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Weight-Loss Procedure Removes Stomach Through Mouth

A California woman had 80 percent of her stomach removed through her mouth using a minimally invasive technique, according to surgeons who say it may be the first of its kind in the world.

Surgeons at the University of California, San Diego Medical Center performed the sleeve gastrectomy on Aug. 3. The patient, Connie Harris of Carlsbad, Calif., is recovering at home and doing well.

“We remove 80 percent of the stomach to try to create a sensation of fullness and make the patient lose weight,” said Dr. Santiago Horgan, chief of minimally invasive surgery and director for the UCSD Center for the Treatment of Obesity.

A sleeve gastrectomy allows patients to lose two to four pounds each week after surgery. Before surgery, Harris, 61, weighed almost 200 pounds at just 5-feet, 4-inches tall.

She lost a lot of the weight before surgery because she was put on an all-liquid diet, and now, after the surgery, she weighs 175 pounds.

“At some point, you tell yourself the truth that all of the diets that you’ve been on haven’t been working,” said Harris, adding that she’s been dieting since she was 7 years old. “I think it’s the future. I think people should really look into it.”

The sleeve gestrectomy incorporates two minimally invasive techniques – laparoscopic surgery and natural orifice translumenal endoscopic surgery (NOTES) – both intended to reduce scarring.

Five small incisions are made in the abdomen to insert the instruments used for preparing 80 percent of the stomach for removal. Then, surgeons use an endoscope to reach the stomach through the mouth and pull the divided portion out. The stomach is closed with staples applied through the abdomen, leaving the patient with a stomach about the size of a banana.

“By doing this, what we achieved was the possibility of doing this operation without any of the big scars on the abdomen,” Horgan said. “The patients don’t have pain, they have less chance of hernia and they have less chance of infections.”

The sleeve gastrectomy received approval as a bariatric surgery option in 2009 from the American Society for Metabolic and Bariatric Surgery (ASMBS), "primarily because of its potential value as a first-stage operation for high-risk patients," the ASMBS committee wrote in a 2009 position paper.

The procedure can be used as an alternative to gastric bypass surgery – the most common weight-loss surgery in the U.S., according to the Mayo Clinic – or to better prepare extremely obese patients for it by reducing their risks through weight loss.

While a stomach reduction done through the mouth is less invasive than a gastric bypass, it still carries certain risks, including leakage at the site of a staple, blood clots and what Horgan calls the “unknowns” of any surgery. Horgan said that his team has not been able to identify any other similar procedures in the U.S. or the world, meaning this surgery may be the first stomach reduction through the mouth to ever be performed.

Horgan has performed more than 100 NOTES procedures, including oral appendix removal and gallbladder removal. The Center for the Future of Surgery team at UCSD was the first to perform an oral appendix removal, as well as an oral gallbladder removal, according to a press release.

“The number of options for minimally invasive weight-loss surgery is rapidly evolving,” Horgan said. “Our goal is to offer patients a customized long-term solution for losing weight with as few scars as possible, and if desired, no medical devices.”

“The main thing is that… I’m not hungry. I’m only eating about 500 calories a day. And that never happens,” Harris said.