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Patients Travel to Boston for Gastric Bypass Repair Procedure

Monday July 18, 2005
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Endoscopic pouch repair offers a second chance for success
Each year, about 100,000 morbidly obese people undergo gastric bypass surgery to help them shed pounds. Because of post-surgery complications, however, some patients regain much of the weight they lose, and others regain every pound. Until recently, patients had to endure a second surgery or live with the fact that their weight-loss surgery had failed them.
Jim Slattery, RN, CGRN, a staff endoscopy nurse at Brigham and Women's Hospital in Boston, says a problem develops in as many as 20% of Roux-en-Y gastric bypass surgeries. Roux-en-Y gastric bypass is a restrictive/malabsorptive type of bariatric surgery. During surgery, the surgeon creates a small pouch in the stomach to restrict food intake. Ideally, the postoperative patient will feel full more quickly and will stop eating after ingesting smaller amounts. As a next step, the surgeon attaches a Y-shaped section of the small intestine to the pouch to allow food to bypass the lower stomach and part of the small intestine. This reduces the number of calories and nutrients the body absorbs.
A pouch-related complication
Problems occur when an opening develops between the pouch and the other part of the stomach, or when the opening between the pouch and the Y-shaped portion of the small intestine becomes larger than it should be. This results in the pouch emptying more quickly.
"The pouch then doesn't hold any food in it to create a feeling of fullness," Slattery says. "People keep eating larger volumes as they try to feel full from a meal."
The result is weight gain.
It's not clear why complications develop. One theory is they are caused by a loss of blood flow; another suggests the staple line that creates the pouch separates if the patient vomits. "The bariatric surgeons either don't want to or cannot go in and repair these openings," Slattery says.
Endoscopy to the rescue
Slattery and Christopher Thompson, MD, advanced therapeutic endoscopist and director of developmental endoscopy at Brigham and Women's Hospital, have developed a procedure to correct pouch problems and help patients avoid another invasive procedure.
Thompson's procedure employs an endoscope that features an attached sewing device. The endoscopist inserts the endoscope (following the administration of general anesthesia) through the patient's mouth and uses the sewing device to repair the problem.
"We're not the only people in the country who are attacking this problem this way," Slattery says. "But we've probably fixed more openings between the pouch and stomach than any other facility in the country. We're the only facility doing this volume of pouch repair procedures."
Slattery says it is difficult to spot complications following Roux-en-Y gastric bypass surgery because weight gain usually occurs over time. The only thing that may indicate a problem immediately after surgery is gastric reflux, which may result from an opening between the pouch and the rest of the stomach. The pouch created during surgery contains no stomach acid; consequently, acid reflux cannot occur. When an opening develops, however, acid leaks into the pouch and gastric reflux is possible.
As patients, surgeons, nurses, and Internet chat room patrons spread the word about endoscopic gastric bypass repair, more patients from across the nation are expected to continue to travel to Boston to undergo this procedure.
Scott Williams is a freelance writer.