WO2008068715A2 - Procédure de restriction gastrique pour le traitement de l'obésité et des co-morbidités associées - Google Patents

Procédure de restriction gastrique pour le traitement de l'obésité et des co-morbidités associées Download PDF

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Publication number
WO2008068715A2
WO2008068715A2 PCT/IB2007/054920 IB2007054920W WO2008068715A2 WO 2008068715 A2 WO2008068715 A2 WO 2008068715A2 IB 2007054920 W IB2007054920 W IB 2007054920W WO 2008068715 A2 WO2008068715 A2 WO 2008068715A2
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WO
WIPO (PCT)
Prior art keywords
gastric
pouch
stomach
proximal
procedure
Prior art date
Application number
PCT/IB2007/054920
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English (en)
Other versions
WO2008068715A3 (fr
Inventor
Jean-Marie Calmes
Teresa Sewell
Original Assignee
Jean-Marie Calmes
Priority date (The priority date is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the date listed.)
Filing date
Publication date
Application filed by Jean-Marie Calmes filed Critical Jean-Marie Calmes
Publication of WO2008068715A2 publication Critical patent/WO2008068715A2/fr
Publication of WO2008068715A3 publication Critical patent/WO2008068715A3/fr

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Classifications

    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
    • A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
    • A61B17/11—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis
    • A61B17/1114—Surgical instruments, devices or methods, e.g. tourniquets for performing anastomosis; Buttons for anastomosis of the digestive tract, e.g. bowels or oesophagus
    • A—HUMAN NECESSITIES
    • A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
    • A61F—FILTERS IMPLANTABLE INTO BLOOD VESSELS; PROSTHESES; DEVICES PROVIDING PATENCY TO, OR PREVENTING COLLAPSING OF, TUBULAR STRUCTURES OF THE BODY, e.g. STENTS; ORTHOPAEDIC, NURSING OR CONTRACEPTIVE DEVICES; FOMENTATION; TREATMENT OR PROTECTION OF EYES OR EARS; BANDAGES, DRESSINGS OR ABSORBENT PADS; FIRST-AID KITS
    • A61F5/00—Orthopaedic methods or devices for non-surgical treatment of bones or joints; Nursing devices; Anti-rape devices
    • A61F5/0003—Apparatus for the treatment of obesity; Anti-eating devices
    • A61F5/0013—Implantable devices or invasive measures
    • A61F5/0083—Reducing the size of the stomach, e.g. gastroplasty

