Background

As the number of patients who have undergone Roux-en-Y Gastric Bypass surgery (RYGBS) has increased so has the need for revisional surgery. An array of techniques has been described in the treatment of this complex surgical subject. In regard to gastric pouch and blind limb enlargement, we sought to evaluate the use of pouch reduction with an endoscopic technique. We hypothesized that this endoscopic surgical procedure is a safe, feasible, and efficacious way to treat gastric enlargement.

Methods

All patients in need of revisional surgery underwent a pouch reduction via an endoscopic approach using the OverStitch device. The procedure was performed by a single surgeon, and the patient’s plan for discharge was on the day of surgery. Data, including age, baseline weight, change in weight loss, procedure time, length of stay, 30-day readmission, and any intra-operative or post-operative complications, were collected and assessed.

Results

Sixteen patients underwent endoscopic pouch reduction from 2015 to 2017. All 16 patients were female, with an average age of 51 (range 38-64) years old at the time of procedure. Procedure time ranged from 45-94 minutes with an average of 74 minutes. There was no significant change in operative time over the two year study period (p-value=0.46). The average weight loss achieved was 36.6 pounds (range 0-113). All patients maintained outpatient status. No patient required readmission within the first 30-days, and there were no observed post procedure complications.

Conclusions

As the prevalence of patients who have undergone RYGBS has increased so has the need to perform revisional surgery. These patients are at risk for an array of post-operative concerns, one of which is dilation of the remnant pouch and/or blind Roux limb. This is believed to contribute to less than adequate long-term results due to the diminished restrictive capacity of the procedure. As a result, revisional surgeries are often considered. This study evaluated an endoscopic suturing technique that reduces the size of the gastric pouch. It was found that this procedure is extremely safe, as no post-operative complications or readmissions were observed. In addition, the feasibility of procedure was assessed, and it was found that the average procedure time was 74 minutes, with no significant learning curve noted over a two year period. Lastly, efficaciousness was examined, and it was found that the average weight loss was 36 pounds. Thus, we conclude that this endoscopic procedure is safe, feasible, and efficacious.