rose procedure

The Rose Procedure

New surgical tools now permit surgeons to treat a possible source of weight regain. The new tools decrease the size of the pouch and stoma through the patient’s mouth without performing any outer incisions into the body.  Your bariatric doctor may call this the “ROSE” procedure, which stands for Restorative,Obesity Surgery, Endolumenal. Since there are no incisions, it means lower risk than conventional open or laparoscopic surgery, minimal post operative pain, fast recovery time and no scarring.

Before the ROSE procedure, patients who experienced weight regain after gastric bypass typically had little treatment choices.  Scarring and adhesions associated with the original bypass procedure make open or laparoscopic revision surgery significantly challenging.  The revision surgery procedure time is generally lengthier in comparison to the first bypass procedure and patients risks to experience a complication are increased threefold after revision surgery.  Therefore, most patients who regain weight after gastric bypass choose not to have open or laparoscopic surgical revision after reviewing the risks and rewards.  

How would a person regain weight after gastric bypass?
Clinical research suggests that patients regain weight due to the progesssive enlargement of the surgically changed small stomach pouch and stoma, (connection between the stomach and small intestine).  When the Roux-en-Y procedure is performed, the stomach and stoma are made very small, which slows the consumption of food and the person has a fullness feeling after eating only a small portion of food.  It is believed that when the stomach pouch and stoma gradually enlarge, the fullness feeling disappears, patients eat larger portions, and weight regain happens. 

Am I eligible for this new incisionless, restorative ROSE procedure? 
Patients who had a Roux-en-Y gastric bypass greater than two years ago, lost over half their excess weight and now regained 15% or more of their weight are excellent prospects for this procedure.  

After an initial interview, you will have a series of tests including nutritional and dietary counseling, a full medical exam and endoscopy to determine if you are a good candidate. 

What is involved during the ROSE procedure?
The ROSE procedure is achieved with a small flexible endoscope and a state of the art EndoSurgical Operating System (EOS).  The scope and the EOS instruments are inserted through the mouth into the stomach pouch the same method as a conventional endoscope.  Tissue anchors are used to produce multiple, circumferential tissue folds around the stoma to decrease the diameter, generally to nearly 10mm.  The surgeon will then use the same method to place anchors in the stomach pouch to decrease its capacity.  After the procedure the patient will enter the institution’s normal bariatric surgery follow-up program for nutritional counseling and exercise, very much like the one prescribed after their original gastric bypass surgery. 

Where will the procedure be performed?
The ROSE procedure may be performed in a Hospital Operating Room, an Outpatient Surgery Center or an Endoscopy Suite.  Your doctor will select the place that is best for you and his surgical team.  

How long will I need to stay in the hospital?
In general, patients stay no more than 23 hours.  You may be sent home the very same day if the procedure was performed early enough in the morning, or you may stay overnight.  Your surgeon will make the final decision after your procedure. 

What are the benefits of an incisionless procedure?
By not having any skin incisions, this new procedure may provide important benefits to patients such as reduced risk of infection and associated complications, less post-surgical pain, quicker recovery periods, and no abdominal scars. 

Any side effects to expect?
It is anticipated that patients will feel little or no discomfort from the procedure.  Currently, the only side effects were short-term sore throat, swollen tongue and lip pain due to the insertion of the instruments into the mouth.

What is the rate of success?
The procedure has been accepted positively and the first few patients have experienced weight loss within the initial four weeks along with a decrease in food volume capacity. 

What is the recovery process?
Generally patients go back to their normal activity within a few days of their procedure.  Your physician will advise you with specific instructions.  Moreover, patients are recommended to abide to their post bariatric surgery diet and exercise plan, just like the instructions given after the first bypass surgery.  Plus, follow-up appointments with your doctor and their bariatric support staff will be necessary.  

Is it covered by insurance?
As with gastric bypass surgery, insurance coverage will depend on the insurance provider you personally have.  If insurance does not cover the procedure, financing options may be available.  Confirm with your bariatric surgeon's office for possible financing options.    

Is incisionless surgery made especially for gastric bypass restorations?
Not necessarily> Incisionless surgery is called the next generation in minimally invasive procedures. In addition to obesity, it has sparked interest from physicians in other areas.  

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