ROSE, which stands for Restorative Obesity Surgery, Endolumenal, is a new, safer, incisionless, gastric bypass revision. It is not a primary method of weight loss surgery, but a follow-up procedure that is specifically designed for gastric bypass patients with weight regain.


The ROSE procedure is indicated for gastric bypass patients who were initially successful in losing the excess weight but are now regaining some of the lost weight because the stomach and stoma have stretched out and no longer effectively control hunger and food intake.


Why is the ROSE procedure performed?


The purpose of the ROSE procedure is to reduce the size of the stomach and stoma to recreate the restriction of the original gastric bypass.


Most gastric bypass patients are able to lose a significant amount of excess weight following surgery and keep it off long-term. While slight weight regain after the first 18 to 24 months is common, some patients gain back more weight than desired.


In many cases of failed gastric bypass, weight regain is due to the stomach pouch and stomach outlet (stoma) stretching out over time. Stretching often occurs from poor portion control. When the stomach and stoma become enlarged, they no longer effectively restrict food intake or reduce hunger sensations.


How is the ROSE procedure performed?


The ROSE procedure is performed endoscopically and does not require external cuts or incisions.


With endoscopic procedures, such as the ROSE, the doctor operates via a natural body opening using small, flexible surgical tools. To reach the surgical area, a special FDA-approved medical device is inserted through the mouth, down the esophagus, and into the stomach pouch. The tool gathers together sections of stomach tissue to create a pleat which is then sutured together. With this process, the stomach volume and stoma diameter can be reduced to increase restriction and encourage weight loss.


Patients will be put under general anesthesia. It takes about one hour to complete the operation, which is often performed on an out-patient basis. Most patients will feel little or no discomfort.


What is the expected recovery?


Most patients are able to go home within 24 hours and can resume a normal schedule within a few days. Post-operative symptoms are minimal. Most patients experience little more than a few days with a mild sore throat, hoarseness, swollen lip, and lip pain due to the endoscopic instruments that were inserted into the mouth. Most patients don’t experience stomach pain as they did with gastric bypass surgery. Since no incisions are made into the skin, the risk of infection and associated complications is low, recovery time is faster, post-operative pain and discomfort is minimal, and there are no visible scars.


What is the post-operative diet?


To give the stomach sutures time to heal, the diet will be similar to the post-op gastric bypass diet. The first week is full liquids, followed by two weeks of soft foods. Solid foods will slowly be reintroduced back into the diet after healing. Portion control will help to reduce the risk of restretching the stomach and stoma.


What are the advantages of the ROSE procedure?


The ROSE procedure is performed endoscopically and does not require cuts or incisions. This offers many gastric bypass patients a safer option than most of the other revision options currently available. Most other revision options require open or laparoscopic surgery which is very challenging because of the scar tissue and adhesions that develop after the initial gastric bypass; they typically take longer and are more likely to cause complications than the original procedure. Because the risks tend to outweigh the benefits, many patients decide not to undergo an open or laparoscopic surgical revision.


Benefits of the ROSE procedure include:


Endoscopic procedure, therefore no external cuts or incisions
Quick procedure (1 hour)
Usually performed on an outpatient basis
Quick recovery time, resume normal activities within a few days
Overall risks much lower than with open or laparoscopic surgical revision
No visible scars
Low risk of infection
Minimal pain and discomfort
Reduces size of stomach pouch, thus limiting food intake
Reduces stoma diameter to slow digestion, thus increasing satiety


What other revision options do gastric bypass patients have if they regain weight?


Revision options for gastric bypass include:


Revision surgery to restore the original gastric bypass anatomy
Conversion to Vertical Sleeve Gastrectomy (Gastric Sleeve)
Conversion to Duodenal Switch
Conversion to Bilio-Pancreatic Diversion (Scopinaro-type)
Adjustable Gastric Banding (LAP-BAND or REALIZE Band)
Gastric bypass revision with StomaphyX
Are you a candidate for the ROSE Procedure?


The ROSE procedure is designed for patients who previously had a Roux-en-Y gastric bypass and were successful in losing over 50% of their excess weight but are now gaining back weight. Typically, the original procedure must have been performed more than 2 years ago and weight regain has reached 15% or more of the lost weight. In some cases, patients may also be a candidate if they underwent gastric bypass surgery but failed to lose weight.


Patients will first be screened by a bariatric surgeon to determine if they meet the criteria for ROSE. Then, patients must undergo a series of evaluations including nutritional and dietary counseling, a full medical exam, and endoscopy (EGD and Upper GI series). During the endoscopy, measurements will be taken of the stomach size and stoma diameter to determine whether or not there is sufficient enlargement to qualify.


How will it help with weight loss?


The ROSE procedure will help a person eat less by recreating the restriction of the initial gastric bypass surgery. By reducing the stomach volume, it will help limit meal portions and food intake. By making the stoma diameter smaller, it will slow down the movement of food out of the stomach pouch. This will prolong the feeling of fullness after a meal and lessen hunger sensations between meals.


The procedure is new, but early weight loss results have been positive. Patients can expect immediate results, at a weight loss rate of one to two pounds per week.