Morbid Obesity/obesity is the epidemic of the 21^st Century.  This problem affects millions of people in the USA and around the world.  In the USA, less than 5% plus of people who would benefit from weight loss surgery are actually able to undergo surgery.  The actual number of people who are able to access weight loss surgery is increasing yearly.  The Roux en-Y Gastric Bypass is still the most commonly performed procedure.  Most that have the Roux en-Y Gastric Bypass lose more than 50% of excess body weight (EWL) in one to two years depending on the pre-op BMI/weight. A high percentage of the patients, approximately 75% plus, still maintain greater than 50% EWL.  25% of patients experience gradual regain of weight over an extended period of time due to compliance and behavior issues, such as snacking on starchy carbs, increasing portion size, drinking alcoholic beverages and drinking while eating, etc.  You all know what I am talking about.

The other reasons are mechanical. These include, most commonly, dilatation of the opening between the pouch and the small intestine (stoma). Additionally, you can have a breakdown of the staple line with communication between the lower portion of the stomach and the pouch allowing you to eat more.  This is less common now that the stomach is divided separating the pouch and the lower stomach. A pouch may also stretch a little over time with attentive use.  Some, however, enlarge to the point where pouch reduction becomes necessary. There are also circumstances and reasons that require adding more mal-absorption to the procedure by changing the length of the bowel segments.

The approach to performing revisions is either through an incision or with laparoscopy.  The most common problem requiring revision is stoma dilatation.  This now can be repaired, in many cases, through Natural Orifice Surgery, which is done without an incision, using an endoscope.

New technology and endoscopic equipment allowed new surgical techniques to be conceived and developed to make the stoma smaller.  There are endoscopic devices that place clips around the stoma reducing the size as much as is required. This allows a sense of longer satiety by decreasing how rapidly the pouch empties.  The sense of satiety is similar to what was originally experienced with the first operation. However, with all minimally invasive approaches there may be events that occur that are un-expected, or findings that are not appropriate to continue to pursue this technique and may require a more invasive approach to accomplish the desired results. However, using the endoscope for revisions of stoma dilatation is the latest advancement in techniques and technology.  Dr. Gonzalez will be presenting the information about REVISIONS: NEW TECHNOLOGY AND TECHNIQUES.  He has participated in a State of the Art training course using this new technology and techniques for stoma revision.  There are many of you who could benefit from a revision, probably using this approach. I think this will be a terrific presentation.