ROSE Procedure - Mark Fusco MD

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. Dr. Fusco 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.

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 stoma, (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.

How do I find out if I’m eligible for this new incisionless, restorative ROSE procedure?

Patients who had a Roux-en-Y gastric bypass more than 2 years ago, lost over 50% of their excess weight and have now regained 15% or more of this weight are ideal candidates for this procedure.
After an initial screening, you will undergo a series of evaluations including nutritional and dietary counseling, a full medical exam and endoscopy to determine if you are a good candidate.

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. Dr. Fusco will then use the same technique to place anchors in the stomach pouch to reduce its volume capacity.

Where will the procedure be performed?

How long will I need to stay at the Surgery Center?

You will be discharged the same day if the procedure was done early in the morning.

What are the benefits of an incisionless procedure?

By eliminating skin incisions, 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.

Is it safe?

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 success rate?

It is too soon to estimate the likely procedure success rate. However, to date, the procedure has been well tolerated and the first few patients have experienced weight loss within the first 4 weeks and a reduction in food volume capacity. Early studies have shown that patients who formally were steadily REGAINING weight before the procedure began losing on average of 35% regained weight.

What is the recovery process?

Typically patients return to normal activity within a few days of their procedure. Dr. Fusco will give you specific instructions. 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.

Will it be covered by insurance?

The ROSE procedure is a new innovative procedure that does not have a "CPT code" and as such is not billible to insurance. Some of the preoperative evaluation may be covered but the procedure itself is not covered.

What will the procedure cost?

Your initial consultation will be billed to your health insurance. Patients also will need a preoperative endoscopy to see if they are candidates for the procedure. This also is billed to the patients health insurance. For patients without health insurnace coverage these two activities are $100 and $1000 respectively. The Rose procedure is NOT billable to insurnace.

Is incisionless surgery just for gastric bypass restorations?

This procedure is one of the first of many potential applications for Incisionless Surgery. Incisionless Surgery is considered the next wave in minimally invasive procedures and, in addition to obesity, it has generated interest among physicians in areas such as GERD, GI cancer and NOTES (Natural Orifice Translumenal Endoscopic Surgery).

What is the ROSE PROCEDURE?