The most effective weight loss procedures in the United States are both roux-en-Y gastric
bypass (RYGB) and sleeve gastrectomy (SG)where the majority are performed laparoscopically.
Estimated excess body weight loss (EBWL) is >50% at the end of one year. However, nearly 20%
of patients fail to meet the estimated EBWL or they may experience weight gain recidivism.
The first step is nutritional counseling, medically supervised diets, and medical therapy.
Surgery would be for those who still fail to lose weight despite the aforementioned efforts.
It is hypothesized that failure of weight loss for RYGB is gastrojejunostomy (GJ) dilation
defined as >2 cm. Surgical treatment would require revision of this dilation. Unfortunately
many of these revision procedures cannot be done laparoscopically given dense intra-abdominal
adhesions. This will require conversion to an open surgery in a morbidly obese patient thus
raising postoperative morbidity and mortality estimated to range between 15%-50%.
The investigators propose to use the endoscopic suturing device designed by Apollo
EndoSurgery to decrease the GJ dilation to 5-6 mm thus causing restriction, delayed food
transit time, and promote early satiety. These efforts will limit overall caloric intake
thereby promoting weight loss.
It is thought that patients with previous SG may have a dilation of their stomach. The
investigators propose a pyloric cerclage using the Apollo EndoSurgery suturing device by
decreasing the opening of the pylorus thus achieving the same goals that the investigators
proposed above with RYGB revision.
Endoscopic procedures are same day procedures with little morbidity and mortality when
compared to laparoscopic or open bariatric surgery revision.