Stomaphyx Gastric Sleeve Revision

The Stomaphyx is a new and innovative revision procedure for individuals who have a had a Roux-en-Y gastric bypass and then regain their weight secondary to having their stomach pouch stretch or having enlargement of the outlet of the stomach pouch into the bypass. The Stomaphyx procedure reduces the size of the stomach pouch and size the stomach outlet back to with the way the original pouch and outlet were first created and this is done without traditional surgery because no incisions are involved. With this new approach, the surgeon inserts a special operating endoscope and is able to plicate or over-sew the pouch or pouch outlet. This procedure is quite promising given the fact that it does not require traditional surgery and as a result it has some other perceived benefits and the perceived benefits include:

  • Reducing the overall risk of traditional surgery.
  • Does not require abdominal or internal surgical incisions.
  • No visible scars.
  • Reduces risk of infection.
  • It does assist in reducing the size the stomach pouch and limits the food intake.
  • Reduces the enlarged and stoma.
  • Faster Recovery
  • Less Pain

However there are still risks associated with the procedure and the most significant risk is that there are no long-term studies because this procedure is new and only received its FDA approval in 2007. Other risks include bleeding and perforation. The figure below shows how the Stomaphyx works.

Suction is used to draw a large fold of stomach wall into the tissue port. The fold is fastened with a non-resorbable polypropylene H-shaped fastener.

 

Texas Bariatric Specialists does not offer the Stomaphyx procedure in any of its locations in San Antonio, Corpus Christi or Austin. It is our belief that if a gastric bypass fails, it must first be evaluated by a skilled revision surgeon. At that point, the size of pouch and the size of the stoma need to be evaluated objectively. This can be done with endoscopy and obtaining a dual contrast xray which will help us approximate a near three-dimensional view of the pouch and able to “size” it.

Lack of restriction, after gastric bypass surgery is an indication for revision; however, this alone is NOT an indication for surgical intervention. Our initial intervention is a thorough evaluation by our staff nutritionist to ensure that the lack of restriction is not being exaggerated by poor food choices, grazing and other issues of compliance. With these evaluations, you can consider actually undergoing a formal revision surgery. Procedures that were done laparoscopically in the past are more easily revised compared to open gastric bypasses. This evaluation once again needs to be made by an experienced revision surgeon.

The lack of long-term data related to the Stomaphyx procedure in addition to the fact that this is not an insurance approved procedure should raise one’s extreme reluctance in pursuing this procedure. In fact the Stomaphyx can cost as much as $9,500-$10,500 for a single application with results that can be as limited as three months. While the manufacturers handout reports up to a 20% excess weight-loss, the durability of these results are not well defined.

Everyone considering a revision really needs to weigh the pros and cons of this procedure against a traditional relational procedure particularly if insurance authorization can be achieved for a true surgical revision. Texas Bariatric Specialists is successful in achieving insurance authorization for revision procedures as high as 90% of the time. We strongly recommend that you visit our revisions page and consider an online consultation or in person consultation with Dr. Patel.

 

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