Clovis Community offers new option for bariatric revision surgery
ROSE or Restorative Obesity Surgery Endolumenal offers new hope to people who have regained weight after gastric bypass surgery. The incision-less surgery, which can restore the results of the initial gastric bypass, is now being offered at Clovis Community Medical Center, rated 5-stars three years in a row for weight-loss surgery by a national outside agency, HealthGrades.
“It’s outpatient surgery. There’s no pain, no incisions … You go back to work the next day,” said Dr. Daniel Swartz, outlining the benefits. “All three of the patients I’ve done so far have reported immediately afterwards that they’re just not hungry. Their appetite is gone. They just don’t feel like eating. They are thrilled.”
Using the ROSE procedure, Dr. Swartz uses the mouth and esophagus to thread surgical tools into the stomach, avoiding the necessity to cut through scar tissue from the previous surgery. Then from inside the stomach, he uses anchors to fold or bunch up tissue to reduce the diameter of the stomach pouch and the opening to the intestine. “I can permanently restore the pouch to its smaller size,” he said. “We have data (from cinical studies) out to one year showing that the anchors absolutely stay in place without any deterioration.”
By eliminating incisions, this new procedure may provide important advantages to patients, including reduced risk of infection and associated complications such as bleeding or leakages, less post-operative pain, faster recovery time and no abdominal scars.
Dr. Swartz said about 20% of gastric bypass patients experience significant weight gain about four to five years after their surgery. “Most of that is going back to old bad habits. And those people don’t need any type of revision,” Dr. Swartz said. “They do well with nutritional and exercise coaching. They just need to stop the grazing and snacking and stop the stress eating and get off the couch. But there are a small number of people who regain weight because either the (stomach) pouch or the opening of the pouch to the intestine stretches out and so it takes more food to feel full.”
To make sure patients fall into the latter category of having a stretched out stomach, Dr. Swartz does an endoscopic examination. To qualify for the ROSE procedure the pouch needs to be a minimum of 5 centimeters long to easily maneuver surgical instruments. Occasionally patients who meet this criterion are not candidates because of severe acid reflux problems that make endoscopic procedures too irritating for the esophagus.
Although insurance companies do not currently pay for gastric bypass revisions purely done for weight gain reasons, Dr. Swartz points out that the ROSE procedure is significantly less expensive than traditional laparoscopic revision surgery.
“Anyone regaining weight after gastric bypass should come back in to their surgeon and see why,” advised Dr. Swartz. “There may be an issue that needs fixing. But if they’re getting full after eating half a cup and feeling full for three hours, I don’t even worry about them.”
But for others, ROSE offers long-term hope. “Clinical studies show people who have had this are continuing to lose weight for a long time afterwards,” Dr. Swartz said.