S4140 Successful Management of Weight Regain Following Roux-en-Y Gastric Bypass Using the OverStitch NXT Suturing Device

Introduction: Roux-en-Y gastric bypass (RYGB) is a widely used bariatric procedure for weight loss and managing obesity-related conditions. Despite its effectiveness, long-term weight regain is a common issue, with over 25% of patients regaining significant weight within 10 years. The diameter of the gastrojejunal anastomosis (GJA) is a key factor in this weight regain. Transoral outlet reduction (TORe) has been developed to address this, and newer devices like the OverStitch NXT suturing device offer advanced features for this procedure. Case Description: A 50-year-old woman underwent laparoscopic RYGB surgery at 37 years old in 2010. Initially weighing 262 lb with a body mass index (BMI) of 42.7, she suffered from hypertension, obstructive sleep apnea, and gastroesophageal reflux disease. She reached a nadir weight of 115 lb and a BMI of 18.6. Her weight gradually increased, reaching a maximum weight of 253 lb 13 years later, so she was scheduled for a TORe procedure. The gastroesophageal flap valve was classified as Hill Grade IV, and a 4 cm gastric pouch, half of which was herniated into the thorax through a hiatal hernia, was noted. The gastrojejunal anastomosis was dilated to 30 mm. Argon plasma coagulation was used to ablate mucosa around the anastomosis, and the OverStitch NXT suturing device was used to place 8 stitches into the tissue ridge of the anastomosis. The suture was tightened and cinched, and another suture was placed in a U-shaped configuration to reduce the distal pouch into a tubular-shaped outlet. A successful zipper-like outlet closure was achieved and the outlet was estimated to be approximately 8 mm. The patient was discharged the same day and successfully lost 35 lb within the first 2 months post-procedure. Discussion: We discussed the application of the new OverStitch NXT endoscopic suturing device for performing an outlet revision case of weight regain following RYGB, complicated by a hiatal hernia. This device proved particularly valuable due to several advanced features. Its single-channel endoscope system provides a clear, unobstructed view and eliminates the need for double-lumen scopes. Additionally, the device's clutch system enables the tip to articulate at sharper angles, enhancing its ability to reach and maneuver within various anatomical sites and orientations. Lastly, the streamlined helical retractor operates in the same plane as the suturing arm, allowing for effective full-thickness tissue acquisition.