|
Back to 2015 Annual Meeting Program
Weight Regain Following RYGB Can Be Effectively Treated Using a Combination of Endoscopic Suturing and Sclerotherapy
Amilcar Alzaga1, Lee L. SwanströM1, 2, Pietro Riva*1, Silvana Perretta1
1Surgical Innovation School, IHU Strasbourg, Strasbourg, France; 2Oregon Clinic, Portland, OR
Motivation:
Obesity is a leading cause of mortality, morbidity, disability, healthcare utilization and costs. Laparoscopic gastric bypass has shown short and mid-term weight loss in more than 90% of patients.
Background:
Substantial weight regain occurs in nearly 25% of gastric bypass patients. Some of these are primarily due dilation of the gastro-jejunostomy, and/or gastric pouch enlargement and are amendable to surgical correction.
Endoluminal surgery is an alternative to address weight regain with lower morbidity than intra-abdominal surgery.
We present our experience using an endoscopic suturing device +/- hypertonic saline injection.
Methods:
This study focuses on evaluating safety and medium-term efficacy of gastrojejunal anastomosis(GJ) restriction and / or pouch reduction using an endoscopic suturing system in patients with regain of >50% of peak loss after at least 2 years after RYGB and who had participated in multidisciplinary follow-up programs.
Data on safety, intra- and postoperative complications, weight-loss efficacy and additional EWL(excess weight loss) (defined as the additional %EWL since the revision procedure) was recorded. Postoperative stoma size and the adjunct use of hypertonic saline injection was also recorded.
Results:
A total of 22 subjects were included. 12 month or more data were available for 18 of 22 subjects. All patients had GJ stoma restriction with a mean of 3.4 sutures. 12 patients also had pouch reduction sutures. 11 patients had adjunct injection of 4% hypertonic saline to achieve fibrosis.
At longest followup, 22/22 (100%) patients achieved weight loss and no one had further weight gain.
The weight loss at an average of 22 (range 11 to 38) months (n=19) was 20.5 ± 11.4 kg (range +5 to +54 kg), and additional EWL was 57.4% ± 34.7% (range +7.7% to +160%).
The correlation between the final stoma diameter and the weight loss at 6 and 22 months after the procedure is statistically significant (p = 0,007 and p = 0,001). At 22 months the difference in weight loss between the group with the anastomosis smaller or equal to 10mm and the group with the anastomosis bigger than 10mm is statistically significant (p=0.017). Gastric pouch sutures showed no improvement in terms of weight loss.
At 22 months, the use of hypertonic saline injection (n=11) correlated to a greater weight loss compared to suture repair alone. The p value approached statistically significance (p=0.06).
Conclusions:
Redo surgery is seldom offered to these patients with weight regain after RYGB due to its difficulty and risks. Endoluminal suturing can restore weight loss in patients. Maximal results are achieved if the stoma is restricted to less than 10 mm at the time of the procedure. Adjunct sclerosis with 4% hypertonic saline seems to provide better long term results.
Back to 2015 Annual Meeting Program
|
