ncision-Free Weight Loss Surgery in Experimental Phase ( Part 1)

Obesity is proliferating in the United States. Research statistics show that between 1962 and 2000, the number of obese Americans grew from 13 percent to 31 percent of the population. Obesity surgery has been shown to be the only long-term effective means of weight loss for morbidly obese patients, typically working far better than diet, exercise or drugs. Over the years, these operations have become less painful and invasive. The most common bariatric operation, which once required a large incision, is now performed through several small incisions in the abdomen. A new weight loss surgery currently being evaluated in a U.S. study also allows doctors to reduce the size of the stomach, but with one big difference—no surgical incisions.

In the procedure, named Toga, for transoral gastroplasy, surgeons pass a stapler down the throat and staple the stomach from the inside, forming a thumb-sized tube that holds only a small amount of food. This gives patients a feeling of fullness after a small meal. The procedure is intended to be safer and easier for patients to tolerate than conventional obesity surgery. However, the procedure isn’t quite as simple as it sounds.

First, the patient is given general anesthesia and put on a respirator. Then the surgeons thread a dilator, a tube about three-quarters of an inch wide, down the patients’ throat to stretch the esophagus. The stomach is inflated with carbon dioxide to create a space to work. Next another wide tube, this one about two feet long, which contains the stapler, is inserted.

After the stapler is properly positioned, it is activated and a sail and curving wire emerges to help push aside the folds of the stomach. Then a vacuum pump is used to draw parts of the front and back walls of the stomach into the device to be stapled together. Three rows of staples are needed, but the stapler only holds one row. Consequently, the device has to be withdrawn, rinsed, reloaded, inserted back down the throat and repositioned for each row. The surgery takes about three hours.