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Bariatric Surgery: Endoluminal Techniques


Obesity surgery is probably the most logical application for boneless surgery because it has a high incidence of incisional hernias. Using a laparoscopic approach reduces the incidence of this difficulty, but does not leave it absent. The use of natural orifices is only possible to eliminate the risk of incisional hernias.

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Sub-skin fat is a major barrier in weight loss surgery. This thick, fatty layer causes a severe impediment to the rapid manipulation of laparoscopic instruments because it reduces the mobility of the throws that make the instruments needed for dissolving its harbor. This limitation is in addition to the reduced number of existing freedom that contains laparoscopy characteristics. Fat accumulation is also mainly located in the peritoneal cavity, in the mesentery, and in the omentum, but usually not within the viscera. Therefore, an endoscopic approach logically avoids the limitations caused by sub-skin fat and intraperitoneal fat.

A number of recent technological developments allow for an endoscopic approach to the implementation of established procedures. The tools used for the endoscopic approach must be long due to the natural distance between the mouth and the stomach, the most target organs in obesity surgery. Since all the tools are contrary to the top strength of the effective tools, this long-distance is one of the most significant obstacles in the performance of endoscopic surgery. In addition, for safety and practical reasons, it is necessary to limit the offerings within the afferent organ (esophagus) and to obtain the maximum power at the tip. This can be achieved by over-tube (USGI) or by making the semi-stiff tools at the shaft and extremely mobile at the tip (Flexible Endostitch, Covidien). Great stitching devices (Eagle Claw, Olympus; Spiderman, Ethicon) have also emerged to achieve this goal. For the transfer of out-of-body handling devices into effective activities within the body, specific devices are designed e.g. master slave (intuitive) robotic systems or computerized agents of specialized endoscopic instruments (Rothstein, Marescaux, Swanstrom). Technological improvements such as the above have enabled the modern endoscopist to perform high-end-endometric procedures, repeating established procedures such as vertical band gastroplasty (VBG) or sleeve gastrectomy, now correctly named gastroplasty sleeve (TOGA). . The preliminary findings of the novel approach to “old” operations are promising.

Interestingly, progress in endoscopy techniques has enabled surgeons to extend the range of operations across the stomach. Prosthetic devices were developed to bypass the duodenum and the proximal jejunum (Endobarrier) or bypass the stomach and small external bonus (ValenTx). While the surgical community is very familiar with the use of foreign objects for restraint (adjustable gastric band), these devices are usually placed outside the viscus. The newer prosthetic devices are now located within the viscera. Diversification systems for the prosthetic sleeve are diverse and safety remains an important issue (TERIS).

The wall of the scenery is no longer an insurmountable boundary for endoscopic surgery. The emergence of NOTES is all after surgery to lose weight for changing weight. Gastroenterostrophies can now be performed without skin biases, opening up a range of endoscopic procedures that may exist to care for the obese patient. By working within an organ, it leaves the most important problem in redo surgery: adhesives. Repeat surgery is carried out on a regular basis in barric patients and some operations are designed even as phased procedures (Duodenal Switch). Patients who re-establish weight years after their initial operation can now be used strictly by endoscopic methods (ROSE procedure, StomaPhyx, EndoCinch). Existing pouches can be made smaller and anastomosis can be intensified, thus approaching the initial post-operational conditions. Finally, endoscopic techniques are very helpful in the care of obese patients. Some endoscopy methods can argue some existing procedures and new operations designed for this new approach have emerged in recent years. While it is too early to properly evaluate this approach, it seems that the repeat of bariatric procedures is a fruitful area for surgery without offense.

Endoluminal Gastric Bypass

Obesity is a major health problem and the second most common cause of death (after smoking). Obesity involves many medical comorbidities that affect almost all human systems and is heavily associated with increasing the number of diabetes, as well as cardiovascular disease and cancer. The pillars for treating obesity are considered to be diets and exercise programs but long-term sustained weight loss studies have failed to show the vast majority of patients. At present, bariatric surgical procedures appear to be the only means by which sustained weights as well as reversal of proportions arise.

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