Less-invasive surgery options for weight loss

October 24, 2008 8:36:55 AM PDT
Lean procedures may help people lose weight when diet and exercise don't work.Surgery is too extreme for some.

Every day, millions of Americans go up against the scale. They diet and exercise, even take weight loss medication. But in the end for many, the battle against the bulge can seem out of reach.

"I had done Meridia, Weight Watchers, you name it I did," Carrie Williamson said.

Williamson knows the frustration. The 30-yerr-old from Granite City, Illinois has been overweight since she was a child.

But in two weeks, she was able to lose nine pounds. What's her secret? Williamson is the first American patient to undergo a new form of stomach stapling that shrinks the stomach without a single incision. It's called Transoral Gastroplasty or TOGA.

"The one thing that's been unique about this is that it's all done through the mouth," said Dr. J. Christopher Eagon, surgeon, Washington University School of Medicine.

Washington University surgeons stapled Williamson's stomach by passing flexible instruments down her esophagus to the stomach where a restrictive pouch was created. It collects food as it enters the stomach giving the patient a feeling of fullness after a meal.

"I had surgery on Wednesday and went back to work on Monday," Williamson said.

In a pilot study, patients on average lost 40 percent of excess body fat within a year of the procedure. Doctors say that's slightly less than gastric bypass, but patients recovered quickly and had a low risk of complications.

The pounds have been rolling off Barbara Mcmackin since she got another experimental treatment called the endobarrier.

"Endobarrier is a sleeve that is placed without surgery into the patient's small intestine to help them achieve weight loss," said Dr. Keith Gersin, surgeon, Carolinas Medical Center.

Endobarier, also known as a gastric sleeve, is placed endoscopically through the mouth and lines the first two feet of the small intestines. Early results show patients who got the device lost more weight than those who didn't. At this point, endobarrier is only being studied as a temporary fix, a prelude to weight loss surgery. But some doctors say its future is promising.

"We're looking at a market of between 15 and 30 million people that could potentially be helped by this," said Gersin.

Surgeon John Alverdy performs gastric bypass. He says past research has shown that you won't have significant weight loss without bypassing the upper part of the stomach and the small bowel. He cautions those who want dramatic effects without surgery not to get too excited yet.

"These are attempts to try to market to that group and the question only will be are these as good as the other operations and more importantly are they durable?" Alverdy said.

Alverdy said the Food and Drug Administration is keeping a close eye on the trials of these experimental weight loss procedures and others. The bottom line, aside from safety, will be whether treatments like these will be enough to keep weight off for good. Those are issues that could take years to sort out.

More info:

TOGA:
http://clinicaltrials.gov/ct2/show/NCT00661245?spons=%22Satiety%2C+Inc.%22&spons_ex=Y&rank=1
www.togaclinicalstudy.com

Endobarrier:
http://www.gidynamics.com/endobarrier_technology
Carolinas Weight Management and Wellness Center
704-355-9484

John C. Alverdy, MD
Director, Center for the Surgical Treatment of Obesity
Director, Minimally Invasive Surgery
University of Chicago Medical Center
5841 S. Maryland Avenue, MC 6090
Chicago, IL 60637
(773) 834-3524
www.uchospitals.edu


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