Bariatric Surgery

Endo Bariatrics

Endoscopic Sleeve Gastroplasty:

The surgeons at Advanced Surgical & Bariatrics are the first in New Jersey to have performed endoscopic sleeve gastroplasty, a new non-surgical option for weight loss involving plicating the stomach with full-thickness sutures which are placed using an endoscopic suturing device. The result is the creation of a thin, sleeve-shaped stomach similar to sleeve gastrectomy but without surgery and without cutting across or removing the stomach tissue. If you are interested in this option, please call to set up your consultation visit and Dr. Sadek, Donaire, or Melman can determine whether you are a candidate for this procedure.

Endoscopic Suturing:

Patients that have regained weight despite having success from original weight loss surgery, now have multiple options to get back on their path.

After the initial success from weight loss surgery, have you had trouble keeping the weight off and even start to regain some of it back? Over time, the stomach pouch or outlet that connects to the small intestine can stretch and cause patients to eat more than normal before reaching that full, satisfied feeling. The Advanced Surgical Bariatrics of New Jersey now offers an endoscopic procedure that is effective and safe for patients. This procedure can significantly reduce the enlarged pouch and outlet to its initial post-operative size.

Why would I regain weight after Weight Loss Surgery? (WLS)

According to numerous studies, the majority of patients that undergo Weight Loss Surgery regain a significant amount of weight after the procedure. One common cause of this is the gradual stretching of the stomach or pouch outlet. Experts have proven that once the stomach and pouch begin to progressively stretch, it will take the patient longer to feel full and can soon regain the weight. The standard-of-care WLS procedure includes a reduction of the stomach and outlet size to decrease the amount of food a patient can eat. The new small size of the stomach and outlet also slows the digestive track process down by decelerating the passage of food. This can help the patient to feel fuller longer.* This combination can result in a dramatic decrease in calories, which in turn can help with weight loss.

Endoscopic outlet and pouch repair

The Advanced Surgical Bariatrics of New Jersey now offers qualified patients an endoscopic procedure than will reduce the capacity of which food can enter the stomach. A small flexible endoscope and other specialized devices will allow for sutures to be properly placed through the endoscope. Similar to a standard endoscope, the scope and suturing devices are inserted through the mouth and into the stomach pouch. Once the sutures are placed around the outlet to reduce the diameter, they typically reduce the outlet from the size of a silver dollar to the size of a dime. Additional sutures in the stomach pouch may be placed to reduce more of its volume capacity if needed.

What are the benefits of the endoscopic procedure?

At times open or laparoscopic revision surgery can be very difficult and even impossible due to scarring and adhesions from the original Weight Loss Surgery procedure. During the longer abdominal revision surgery, patients are three times more likely to develop complications during this than original WLS. In comparison to abdominal revision surgery, a revision through an endoscopic procedure decreases the patient’s risks of complication as well as less pain, faster recovery, and no abdominal scarring.* Although it is common for patients to go home the same day, the Advanced Surgical Bariatrics of New Jersey physician’s will discharge patients based on their personal data.

What are the side effects?

As a result of the endoscopic procedure, patients typically feel little or no discomfort with minor side effects such as gas pain, nausea, sore throat, swollen tongue, and lip pain from the oral insertion of the endoscope.*

What is the recovery process?

At the conclusion of the procedure, patients usually return to their normal routine within 48 hours. It is important that patients follow the same diet and exercise regime from their original weight loss surgery after the finish of the outlet and pouch repair.

Will it be covered by insurance?

Depending on the patient’s insurance plan, the procedure will be covered. If the plan does not qualify, there are cash pay options available. Further information can be provided upon request at your next appointment with Dr. Sadek.

Fistula Repair:

Fistula repair is an endoscopic procedure that can provide solutions to insignificant weight loss or weight gain after gastric bypass surgery.

After gastric bypass surgery, a gastro-gastric fistula can form and become an abdominal connection between the old stomach remnant and the new stomach pouch. A larger amount of food can be eaten without restriction due to this surgical defect because it will allow ingested food to be passed from the new stomach pouch to the old stomach. Through this volume intake of food and beverage, one can render the gastric bypass surgery ineffective.

Symptoms of a gastro-gastric fistula may include:

  • Inadequate or insignificant weight loss after gastric bypass
  • Weight regain after gastric bypass
  • Ability to tolerate normal or large portions of food without issue
  • Abdominal pain
  • New heartburn symptoms months after surgery

A combination of tests including upper endoscopy, upper GI series, barium swallow, abdominal ultrasound or CT scan can assist a diagnosis of a gastro-gastric fistula.

For this procedure, the patient will be administered general anesthesia. The endoscope, which is a thin, flexible tube, is then inserted through the mouth and into the stomach to search out the defect. Using a combination of sutures, mesh, fibrin glue, clips, and other equipment, the tissue is prepared and repaired endoscopically. Therefore, there is virtually no pain, no external cuts, and minimal to no blood loss.

