Natural Orifice Surgery: Endoluminal Pouch Reduction Following Failed Vertical Banded Gastroplasty

Following vertical banded gastroplasty (VBG), patients may develop pouch complications such as dilation and staple-line dehiscence. This may contribute to weight regain, and if conservative measures are exhausted, traditionally, open revisional surgery of the pouch or conversion of the VBG to Roux-en-Y gastric bypass (RYGB) would be considered. StomaphyX(TM) is an endoscopic device used with a conventional gastroscope for the approximation of tissue in gastric pouches or across gastroenteric anastomoses to enhance restriction. The objective of this study is to analyze the outcomes of StomaphyX(TM) endoluminal pouch revision following failed VBG. Patients with weight gain following VBG had endoluminal pouch reduction performed using the StomaphyX(TM) device in revisional bariatric surgery clinic, tertiary care hospital, Canada. Pre- and postoperative weights were compared, and a regression model was developed to examine for predictors of weight loss following StomaphyX(TM). Fourteen patients were included in the study. Patients had a mean age of 47.3 +/- 7.9 years, and 13 of 14 were female. Significant reductions were appreciated between pre- and postoperative weight and BMI (119.5 +/- 25.9 kg vs. 109.6 +/- 24.4 kg; 43.4 +/- 9.7 kg/m(2) vs. 39.8 +/- 9.1 kg/m(2), respectively). There was no correlation between preoperative pouch status and weight loss. Three patients had two separate StomaphyX(TM) procedures performed. Only minor complications (headache, back pain) were identified. The StomaphyX(TM) device may be safely used for reduction of pouch size in patients following VBG. Further studies are required to determine the role of StomaphyX(TM) endoluminal pouch reduction in comparison to open or laparoscopic revisional surgery.