ARH Bariatrics

Restorative Obesity Surgery, Endolumenal (ROSE) procedure


We are very pleased to offer a new, less invasive surgical option to treat weight regain in gastric bypass patients. If you were originally successful with your bypass surgery but now find yourself regaining some of your lost weight, you may be a candidate for the ROSE procedure (Restorative Obesity Surgery, Endolumenal).

Weight regained after gastric bypass surgery may be caused by a gradual enlargement of the small stomach pouch and/or stretching of the stoma, the opening between the stomach pouch and small intestine. The ROSE procedure is a new surgical option to treat these causes of weight regain in post-gastric bypass patients.

The ROSE procedure uses FDA-cleared endoscopic instruments to decrease the size of the stomach pouch and stoma to more closely match post-bypass surgery proportions. The procedure does not require surgical incisions. Instead, special instruments are introduced through the mouth and into the stomach pouch. Sutures are placed in the pouch to reduce its volume capacity and around the stoma to make it smaller. This recreates the restriction that hastens the feeling of “fullness” – enabling patients to better limit food intake and lose weight.

The ROSE procedure is expected to provide important advantages, including less risk than traditional open or laparoscopic revision surgery, minimal post-operative pain, fast recovery time and no scarring.

If you have had a previous open or laparoscopic gastric bypass and were unable to lose sufficient weight or have been regaining weight, this could be a result of a gradual enlargement of the small stomach pouch and/or stoma. If you are considering a revisional weight loss procedure, the Restorative Obesity Surgery, Endolumenal (ROSE) Procedure may be a good option for you.

Why would I gain weight after gastric bypass?

A number of studies suggest that patients regain weight due to the gradual enlargement of the surgically altered small stomach pouch and stomas, (connection between the stomach and small intestine). When the Roux-en-Y procedure is performed, the stomach and stoma are made very small, which slows the passage of food and creates a feeling of fullness after just a small volume of food is eaten. It is believed that when the stomach pouch and stoma gradually enlarge, the feeling of fullness is no longer present, patients can eat larger meals, and weight regain occurs.

What options do I have if my stomach pouch and stoma stretch out?

New surgical tools now allow surgeons to reduce the size of the pouch and stoma through the patient’s mouth without making external cuts into the body. Your doctor may refer to this as the “ROSE” procedure, which stands for Restorative Obesity Surgery Endoscopic.

Before the ROSE incisionless procedure, patients who regained weight after gastric bypass generally had few treatment options. Scarring and adhesions related to the initial bypass procedure make open or laparoscopic revision surgery very challenging. Revision surgery procedure time is typically longer than the original bypass procedure and patients can be up to three times more likely to develop a complication following revision surgery. Therefore, most patients who regain weight after gastric bypass opt not to undergo open or laparoscopic surgical revision after weighing the risks and benefits.

What does the ROSE procedure entail?

The ROSE procedure is performed using a small flexible endoscope and a new EndoSurgical Operating System (EOS). The scope and the EOS instruments are inserted through the mouth into the stomach pouch the same way as a standard endoscope. Tissue anchors are used to create multiple, circumferential tissue folds around the stoma to reduce the diameter, typically to about 10mm. The surgeon will then use the same technique to place anchors in the stomach pouch to reduce its volume capacity. After the procedure the patient will enter the institution’s standard bariatric surgery follow-up program of nutritional counseling and exercise, similar to the one prescribed after their original gastric bypass surgery.

How long will I need to stay in the hospital?

Typically, patients go home that day. Your surgeon will make the determination following your procedure.

What are the benefits of an incisionless procedure?

By eliminating skin incision, this new procedure may provide important advantages to patients, including, reduced risk of infection and associated complications, less post-operative pain, faster recovery time, and no abdominal scars.

What type of side effects can I expect?

It is anticipated that patients will feel little or no discomfort from the procedure. To date, the only noted side effects have been short-term sore throat, swollen tongue and lip pain from the insertion of the instruments into the mouth. As with any surgery there is risk involved. This less invasive approach should reduce the likelihood of many of the complications associated with the open or laparoscopic revision surgery.

What is the recovery process?

Typically patients return to normal activity within a day or two after the procedure. In addition, patients are asked to follow a post bariatric surgery diet and exercise plan, similar to the regimen prescribed following the initial bypass surgery. In addition, follow-up appointments with us and regular visits with bariatric support staff are, of course, very important.

Will it be covered by insurance?

As with gastric bypass surgery, coverage will vary depending upon the insurance provider. A specialist in your physician’s office will discuss your plan with you. In the event insurance will not cover the procedure, financing options may be available.

What will the procedure cost?

The cost for the procedure will vary depending upon where the procedure is performed, how long you stay in the facility and other factors.