body is not able to use blood glucose (sugar). Blood sugar levels are controlled by insulin, a hormone in the body that helps move glucose from the blood to muscles and other tissues. Diabetes occurs when the pancreas does not make enough insulin or the body does not respond to the insulin that is made. There are two main types of diabetes mellitus: Type 1 Diabetes and Type 2 Diabetes. All forms of diabetes have been treatable since insulin became medically available in 1921, but there is no cure.

Metabolism All of the processes that occur in the body that turn the food you eat into energy your body can use. Exercise, food, and environmental temperature influence metabolism.

Surgical Staples Surgical staples are specialized staples used in surgery in place of sutures to close skin wounds. Stapling is much faster than suturing by hand, and also more accurate and consistent. In bariatric surgery, staples are primarily used because staple lines are less likely to leak blood, air or bowel contents. In skin closure, dermal adhesives (skin glues) are also an increasingly common alternative. The technique of stapling for surgery is said to have been influenced by the Roman use of ants for wound closure.

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

Type 2 Diabetes Previously known as "noninsulin-dependent diabetes mellitus" or "adult-onset diabetes" -- Type 2 diabetes is the most common form of diabetes mellitus. About 90 to 95 percent of people who have diabetes have type 2 diabetes. People with type 2 diabetes produce insulin, but either do not make enough insulin or their bodies do not efficiently use the insulin they make. Most of the people who have this type of diabetes are overweight. Therefore, people with type 2 diabetes may be able to control their condition by losing weight through diet and exercise. They may also need to inject insulin or take medicine along with continuing to follow a healthy program of diet and exercise. Although type 2 diabetes commonly occurs in adults, an increasing number of children and adolescents who are overweight are also developing type 2 diabetes.

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.