A few doctors around the United States are beginning to use an elegant new procedure to reduce the size of the stomach, without incisions, in gastric-bypass-surgery patients who have started to regain weight.

Because their stapled stomachs start to stretch out and enlarge, some 44 percent of gastric-bypass patients regain weight after a few years and again become subject to the morbidities of obesity. But with the new technique, called "ROSE" (Restorative Obesity Surgery, Endolumenal), doctors can reduce the patient's stomach pouch and the opening (stoma) to the small intestine to their original post-gastric-bypass size.

They do it by employing a small, flexible endoscope and a new EndoSurgical Operating System (EOS) created by USGI Medical Inc. The doctors guide these through the mouth and down into the stomach. With the EOS, the practitioners grasp tissue around the stoma and in the interior wall of the stomach and insert suture anchors, which are used to pull together the walls of the opening and the organ. This creates multiple tissue folds that reduce the size of both stoma and stomach. And, voila!, the patient is once again on the road to weight loss.

"To date, revision options [for gastric-bypass weight regainers] have been expensive, difficult to perform and risky for the patient, effectively leaving them without any treatment options," said Dr. G. Derek Weiss of Bluegrass Bariatric Surgical Associates in Lexington, Ky.

Weiss' colleague at Bluegrass Bariatric, Dr. John Oldham Jr., said, "By eliminating skin incisions, this new procedure may provide important advantages to patients, including reduced risk of infection and associated complications, less post-operative pain, faster recovery time and no abdominal scars."

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