Endoscopic cervical bariatric surgery: follow-up study in a porcine model.
BACKGROUND
The realisation of bariatric surgery has to date modified the digestive process solely through procedures within the abdominal cavity. However, endocrine surgeons have recently demonstrated the feasibility of a minimally invasive approach to the neck. In this study, we explored the feasibility, safety and weight progression of a bariatric procedure performed at the neck.


METHODS
Eleven 40-50 kg Yorkshire pigs underwent endoscopic placement of an adjustable band to the cervical esophagus (ECB). Weight was monitored at postoperative days 15, 30, and after 7 weeks; weight progression was compared with an identical group of pigs who underwent a sham procedure. At autopsy, the surgical site was evaluated in a microscopic and macroscopic manner.


RESULTS
Mean operating time was 66 +/- 5.76 min. All pigs tolerated the procedure well, except one subject that experienced food intolerance. The ECB group experienced significantly slower weight gain than the sham group (P = 0.005). Proper location of the band and absence of microscopic lesions at the esophageal wall were confirmed at autopsy and pathological examination.


CONCLUSIONS
Bariatric surgery at the neck is feasible and produces effects on weight reduction. Further refinements and longer observation periods are required to propose this procedure as safe and effective alternative in humans.
del Genio
Gianmattia
G
Foregut and Obesity Pathophysiology Study Center, Department of Surgery, University of Naples II, via Pansini, Naples, Italy. gdg@doctor.com
Gagner
Michel
M
Nocca
David
D
Cuenca-Abente
Federico
F
Biertho
Laurent
L
Waage
Anne
A
Faife
Barbara
B
del Genio
Federica
F
Boza
Camilo
C
Aggarwal
Rajesh
R
Del Genio
Alberto
A
D000818:Animals; D004724:Endoscopy; D004947:Esophagus / Q000473:pathology / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D015391:Gastroplasty / Q000379:methods*; D009092:Mucous Membrane / Q000473:pathology; D009333:Neck; D013552:Swine; D015431:Weight Loss