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A novel approach for weight regain after Roux-en-Y gastric bypass: Staged transoral outlet reduction (TORe) followed by surgical type 1 distalization
Roux en-Y gastric bypass (RYGB) is an effective modality for substantial long-term weight loss. Although patients experience 60% to 80% excess weight loss after RYGB, about one-third of these patients experience weight regain and relapse of obesity-related pathologies over time.1,2 This subset of patients presents a treatment challenge because lifestyle modifications and pharmacologic therapies may have limited efficacy.3Endoscopic sleeve gastroplasty is feasible after failed modified primary obesity surgery endoluminal procedure
Endoscopic sleeve gastroplasty (ESG) or gastric plication is a recent, minimally invasive treatment in bariatric endoscopy. The basic mechanisms of action are gastric volume reduction and alteration of gastric peristalsis.1 Currently, 3 devices are used in daily clinical practice: Apollo Overstitch (Apollo Endosurgery, Austin, Tex, USA), Endomina (Endo Tools Therapeutics, SA-ETT, Gosselies, Belgium), and an incisionless operating platform (USGI Medical, San Clemente, Calif, USA). They are used to perform the modified primary obesity surgery endoluminal (POSE-2) procedure.Endoscopic gastric plication for the treatment of GERD and underlying class I obesity
GERD is a common gastrointestinal disorder that affects approximately 25% of the U.S. population.1 Several studies have demonstrated a higher prevalence of GERD in patients with obesity compared to those with a normal body mass index (BMI).2 Specifically, a gain of at least 3.5 kg/m2 in BMI is associated with a 3-fold increase in rates of GERD compared with those with a stable BMI.3 Potential mechanisms include an increase in intragastric pressure, transient relaxations of the lower esophageal sphincter, prevalence of hiatal hernia, esophageal dysmotility, and a decrease in lower esophageal sphincter pressure in patients with obesity.Laparoscopic hernia repair and fundoplication with endoscopic sleeve gastroplasty for complex hernia and GERD management in morbid obesity
Symptomatic hiatal hernia (HH) and gastroesophageal reflux disease (GERD) pose a unique medical and surgical challenge in the context of morbid obesity. On one hand, morbid obesity is a strong risk factor for GERD and HH1,2 as a result of increased intra-abdominal pressure and ineffective lower esophageal sphincter.3 On the other hand, management of HH and GERD in morbid obesity is challenging because of the high risk of hernia recurrence after conventional surgical repair.4 Therefore, an optimal solution for HH and GERD in morbid obesity is one that would provide durable hernia repair and weight loss.
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