The ROSE - Restorative Obesity Surgery Endolumenal
Have You Regained Some of the Weight You Initially Lost After Gastric Bypass Surgery?
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. Pasco Regional Medical Center now offers Restorative Obesity Surgery Endoscopic (the ROSE), an incisionless surgical procedure that restores the size of the pouch and stoma close to the original post-bypass proportions. Due to the lack of external incisions, the ROSE procedure provides 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 gastric bypass 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, the ROSE may be right for you.
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 gastric bypass generally had few treatment options. Scarring and adhesions related to the initial bypass procedure make open or laparoscopic revision surgery very challenging. Revision surgery procedure time is typically longer than the original bypass procedure and patients can be up to three times more likely to develop a complication following revision surgery. Therefore, most patients who regain weight after gastric bypass opt not to undergo open or laparoscopic surgical revision after weighing the risks and benefits.
Have Questions About the ROSE? Here Are Your Answers:
Why would I gain weight after gastric bypass?
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.
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Who is eligible for the ROSE?
Patients who were originally successful losing weight following Gastric Bypass and now find themselves regaining weight may be 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.
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What does the ROSE procedure entail?
The ROSE procedure is performed using a small flexible endoscope and a 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, typically to about 10mm. 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 gastric bypass surgery.
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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). The surgeon easily advances the TransPort™ 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 TransPort™ 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 TransPort™ allows the surgeon to use both hands to manipulate and view tissue.
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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.
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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.
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What type of side effects can I expect?
It is anticipated that patients will feel little or no discomfort from the procedure. The most common reported side effect has been short-term sore throat.
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Is the ROSE safe?
As with any surgery there is risk involved. This less invasive approach should reduce the likelihood of many of the complications associated with the open or laparoscopic revision surgery.
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What is the success rate?
As with any weight loss procedure, results vary with each patient. The ROSE procedure has been well tolerated and most patients experience weight loss as they eat less – with the return of the early feeling of “fullness” due to the restriction of the new, smaller pouch. The ROSE procedure is new and long term data is not yet available.
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