A new, less invasive surgical option is now available to treat weight regain in gastric bypass patients. If you were originally successful with your bypass surgery but now find yourself regaining some of your lost weight, you may be a candidate for the ROSE procedure (Restorative Obesity Surgery, Endolumenal).
Your stomach pouch or stoma (the connection between the pouch and small intestine) may have stretched out in the years since your original surgery, reducing the feeling of fullness after you eat.
To resolve this problem, surgeons at Southeast Bariatrics can use new surgical tools to create and suture folds into the pouch, reducing its volume and at the stoma to decrease its diameter. Our surgeons perform the procedure entirely through the mouth without making any external incisions into the body making it a true incisionless procedure.
Due to the lack of external incisions, the ROSE procedure is expected to provide important advantages, including less risk than traditional open or laparoscopic surgery, minimal postoperative pain, fast recovery time, and no scarring.
Keeping your weight down after bariatric surgery is vital to improve your health and reduce the co-morbidities associated with obesity such as Type II diabetes, heart disease, joint disease, and respiratory conditions. If you have started to regain weight since your initial surgery, contact Southeast Bariatrics at 704-347-4144 (Toll free:877-347-4143) to see if the ROSE procedure might be right for you.
Our surgeons at Southeast Bariatrics, Dr. Don Balder and Dr. David Voellinger, have the largest series of ROSE patients in the Southeast.
What is the ROSE PROCEDURE?
New surgical tools now allow surgeons to reduce the size of the pouch and stoma through the patient's mouth without making external cuts into the body. Your doctor may refer to this as the "ROSE" procedure, which stands for Restorative Obesity Surgery, Endoscopic.
Before the ROSE incisionless procedure, patients who regained weight after bariatric surgery generally had few treatment options. Scarring and adhesions related to the initial procedure make open or laparoscopic revisional surgery very challenging. Revisional surgery procedure time is typically longer than the original bariatric procedure and patients can be up to three times more likely to develop a complication following revisional surgery. Therefore, most patients who regain weight after bariatric surgery opt not to undergo open or laparoscopic surgical revision after weighing the risks and benefits.
Why would I gain weight after bariatric surgery?
A number of studies suggest that patients regain weight due to the gradual enlargement of the surgically altered small stomach pouch and stoma, (connection between the stomach and small intestine). When the Roux-en-Y procedure is performed, the stomach and stoma are made very small, which slows the passage of food and creates a feeling of fullness after just a small volume of food is eaten. It is believed that when the stomach pouch and stoma gradually enlarge, the feeling of fullness is no longer present, patients can eat larger meals, and weight regain occurs. Patients who have had vertical banded gastroplasty and sleeve gastrectomy can also gradually enlarge their stomach.
How do I find out if I'm eligible for this new incisionless, restorative ROSE procedure?
Patients who had bariatric surgery more than 2 years ago, lost over 50% of their excess weight and have now regained 15% or more of this weight are ideal candidates for this procedure.
After an initial screening, you will undergo a series of evaluations including nutritional and dietary counseling, a full medical exam and endoscopy to determine if you are a good candidate.
What does the ROSE procedure entail?
The ROSE procedure is performed using a small flexible endoscope and the new EndoSurgical Operating System (EOS). The scope and the EOS instruments are inserted through the mouth into the stomach pouch the same way as a standard endoscope. Tissue anchors are used to create multiple, circumferential tissue folds around the stoma to reduce the diameter. The surgeon will then use the same technique to place anchors in the stomach pouch to reduce its volume capacity. After the procedure the patient will enter the institution's standard bariatric surgery follow-up program of nutritional counseling and exercise, similar to the one prescribed after their original bariatric surgery.
What instruments are used?
The ROSE procedure is performed with a new EndoSurgical Operating System (EOS) and a small flexible endoscope for visualization. The EOS consists of a long narrow access platform called the TransPort and specialized surgical tools (that grab tissue, hold it in place and insert anchors and sutures), all of which are cleared by the U.S. Food and Drug Administration (FDA).
Your surgeon carefully advances the TransPortTM into the GI tract in its flexible state, guided by the camera and light in the endoscope that's inserted into one of its four working channels. With a squeeze of the handle, the TransPortTM locks into place, conforming to the patient's unique anatomy. Once locked in place, the surgeon can advance the different surgical tools through its remaining three channels and then steer the end of the device freely to visualize a site and operate with efficiency and precision. The TransPortTM allows the surgeon use both hands to manipulate and view tissue.
Where will the procedure be performed?
The ROSE procedure may be performed in a Hospital Operating Room, an Outpatient Surgery Center or an Endoscopy Suite. Your doctor will choose the location that is best for you and his surgical team.
How long will I need to stay in the hospital?
Typically, patients stay less than 23 hours. You may be discharged the same day if the procedure was done early in the morning, or you may stay overnight. Your surgeon will make the determination following your procedure.
What are the benefits of an incisionless procedure?
By eliminating skin incisions, this new procedure may provide important advantages to patients, including, reduced risk of infection and associated complications, less post-operative pain, faster recovery time, and no abdominal scars.
What type of side effects can I expect?
It is anticipated that patients will feel little or no discomfort from the procedure. To date, the only noted side effects have been short-term sore throat, swollen tongue and lip pain from the insertion of the instruments into the mouth.
Is it safe?
As with any surgery there is risk involved. However, this less invasive approach should reduce the likelihood of many of the complications associated with the open or laparoscopic revision surgery.
What is the success rate?
It is too soon to estimate the likely procedure success rate. Early data suggests a 20-30% excess weight loss after 6 months. Most patients have experienced a reduction in food volume capacity and earlier satiety.
What is the recovery process?
Typically patients return to normal activity within a few days of their procedure. Your doctor will give you specific instructions. In addition, patients are asked to follow a post bariatric surgery diet and exercise plan, similar to the regimen prescribed following their initial surgery. In addition, follow-up appointments with your doctor and regular visits with bariatric support staff will be required.
Will it be covered by insurance?
As with any bariatric surgery, coverage will vary depending upon the insurance provider. A specialist in your physician's office will discuss your plan with you. In the event insurance will not cover the procedure, self pay options with discounting may be available. Check with your surgeon's office for information on possible programs as well as potential tax advantages for any expenses you may incur.
What will the procedure cost?
The cost for the procedure will vary depending upon where the procedure is performed, how long you stay in the facility and other factors. Your doctor or the program coordinator will be able to give you an estimate of the total cost.
Is incisionless surgery just for gastric bypass restorations?
This procedure is one of the first of many potential applications for Incisionless Surgery. Incisionless Surgery is considered the next wave in minimally invasive procedures and, in addition to revisional bariatric surgery, it has generated interest among physicians in areas such as primary bariatric surgery, GERD, GI cancer and NOTES (Natural Orifice Translumenal Endoscopic Surgery).
I'm interested in the ROSE procedure—What's my next step?
Please call Southeast Bariatrics at 704-347-4144 (Toll Free: 877-347-4143) to obtain a patient information packet and schedule an appointment with our surgeons. This packet will need to be filled out and submitted along with your previous bariatric surgery operative report prior to your initial consult. It is also very helpful to have the pre-operative workup & post-operative follow-up information from your previous Bariatric Surgeons office as well as any post procedure notes such as upper endoscopy or barium upper GI study.
We look forward to seeing you in our office and helping you continue your weight loss journey!