Could a stapler down your throat fight fat?

By Matt Sloane
CNN Medical News Producer

When I first heard about the TOGA procedure, I have to be honest, I was a little shocked! TOGA, which stands for transoral gastroplasty, involves doctors putting a garden hose-sized tube down your throat, passing a camera and a staple gun through the tube, and stapling your stomach from the inside. Pretty cool, eh? It's the latest procedure in "natural orifice surgery," an innovative and attention-getting area of medicine. Gallbladder removal through the vagina, brain surgery through the nose, and now stomach stapling through the mouth – the very orifice where most obesity begins.

The procedure – if approved – could help take the place of laparoscopic obesity surgery, which comes with scars, and several days of recovery. Lose weight, no scars, very little recovery time, and the only complaint most people had in the clinical trials was a bad sore throat? Sounds great, but not so fast, says Dr. John F. Sweeney of the Emory University Center for Bariatric Medicine.

"This is really innovative, and it's pushing the envelope on what we're doing endoscopically," said Sweeney, "But stomach stapling really doesn't work long term."

Lets take a step back. There are two types of obesity surgery. Restrictive operations make a pouch or sleeve inside the stomach, thus making it harder for food to pass, and creating a feeling of satiety, or being full. Malabsorptive operations actually re-route the gastrointestinal anatomy, so that there is less stomach surface area to absorb the nutrients you normally take in with food, thus causing you to lose weight. TOGA, as well as procedures like the LapBand are restrictive surgeries, and although they can be very successful at first, the long-term success rate is not stellar.

"Folks often aren't compliant with their diet," said Sweeney, "Sweet eaters easily defeat restrictive operations, other folks overeat and disrupt the staple lines."

And according to a 2002 study in the journal Surgery, Body Mass Index (BMI) for patients that had undergone gastric banding operations declined for the first three years after surgery, but then began to climb – almost to pre-surgery levels in the years following.

So just who would be the right candidate for this procedure?

"The whole point of this operation is to make a pouch where large food will get stuck," said Dr. Edward Phillips, chairman of surgery at Cedars Sinai Medical Center in Los Angeles. "So, if you're a meat-and-potatoes kind of eater, you will probably do pretty well with this type of procedure."

But having done dozens of TOGA procedures himself, Phillips says, "liquid calorie eaters" tend not to lose as much weight.

"If you eat alot of ice cream or liquid calories, those kinds of things are going to pass right through the sleeve very easily."

Overall, in the first phases of clinical trials, the TOGA has resulted in an average of a 45 percent weight loss after one year. How it does after two, three or even five years? That's the big question that will determine how revolutionary the TOGA really is, and we may not get the full story for another year or two.

When the procedure becomes available, would you have the TOGA procedure done to lose weight?

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