Daily Diet: New and Innovative Types of Weight Loss Surgery

Obesity surgery has consistently shown to be the only long-term effective means of weight loss for morbidly obese patients, typically working far better than diet, exercise or drugs. Both tried-and-true and newer innovative methods of surgery are available around the country, but you may have missed some of the up-and-coming weight loss surgery procedures. So here is a round-up of the latest—and what may prove to be the greatest—procedures:

Spider Bariatric Surgery

This new surgical system, a collaboration between The N.E.W. Program weight-loss center in Newport Beach and TransEnterix, Inc., allows surgeons to perform bariatric surgery without the typical surgical incision. The Spider surgical tool enters through a small hole made in the belly button and cuts down the capacity of the stomach, by up to 80 percent.

Approved by the FDA last year, the Spider has multiple instrument channels, allowing the surgeon to insert flexible instruments to expand the abdomen (kind of like an umbrella), miniscule cameras to view the working environment, and surgical tools to trim the stomach and make sutures. The Spider is then removed through the same hole.  

Sleeve Gastrectomy

Sleeve gastrectomy, also known as the gastric sleeve, was originally one part of a staged duodenal switch procedure, but is now being favored as a stand-alone operation. Essentially, a sleeve gastrectomy reduces the stomach in size so it resembles a small tube. This limits the amount of food consumed and can minimize hunger sensations. Hunger is reduced due to the removal of the portion of the stomach wall that produces ghrelin, the hunger hormone.

Weight loss results seen with sleeve gastrectomy are similar to those achieved with gastric bypass surgery and laparoscopic adjustable gastric banding, but without the disadvantages of either. Although short-term data have been positive, long-term results are not available given its relative newness. The jury is still out on long-term success. As a new procedure it has yet to fully approved by all major insurance carriers, so it worth a check before consideration.

EndoBarrier

The EndoBarrier™ Gastrointestinal Liner, or GI sleeve, is a non-surgical, endoscopic therapy for obesity and type 2 diabetes. Developed by GI Dynamics, the EndoBarrier is a Teflon-like liner that is placed in the GI tract endoscopically (via the mouth) to create a barrier between food and the wall of the intestine and to delay the mixing of digestive enzymes with the food. The procedure does not require surgical incisions, does not alter the anatomy, and is removed after the treatment period.

Physicians believe that preventing food from coming into contact with the intestinal wall and delaying digestion until farther down the intestine alters the activation of hormonal signals that originate in the intestine, thus mimicking the effects of a gastric bypass procedure without surgery.

The device has been approved in Europe and is in advanced stages of clinical development in the United States. Study results have been extremely promising, with an average weight loss of 20 percent after the first year. 

POSE

The POSE (Primary Obesity Surgery, Endolumenal) procedure is an incisionless, endoscopic procedure that reduces the size of a patient’s stomach pouch and stoma without external incisions.

The POSE procedure is performed under anesthesia using a small flexible endoscope—a video camera so that the surgeon can view the operative site on a nearby video monitor—and a four-channel tube created specifically for incisionless procedures. The POSE is performed entirely through the mouth without making any external incisions into the body. The surgeon inserts the flexible tube and the endoscope through the patient’s mouth and then uses surgical tools to grasp the stomach tissue and deploy suture anchors to create multiple tissue folds in the stomach wall to reduce its volume capacity. The anchors are reported to hold stomach tissue in place up to two years.

The POSE is currently being evaluated in clinical trials in the United States. Patients who have participated in the study have cited a dramatic decrease in hunger and stomach capacity which has helped them achieve significant weight loss.

Gastric Plication Surgery

One of the newest weight loss procedures is Gastric Plication Surgery (GPS), similar to the Sleeve Gastrectomy above but without involving staples, cutting, or stomach removal. In this procedure, the stomach volume is reduced by folding the stomach in on itself and then stitching it together to keep it folded in on itself.

The GPS procedure is thought to be superior to other methods as there is no malabsorption like gastric bypass, no need for a port or adjustments like gastric banding, and no staple lines or stomach removal like a sleeve gastrectomy. It is also one of the lowest cost weight loss procedure available since it does not involve expensive medical devices.

Early results of the GPS procedure show that patients are full on a small amount of food. Weight loss results are satisfactory and compares favorably with other bariatric surgeries, however there is no long-term data as yet.

TOGA

On the horizon, and currently in a multi-center study to gain FDA approval, is the TOGA System from Satiety, Inc., a less-invasive bariatric procedure that is performed endoscopically (through the mouth). TOGA—which stands for trans-oral gastroplasty —utilizes a set of flexible devices that are inserted through the mouth into the stomach in order to staple together sections of the stomach and reduce its overall food capacity.

Once the device is in place, suction is used to gather together tissue from both sides of the stomach into the device. The collected tissue is then fastened together with titanium staples. The procedure creates a small stomach pouch, shaped like a narrow sleeve, at the top of the stomach. Once the stomach is stapled and the procedure is complete, the device is removed from the body.

Clinical trials on the TOGA method started in July 2008 with an estimated primary completion date of October 2010. If the TOGA System continues to show positive results, it will provide individuals with an effective and less-invasive treatment for obesity.