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June 19th, 2009
01:43 PM ET

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?

Editor’s Note: Medical news is a popular but sensitive subject rooted in science. We receive many comments on this blog each day; not all are posted. Our hope is that much will be learned from the sharing of useful information and personal experiences based on the medical and health topics of the blog. We encourage you to focus your comments on those medical and health topics and we appreciate your input. Thank you for your participation.


soundoff (880 Responses)
  1. Geri S.

    I find these surgical procedures and the search for new medications so sad. After the fact attempts at fixing a much larger social medical problem which we are now finding are not long term solutions in many cases, despite the risks taken of surgical intervention. We need to educate our population about proper nutrition and exercise and start this education when our children begin school.

    As someone who works in the nutrition field, I understand how difficult it can be for people to change their old bad food habits, but it can be done, if the psychological side of food habits are also taken into consideration. It is an entire person process, not just a diet. Diet is most definitely a four letter word!

    June 23, 2009 at 10:22 | Report abuse | Reply
  2. Sara

    Sorry, there's a reason why you want a lap Sleeve Gastrectomy over TOGA. The surgeon needs to also get a look at your other organs which may have been impacted by your obesity–NASH is common, gallstones, etc. Also, removing the remnant stomach reduces significantly the production of ghrelin–one of the hormones that cause hunger. Leaving the remnant stomach in plae, through TOGA, will not cause the ghrelin-effect..thus I highly doubt the procedure will be as effective.

    As it is, restrictive only procedures are modestly successful–roughly a 50-60% EWL over time (although better than any diet or meds). Far better solution for those with significant morbid obesity is the duodenal switch... a sleeve gastrectomy plus bypassing a majority of the small intestine. Great 20 year data, very few issues assuming long-enough common channel, and adequate supplementation (tweaked through annual bloodwork).

    June 23, 2009 at 15:34 | Report abuse | Reply
    • Becky

      I had the duodenal switch operation in January of 02 and went from <300 to 140, the one thing I will say is that it is NOT a silver bullet to being thin, you WILL have to do your share of the work, I work out every single day, I eat healthy and I take my vitamins and supplements. I have personally seen many who try to use the surgery as a silver bullet rather than another tool in the tool box and end up very sick, hair falling out, pale ghost like appearance, in and out of the hospital for various complications involved with the malabsorption issues.

      November 8, 2010 at 06:58 | Report abuse |
  3. Lori

    I had the TOGA procedure on March 31, 2009 as part of the clinical trial. Because this is a blind study I will not know for a year if I was actually stapled or not. At this point I am treated as if I have and have been following the diet and directions from my surgeon.

    Right now my intake of food is about 1 cup per meal and 2 small snacks a day. I can say that it takes will power to avoid the food I am not supposed to eat. Unlike the RNY procedure, I do not get sick or feel bad if I eat something that I am not supposed to. For this reason I feel like this procedure is not for everyone. You have to want it and want it bad for it to work.

    I have been asked if I could just do it on my own, and I don’t feel that I could. I have tried many “diets” and exercise plans and never saw any results. This is working for me, and for that I am thankful and very happy. I feel better, I am off many of the meds I was taking and have a better appreciation for food and it’s place in my life.

    June 29, 2009 at 11:03 | Report abuse | Reply
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Get a behind-the-scenes look at the latest stories from CNN Chief Medical Correspondent, Dr. Sanjay Gupta, Senior Medical Correspondent Elizabeth Cohen and the CNN Medical Unit producers. They'll share news and views on health and medical trends - info that will help you take better care of yourself and the people you love.