Features January 2011 Issue

Incision-free Surgery To Be Next Weight-loss Breakthrough

Innovative procedure is expected to be approved in 2011.

Thousands of Americans have conquered life-threatening obesity thanks to minimally invasive bariatric surgeries such as gastric bypass and gastric banding. Unfortunately, because of the high cost, 99 percent of eligible obese patients donít undergo weight loss surgery. Additionally, some patients perceive these operations to be too drastic or too risky, even though they have proven to be very effective and safe.

But a new incision-free procedure may be the next innovative medical breakthrough that makes weight loss surgery less expensive and less risky.

Itís called transoral gastroplasty, TOGA, an endoscopic weight-loss procedure developed by California-based Satiety Inc.

"The TOGA research study results look very promising," says Philip Schauer, MD, director of Cleveland Clinicís Bariatric and Metabolic Institute. "Patients who have undergone the TOGA procedure have experienced 50 percent to 60 percent loss of their excess body weight. And they also have seen improvement in other medical conditions, such as lower blood pressure and cholesterol, as well as improvements in sleep apnea and diabetes."

How TOGA works

The TOGA procedure includes a specialized flexible device placed in the patientís mouth, which is guided down the esophagus and into the stomach. An endoscope equipped with a tiny digital camera enables the surgeon to visualize the stomach and perform the procedure. After the TOGA device is positioned, it is opened, creating a vacuum, bringing the folds of the stomach together. The cylindrical TOGA device forms a little tube, or a gastric sleeve, which is fastened by titanium staples and a ring at the new stomach outlet.

Because the gastric sleeve is so small, just a little amount of food entering the sleeve pushes against its wall, creating a fullness sensation. This encourages the patient to stop eating.

Unlike gastric bypass, TOGA does not require patients to take extra vitamin supplements.

"What we donít know about TOGA is how durable the staples are because we donít have five-year data," says Dr. Schauer. "However, the one- and two-year data looks pretty promising for the procedureís durability."

Potential to Improve

Dr. Schauer believes TOGA has the potential to improve the attractiveness of weight loss surgerybecause it takes only 90 minutes to perform, leaves no external scars and the pain is minimal.

"As surgeons become familiar with TOGA, I think it could be performed within 30 to 45 minutes, which means patients would be able to return home the same day and return to work within a few days," saysDr. Schauer. "Eventually, I think weíllsee this procedure performed in an outpatient setting, which would lower the costs and make weight loss surgery available to many more people who need it."

After reviewing TOGAís study results that were finalized in late 2010, the U.S. Food and Drug Administration may approve the procedure in 2011.