Office Hours: Monday - Friday 8:00am - 5:00pm

Month: April 2014

Weight Loss Tongue Patch !

April 22, 2014 7:35 pm

It is surprising to come across procedures such as “Weight Loss Tongue Patch” that are being performed now. Chugay et.al. (American Journal of Cosmetic Surgery, Vol.31, No. 1, 2014 26-33) reported a series of 81 patients with a mean weight loss of 16 lbs. (range 0-16.8). They concluded “While maintaining a strict low-calorie diet plan and adhering to a regular exercise regimen, patients using a tongue patch can achieve significant weight loss over a 30-day period, with relatively minimal procedural risk.Tongue

The “logic” of this procedure is that placing a mesh on the tongue makes swallowing painful and difficult. The patient is forced to maintain a liquid diet and this causes thus weight loss reported above.

The science and research of weight loss surgical procedures has centered around the metabolic aspect of obesity. Over the years we have moved away from the simple notion of obesity being only a function of over eating and lack of physical activity. The premise that obesity is a disease of energy imbalance is unproven to say the least.

In my opinion, this is a step backward in the surgical treatment of obesity.  I always tell my patients to do their research before signing up for a procedure. This procedure is similar to tried and failed wiring of the jaws. It only created a short-term weight loss that is no more effective than any diet. The notion that a patient should be punished with pain to loose weight should not be tolerated by anyone.

StomaphyX does not reduce regained weight after a failed gastric bypass.

April 17, 2014 9:26 pm

StomaphyX is a procedure (plication device) by which a number of internal “stitches” are placed to reduce the size of the stomach pouch or opening between the stomach pouch and the small bowel in a patient who has had gastric bypass. The idea was that weight regain following gastric bypass would be the result of a dilated gastric pouch, or a dilated gastro-jejunostomy anastomosis. StomaphyX was originally approved as a less invasive treatment for reflux disease in properly selected patients.   A study published in the April 2014 JAMA Surgery (JAMA Surg. 2014;149(4):372-378) concluded that this plication device failed to achieve adequate weight loss.  The study was terminated early, since early analysis of weight loss comparing the group that had the StomaphyX procedure against the control, did not have clinically significant or sustained weight loss.  Success for the procedure in this study was defined as “…achieving EBL reduction from pre- to post-StomaphyX of 15% or great and BMI of 35 or less at 12 months after the procedure.”  The patients that had the control procedure done “..received general anesthesia, and after the initial endoscopy for anatomical visualization, the endoscope was manipulated for 30-45 minutes..” As a bariatric surgeon, I have two comments to make. 1-I see quite a few patients routinely who are seeking revision from previous operation. From a technical perspective placing any non absorbable plication device significantly complicates the revisional operation.  2-The study, directly and indirectly also raises the issues that size of the stomach and the anastomosis (within a broad range) does not matter when it comes to the weight regain after gastric bypass.