The surgical review after a POSE

Over the last few years, different endoscopic techniques have been described with the intention of shifting to minimally invasive surgery in the treatment of obesity. Among them, the procedure known as POSE (Primary Obesity Surgery Endolumenal), which appears as a novel, less invasive and safer technique in the treatment of obesity. Thus, the stomach is plucked in eight / nine locations in the fundus and in three / four in antrum by means of specific sutures. These areas restrict contact of food with the total surface of the stomach. The ankle folds modify their shape and produce a slowing of the gastric emptying, obtaining a satiating effect.

Case study: the surgical review after the POSE

The perfect example is the case of a 41-year-old patient, who underwent a POSE process, which at 18 months fails in terms of weight loss. In fact, he went to the clinic with an increase of twelve kilos in relation to the weight he had before POSE, and with a two-point increase in BMI (from 33 to 35).  In its preoperative period, a gastroduodenal transit was performed, due to its refusal to undergo gastroscopy. In the transit, a completely normal stomach was observed, without reflux and with a pattern of normal folds.Once the preoperative was performed, the patient was involved with a laparoscopic vertical gastrectomy. The surgery was performed by completing the dissection to the Hiss angle and performing a gastrectomy with an endocort and reinforcement with a bearded suture of 2-0. The impression is to be before a completely normal stomach, and when examining the extracted part, there is no observed decrease in gastric capacity. After 48 hours of admission, the patient is discharged.

A technique doomed to failure

Thus, the POSE technique appears along with a significant number of endoscopic techniques that during the last attempt to reproduce the manipulations and physiological effects with which minimally invasive surgery works against morbid obesity. Thus, POSE attempts to reduce the ability to conserve food and induce early satiety.It is possible that more and more patients who have failed with this treatment, and go to a specialist in General Surgery looking for a definitive solution. As shown in the case, a laparoscopic vertical gastrectomy after a POSE does not imply great changes with respect to a patient who has not been previously operated.However, careful and cautious technique is recommended as the percentage of complications may increase.It is therefore necessary to release the adhesions to maintain the normal gastric anatomy, as well as to locate the areas of fibrosis and edema to avoid cutting in the area. Thus, reinforcement with suture in the section line is recommended in this type of patients.