Surgeons Staple Stomach Through Mouth

Researchers have found another way to do stomach-stapling surgery. The surgery is done to treat obesity. Stapling the stomach makes it smaller. People lose weight because they are not able to eat as much. At a conference, researchers reported a way to reach the stomach through the mouth. One hundred Europeans got either the stomach stapling or a fake procedure. Those who got the real treatment lost an average of 45% of their body weight in 18 months. A U.S. study is still in progress.

What Is the Doctor's Reaction?

Not long ago, the idea of surgery to treat obesity just didn't seem right. Shouldn't people have enough desire and motivation to eat less and exercise more? Ideally yes, but in the real world that doesn't work for the great majority of obese people.

People rarely are able to sustain weight reduction over many years by dieting, whether or not they use weight-loss drugs. Bariatric surgery has changed that -- the success rates are terrific. But there are very worrisome consequences of the usual procedures -- stomach reduction with or without bypass of the first portion of the intestine.

Many of the potential problems are related to the intestinal bypass. This surgery reroutes part of the flow of food so the body absorbs fewer calories.

About 1 in 350 people will die as a direct result of this type of weight loss surgery. Some centers have quoted better results. Sometimes a bypass has to be reversed because of severe long-term complications, such as too much weight loss and malnutrition.

But surgeons have developed newer ways to perform weight loss surgery without intestinal bypass. For example, gastric banding can be done through a laparoscope. This instrument includes a camera, so the surgeon can work through much smaller cuts in the body.

A band is placed around the outside of the upper stomach. The band is like a balloon. It can be filled with sterile salt water to compress the stomach as much as needed to decrease the amount of food a person can eat.

Now doctors report a method of reducing the size of the upper part of the stomach without surgery. The procedure uses a tube that goes into the mouth and is threaded to the stomach. Doctors staple the upper part of the stomach so that it is much smaller than normal. The procedure also slows down the passage of food through the stomach. It works in a way similar to gastric banding. The person gets full quickly and just can't eat as much at one sitting.

With any weight loss surgery, diet and exercise are needed to make sure the weight stays off for many years.

What Changes Can I Make Now?

There are fairly standard criteria for who is eligible for weight loss surgery.

You must have either:

• A Body Mass Index (BMI) of 40 or more (about 100 pounds or more over ideal body weight) or


• A BMI of at least 35, with a long-term medical condition directly related to obesity

Examples of conditions related to obesity include type 2 diabetes, high blood pressure that can't be controlled and sleep apnea.

You also must have taken part in a structured program to lose weight, without success.

If you are considering surgery, make sure you completely understand the risks and possible problems that can occur. Some people have died as a result of this surgery. You also must be fully committed to make big changes in your life, including getting regular exercise.

The through-the-mouth procedure for weight loss is still an experiment. You would need to enroll in a clinical trial to have it done. You probably would need to meet the same strict criteria and receive a doctor's evaluation before joining a study.

What Can I Expect Looking to the Future?

The early reports of this new technique look promising. Probably the weight loss will be less than what most people achieve with gastric bypass surgery. But the risk of problems is likely to be lower.