Gastric plication or wrap, with or without adjustable banding, is being marketed by some practices in California and other U.S. and international locations. In contrast to the standard procedures, it does not involve any foreign body implantation, stomach partitioning, or intestinal rerouting. The stomach is suture-folded over itself in multiple layers. The final result mimics the sleeve in shape but not in hormonal changes. It is considered an investigational procedure and is currently not approved by any surgical society, health-plan, or regulatory agency. Long-term results, including complications and true reversibility, remain unknown. The severe swelling generated by the folding process, furthermore, may be permanent even if the wrap could be undone. This thickening is well beyond the capability of current staplers to convert it to another established procedure when it becomes necessary. Following guidelines set by the American Society for Metabolic & Bariatric Surgery, University Bariatrics strongly advises patients against pursuing this procedure until further data is available.
Mini gastric bypass or mini loop gastric bypass or mini sleeve bypass has been marketed to California patients. However, as fully discussed in the gastric bypass section, it is not the same operation as the standard RYGB or VSG. Hesitations and restrictions similarly discussed for the gastric plication exist for this procedure as well.
Known by several different acronyms, single incision surgery has been heavily promoted by the surgical industry. Weight loss operations, normally performed laparoscopically thru a few small (5-12mm) incisions, are done via a larger single umbilical incision. Crowding multiple instruments and devices through a small opening, however, typically creates ergonomic and visualization challenges for surgeons. To this date, with the possible exception of cosmetics, no reproducible advantage has been shown in terms of postoperative pain, recovery, and outcomes. Concerns regarding hernias from the larger umbilical incision remain and are being actively followed. The University Bariatrics team continuously monitors the progress in this field and will discuss this option with you at your initial consultation.
Minilaparoscopy has emerged as a viable and sensible alternative to single incision surgery. The surgeries are carried out in a fashion similar to standard multiport surgery, whilst utilizing 3mm instruments. University Bariatrics will be exploring this option shortly while at the same time cautioning patients against prioritizing cosmetics over safety and health concerns.
Robotic surgery is an alternative and highly marketed laparoscopic method to perform various bariatric and non-bariatric surgeries. With the surgeon sitting at a remote console, the robotic arms that traverse multiple 12mm laparoscopic ports, mimic his/her hand motions to perform some parts of the operation. Similar to single incision surgery, no advantage has been shown in terms of postoperative pain, recovery, or outcomes. The University Bariatrics team continuously monitors the progress in this field and will discuss this option with you at your initial consultation.
Open surgery through a large midline abdominal incision is still a viable option albeit uncommonly used in the era of laparoscopic surgery. University Bariatrics surgeons would reserve that only for unexpected intraoperative concerns that are not amenable to safe laparoscopic surgery.