Benefits of this procedure:

  • There are no cuts from the outside of the body
  • It is virtually painless
  • Patients are able to go home the same day as their surgery
  • Procedure can restore feelings of fullness to promote weight loss
  • Does not require antibiotics
  • Patients are back to work in 2-3 days

The Advanced Surgical Bariatrics of New Jersey specializes in endoscopic procedures that are minimally invasive and provide numerous benefits over the traditional surgical procedure.

The Advanced Surgical Bariatrics of New Jersey supports the performance of endoscopic procedures because there are minimal post-operative discomfort and little to no pain. By providing endoscope procedures that are minimally invasive, our physicians do not cause major damage to any tissues and do not generally require an overnight stay at the hospital. Procedures performed endoscopicaly involve fewer complications and side effects, no external cuts, minimal to no blood loss, a significant decrease of risk of infection, and an overall quicker recovery.

Endoluminal Sleeve:

It is becoming more common for people that have struggled with obesity to overcome obstacles with the success of finding new ways to lose weight without having to hide any scars. If you are one of those people, then you are in luck! The Advanced Surgical Bariatrics of New Jersey is introducing the Endoluminal Sleeve or EndoBarrier Gastrointestinal Liner incision free surgery. These procedures reap the same benefits of weight loss surgery but do not require any incisions to be made.

Despite countless weight loss options, bariatric surgery provides the opportunity to lose stubborn, unwanted weight that is hindering you from reaching your goals. This weight lost option can also decrease the risk of serious life threatening diseases associated with obesity. Only about one to two percent of the people who fall under the obese category will successfully go through with weight loss surgery, due to individual doubts and feelings towards surgery.

As a response to the individuals who have negative thoughts towards surgery, the endolumnial EndoBarrier Gastrointestinal Liner can be the solution they have always desired. This innovative medical procedure is incision free and provides the same results than invasive surgery with incisions or scarring.

About the EndoBarrier Gastrointestinal Liner and How it Works

Enhancing its innovative medical technologies, the EndoBarrier Endoluminal gastric sleeve surgery is a pioneer in incision free bariatric surgery. Once the liner is implanted and removed through the mouth, the sleeve creates a lining on the upper part of the small intestine along the first part of the jejunum and the duodenum. As a result of this surgery, a patient’s response to certain hormones can change their metabolic rate which can ultimately lead to weight loss and possibly a solution for Type 2 diabetes.

The EndoBarrier can provide weight loss before gastric bypass surgery or be used as an independent weight loss method. The gastric sleeve, gastric banding, gastric bypass, or duodenal switch can be done after the initial EndoBarrier procedure if an individual is seeking a pre-surgical method of weight loss. Since bariatric surgery has a higher risk for heavier individuals, this endoluminal procedure can significantly raise the individual’s safety going into the second surgery.

How the Procedure is Performed

The Endoluminal EndoBarrier surgery is completed as an outpatient procedure that can take from roughly 30 minutes to up to 2 hours depending on the patient’s health and situation. The liner can be removed in about 15 minutes once the liner is implanted and left in for up to three months. Experts are currently researching whether or not the EndoBarrier is safe to leave in for six months to ensure a patient’s satisfaction and safety.

Once the EndoBarrier is implanted into the small intestine, there are chances of discomfort for the first week or so. For example, eating too much may cause vomiting. According to numerous endoluminal sleeve studies, there is no risk of the dumping syndrome which can occur when undigested food is discarded into the small intestine too quickly. Symptoms of this include nausea and abdominal cramps.

To maximize the results of the endoluminal sleeve, it is crucial the individual follows a strategic, strict, and multidisciplinary regimen that includes:

  1. A rigorous yet attainable exercise regimen
  2. A healthy diet plan
  3. Behavior modification to change your lifestyle habits

For individuals that have Type 2 diabetes, blood sugar level must be closely monitored before, during, and after the surgery. Your desired results of maximizing weight loss efforts can typically be done faster than you could imagine by following the post-procedure multidisciplinary program.*

Natural Orifice Surgery:

Or NOS is a new technique of minimally invasive surgery allowing the surgeon to use existing orifices in the human body as entry points for surgical tools to perform the procedure. This technique all but eliminates visible scarring and the recovery period is relatively short compared to traditional

Trans Oral Incision less Fundoplication with EsophyX (TIF)

A huge advance in the evolution of the treatment of GERD, the revolutionary TIF (Transoral Incisionless Fundoplication) procedure corrects the root cause of GERD, an anatomic deficiency at the gastroesophageal junction. Performed with the innovative EsophyX surgical device, the procedure reconstructs a durable antireflux valve and tightens the LES (Lower Esophageal Sphincter), reestablishing a barrier to reflux and restoring the competency of the gastroesophageal junction. The result is the effective elimination of GERD. Performed with the patient under general anesthesia, the EsophyX device is introduced into the body transorally (through the mouth) and advanced into the esophagus under visualization of a video camera inserted down the central shaft of the device. The EsophyX device is then used to form and fasten several tissue folds, or plications, to create a robust antireflux valve at the gastroesophageal junction, resulting in the effective elimination of GERD.

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