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.
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