Understanding Transoral ROSE and StomaphyX
Weight Loss Surgery Revision Procedures

By Denise Mann; reviewed by Shawn Garber, MD, FACS

As many as 15 to 20 percent of people who have gastric bypass surgery start regaining weight within three to five years. This occurs because the newly created stomach pouch and stoma (connection between the stomach and intestine) can gradually stretch as the body adapts to the changes. As the stoma gets larger, the stomach empties faster and people don't feel as full as they once did. This results in an ability to eat more (and more) without feeling sick and the weight piles back on; setting the stage for obesity.

This can be extremely disheartening and frustrating after all the hard work that goes into losing weight after bariatric surgery. Until recently, the only way to combat the effects of a stoma stretching was through diet and exercise, or a second invasive surgery.

Now there are a growing number of non-invasive procedures that can help re-shrink the stomach and get people back on the right path to weight loss.

Are You a Candidate?

If you have had bariatric surgery and are now gaining weight, your stomach has likely increased in size, or the connection between your stomach pouch and small intestine has increased in size.

Your physician can confirm this stretching through an upper endoscopy exam. To do this, an endoscope (long, thin and flexible tube with a video camera attached) is inserted through your mouth to measure the stomach pouch and stoma. Your physician should talk to your bariatric surgeon to find out exactly what measurements are needed.

Your bariatric surgeon can determine if you qualify for these new procedures based on the findings of this exam.

There are currently two non-invasive techniques that are being used for revisional bariatric surgery, but more are in development.

The two in use today include:

StomaphyX

To perform the StomaphyX procedure, your surgeon inserts an endoscope through your mouth, down into your stomach pouch. Since it is performed through the mouth, there are no incisions.

The surgeon then suctions sections of stomach tissue into a small opening in the StomaphyX device. This creates folds of tissue that can then be secured together with special H-shaped fasteners. By creating this series of small folds, your surgeon fashions a small stomach pouch similar to the one created during your original gastric bypass surgery. The number of folds needed depends on the size of your stomach.

Your surgeon will use general anesthesia to perform the StomaphyX procedure. It takes about 30 minutes to perform depending on the size of the stomach pouch and how much revision is needed.

As a result of StomaphyX surgery, your stomach is slower to empty, leaving you feeling fuller, faster, and thus able to lose more weight.

Transoral ROSE (Restorative Obesity Surgery)

The new kid on the block is the transoral ROSE technique. Like the StomaphyX procedure, your surgeon inserts an operating system similar to an endoscope with four channels down your esophagus and into your stomach. As such, the transoral ROSE procedure is also an incision free weight loss surgery. Your surgeon then places specialized instruments through the channels of the operating system and sews up the connection between the stomach pouch and the small intestine (the stoma).

With transoral ROSE, your surgeon uses sutures with tissue anchors to create multiple folds around the stoma to reduce its diameter. Sutures are then placed with anchors in the stomach pouch to reduce how much it can hold. The end result is that your stomach is slower to empty, leaving you feeling fuller, faster and better equipped to lose weight.

The ROSE procedure places the sutures more precisely than StomaphyX and can narrow the stoma, whereas StomaphyX can only help to decrease the volume of the stomach pouch. Preliminary results have also shown that the ROSE sutures hold up much longer than the fasteners used in the StomaphyX procedure.

Aftercare for StomaphyX and Transoral ROSE

Your surgeon will likely use general anesthesia to perform either procedure. They each take about 30 minutes to perform depending on the size of the stomach pouch and how much revision is needed. Some people go home the same day of their StomaphyX or transoral ROSE procedure, while others may stay overnight. Neither procedure involves incisions, so there is really no recovery time. You can go back to work the following day.

Risks may include bleeding and perforation as well as any risks associated with general anesthesia.

In the four to six weeks after the procedure, you must consume a soft, mushy diet that is similar to your post-bariatric surgery diet. As the fasteners in your stomach begin to heal, you can start to eat more solid foods. Most people do not notice a difference in their satiety (feeling of fullness) levels or weight until they begin to eat solid foods again.

Exactly how much weight a person loses after these revision procedures varies. Depending on your motivation, you can lose up to 30 percent of your excess weight.

Cost of StomaphyX and Transoral ROSE

The weight loss surgery cost of StomaphyX and transoral ROSE is roughly $8,500 to $12,500.

Insurance may cover select cases if there is a medical reason for undergoing the procedure, such as severe dumping syndrome, or a failed or botched bariatric surgery. Marked by nausea, weakness, sweating, faintness and possibly diarrhea soon after eating, dumping syndrome occurs when food moves too quickly through the stomach and intestines.

Choose a Qualified Bariatric Surgeon

These non-invasive revisional bariatric surgery procedures are relatively new. Choosing a qualified bariatric surgeon who has experience and expertise with StomaphyX or transoral ROSE will help assure you get the results you want. To do this, make sure the surgeon is board-certified by the American Board of Surgery or the American Osteopathic Board of Surgery. This shows that he or she has met defined standards of training and knowledge specifically in the field of surgery.

It is also a good idea to choose a surgeon who is a member the American Society for Metabolic and Bariatric Surgery, which suggests that he or she is certified by the American Board of Surgery or the American Osteopathic Board of Surgery and has performed a minimum of 25 bariatric procedures as the primary surgeon within the past two years. For best results, find a bariatric surgeon with a good deal of experience performing endoscopic procedures. Be sure to ask how many of these revisional procedures the surgeon has performed.

About the Reviewer of This Article

Shawn Garber, MD, FACS, is the chief of bariatric surgery at Mercy Medical Center in Rockville Centre, NY, and the head of the New York Bariatric Group in New Hyde Park, NY. He was one of the first surgeons in the US to perform the StomaphyX and transoral Rose procedure and has performed more than any other surgeon in the world. A member of the American Society for Metabolic and Bariatric Surgery, Dr. Garber received his medical degree from New York Medical College in Valhalla, NY. He completed his residency at Long Island Jewish Medical Center in New Hyde Park, NY and his laparoscopic surgery fellowship at the George Washington University Medical Center in Washington, D.C. Dr. Garber is also an assistant clinical professor of surgery at Albert Einstein College of Medicine in the Bronx, NY and a fellow of American College of Surgeons.