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Non invasive methods in bariatric surgery - 3

III. NON INVASIVE METHODS IN THE BARIATRIC FIELD (3)

- Procedures with stapling :
Whereas the gastric balloon is widely used, endoscopic stapling is a confidential and experimental method. A study has been launched in the USA (FDA), while pilot centers are operating in Mexico and Belgium. Preliminary results are acceptable, but should be improved. This operation aims at reproducing the so called 'Vertical Banded Gastroplasty' or VBG (Mason procedure) that is described in this website in the chapter 'General Surgery'. VBG is regularly performed  through an open approach (laparotomy) or preferably a mini-invasive approach (laparoscopy). It is yet much less popular than the gastric bypass or the sleeve gastrectomy nowadays. One uses endoscopic staples or sutures, which are supposed to be as reliable as the typical surgical materials, at least on a mid-term basis. The so called TOGa device is the most currently updated device represents an interesting lead, although it should be improved (it is still a heavy and cumbersome device). Besides, the outlet system is not yet well defined and could fail in the long run.

- Endoscopic treatment of bariatric complications:
Procedures such as gastric bypass or sleeve gastrectomy may fail and be fixed by this kind of procedure, which have gained momentum in the USA, where many surgeons are being trained. They represent the spearhead of future primary endoscopic treatments. Besides, let us remind you that endoscopy is already an interesting method to assess bariatric procedures intra-operatively.

Hence, acute or late complications can be cured :


1. Post-operative fistulae and bleeding : a stent or a prosthesis can treat a gastric or an anastomotic fistula; an anastomotic stricture can be dilated with a balloon ; a bleeding can be cured with haemostatic clips.

2. One can also propose the plication of an enlarged gastric pouch or of a too wide gastro-jejunal anastomosis that have caused a weight regain. The Endocinch (Bard) procedure has been tested for instance in the USA, or the Stomafix system in Belgium. These may be considered as valuable options while we know that other current reoperations are somehow dangerous and hasardous, e.g. lengthening of the small bowel limbs in bypass surgery.
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