Tuesday, February 15, 2011

The TOGA procedure - new hope for weight loss surgery or ?

A recent announcement stated that the UK had done 450 TOGA procedures for treating obesity.

The TOGA procedure offers an "incision-less" weight loss surgery. What is done is basically stapling the stomach from the inside (a surgical instrument is inserted through the mouth).

American surgeons have appeared to not have greeted this procedure with the same enthusiasm as those in the UK.

Click here to see an animation of the TOGA procedure.

A surgeon's description of "minimally invasive" can be misleading to patients. They simply mean no incision. They do not mean the surgery is lightweight or not complex. This procedure calls for stapling the stomach from the inside into a narrow sleeve and step two is narrowing the lower end of the sleeve so food doesn't go through well. This is supposed to cause the patient to feel full with a lot less food.

It's interesting to note that all the procedures and medications are aimed at cutting appetite but since when do people only eat when they are hungry? The type of appetite we mostly have, is in the head and not fixed by feeling full in the tummy.... which may explain why even the more complex procedures are somewhat ineffective in a number of patients.

As the websites about the TOGA do not seem to be recently updated, it seems that the TOGA may not have become popular in the USA yet, and one wonders whether the weight loss results were less than expected or whether there were a lot of complications in the American trials.

Even if the TOGA holds better than the Rose or the StomaPhX, it may cause a lot of discomfort for the patient. In fact, patients complained of a lot of pain with both the Stomaphx and the Rose procedures but not much additional weight loss. And with the Rose and the stomaphx, they had problems with the staples or clips pulling out after a year or so. The tissue inside the stomach is very soft tissue, so it makes sense that staples or clips would not hold well.

Apparently a study in 2008 did not result in the weight losses claimed by the manufacturer. Also as you notice in the quote, even in a small number of patients (6), researchers observed in some cases "Partially stapled sleeves". In other words, in at least a couple of the members of the cohort, the staples had already begun pulling out.

There were no complications; all but 2 instances of procedure-related adverse effects (nausea, vomiting, pain, dysphagia, pharyngitis) resolved within 5 days and none were serious. The most recent follow-up visits (endoscopy at 3 or 6 months) showed persistent full or partial stapled sleeves in all patients. Weight loss averaged 17.5 lb at 1 month and 24.7 lb at 3 months after treatment (excessive weight loss [EWL], 14.9% and 20.5% at the respective time points). At 6 months, average weight loss was 31.1 lb and EWL was 24.9% for 6 patients followed up so far.

Endoscopy. 2008 May;40(5):406-13.

In reading about this procedure, I somehow am reminded of the title of a book that Susan Powter wrote --- "STOP THE INSANITY".

1 comment:

wriggles said...

Reading the first link I noted how they emphasised safety rather than results, which is admirable in a way.

However in the cause of weight loss via this route it is self defeating as trauma is part of the weight loss of WLS.

Lessening impact will lessen that and increase the likelihood and speed of recovery. As well as the possibility of it not working at all.

I'm not saying trauma is good, more it indicates the kind of thing we are dealing with.

Those dealing in this kind of thing are obssessed with eating as the 'cause' of weight rather than looking at the metabolism as a whole.

That is their overriding theme and they have no intention of getting past it after all, what is it costing them?