Definitions

  • the present invention relates to the treatment of obesity and more precisely to surgical procedures comprising a step where a restriction is created on or near to the stomach. Such a restriction reduces the food and calories intake and results therefore in a weight loss and/or a weight maintenance.
  • the first approach is based on the observation that as food intake volume does not change, the efficacy of food absorption is reduced (jejuno ileal bypass, bilio pancreatic diversion). This first type of procedure has many complications especially liver, kidney or bone failures.
  • the second approach consists in a food restriction provided by a small gastric reservoir or pouch.
  • the first described procedure was the proximal part of gastric bypass (E. Masson, 1966). From there, many other procedures were described using gastric partition principle mainly vertical gastroplasty and horizontal gastroplasty. Physical partition was brought by suturing or stapling the circumscribed small gastric pouch. Other ways to produce reduction of the overall gastric volume were operation as gastric wrapping (with synthetic mesh) or ablative surgery of the major part of the gastric reservoir (Magen Strasse Mill procedure). All the previously described procedures were associated sometimes with peri gastric devices to prevent the risk of the dilatation of the passage between the small pouch and the rest of the stomach (vertical banded gastroplasty i.e.).
  • the invention refers to a surgical method consisting in the creation of an isolated small proximal gastric pouch (ISPG) which is obtained from the stomach proximal part, the ISPG being connected to the other part of the stomach through a calibrated passage ( anastomotic channel).
  • ISPG isolated small proximal gastric pouch
  • the interruption of the anatomical continuity of the gastric wall resulting from the creation of the ISPG prevents gastric wall nerve communication.
  • This configuration prevents reflux of gastric content or even vomiting, as it may be observed with patients having undergone gastric bypass procedure in which the small proximal gastric pouch empties directly in the small bowel.
  • the procedure according to the invention preserves physiologic food pass, without using any prosthetic device, and with a proved eating comfort and an easy reversibility of the restrictive effect by intra gastric trans oral manipulations. Moreover, the other advantages of the procedure according to the invention are to overcome the well known complications associated to other dedicated gastric restrictive surgical or non surgical procedures.
  • a proximal gastric pouch is realised over the cardial part of the stomach and has a volume of 20 to 25 ml.
  • the pouch is created by cutting the proximal part of the stomach, starting at lesser curvature. This may be done by cutting and closing the tissues, either by sewing or with a stapler. At that point, the proximal pouch is isolated to the rest of the stomach.
  • the isolated proximal gastric pouch is connected (anastomosis) to the stomach trough a calibrated channel (gastro-gastrostomy).
  • a calibrated channel gastro-gastrostomy
  • This connection is calibrated by a defined oro-gasthc tube that have a precise diameter (e.g. 1 ,2cm) and the isolated pouch is hand sewn over the calibration tube to the remaining part of the stomach (distal).
  • the channel could also be created with a linear or circular stapler.
  • the anvil of the stapler could be inserted in the proximal pouch by transoral route.
  • the circular stapler is introduced in the remaining part of the stomach through an insision in his anterior part. This incision must be closed at the end of the procedure.
  • bovine pericardium or PTFE could be added to the stapler to diminish the risk of anastomotic intraluminal haemorrhage and/or to prevent further anastomotic dilatation over time.
  • Any other adjustable or non adjustable device/material could be added around the gastro gastric channel in order to modify and adjust it size.
  • the isolated proximal pouch could be stimulated with any electrical device such as a pacing device to increase the restrictive effects and neurological brain effects.
  • Any electrical device such as a pacing device to increase the restrictive effects and neurological brain effects.
  • Two stage approach to treat extreme obesity This new procedure has to be integrated in a global approach and treatment of obesity. This will achieve long term weight control and prevent weight regain.
  • the procedure could be easily reversed either by open or laparoscopic surgery.
  • the reverse conversion is as follows : After entering in the abdomen and after the distal stomach is clear from previous adhesions, a 10mm opening is made few centimetres below the gastro-gastric anastomosis on the small curvature of the distal stomach. A 30mm roticulated linear cutting stapler is introduced in the distal stomach.
  • the distal part of the stapler is guided across the gastrogastric anastomosis with the assistance of a transoral gastroscope.
  • the stapling-cutting device is fired thus enlarging a fourfold the previous anastomosis.
  • the distal gastric opening is closed.
  • NOTES Natural Orifice Transluminal Endoscopic Surgery
  • the isolated pouch is created by hand cutting and sewing or by stapler-cutter devices applied on the proximal part of the stomach (cardia), starting at the level of the lesser curvature.
  • the isolated pouch is connected (anastomosis) to the stomach trough a calibrated channel (e.g. 1 ,2cm gastro-gastrostomy).
  • the channel could also be created with a linear or circular stapler.
  • the anvil of the circular stapler could be inserted in the proximal pouch by transoral route.
  • Various materials as bovine pericardium or PTFE could be added to the linear or circular staplers to diminish the risk of haemorrhage, leaks and/or to prevent further anastomotic dilatation over time.
  • the isolated gastric pouch could be stimulated with electrical device such as a pacemaker, k) The procedure could be reverse either by open, laparoscopic or Natural
  • NOTES Orifice Transluminal Endoscopic Surgery

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  • Health & Medical Sciences (AREA)
  • Surgery (AREA)
  • Life Sciences & Earth Sciences (AREA)
  • Public Health (AREA)
  • Nuclear Medicine, Radiotherapy & Molecular Imaging (AREA)
  • Veterinary Medicine (AREA)
  • General Health & Medical Sciences (AREA)
  • Animal Behavior & Ethology (AREA)
  • Engineering & Computer Science (AREA)
  • Biomedical Technology (AREA)
  • Heart & Thoracic Surgery (AREA)
  • Vascular Medicine (AREA)
  • Child & Adolescent Psychology (AREA)
  • Orthopedic Medicine & Surgery (AREA)
  • Nursing (AREA)
  • Gastroenterology & Hepatology (AREA)
  • Obesity (AREA)
  • Physiology (AREA)
  • Medical Informatics (AREA)
  • Molecular Biology (AREA)
  • Surgical Instruments (AREA)

Abstract

L'invention concerne un procédé chirurgical pour le traitement de l'obésité comprenant une étape qui consiste à créer une petite poche gastrique proximale isolée (3), ladite poche (3) étant obtenue à partir de la partie proximale de l'estomac et étant connectée à l'autre partie de l'estomac (6) par un canal anastomotique (8).
PCT/IB2007/054920 2006-12-05 2007-12-04 Procédure de restriction gastrique pour le traitement de l'obésité et des co-morbidités associées WO2008068715A2 (fr)

Applications Claiming Priority (2)

Application Number Priority Date Filing Date Title
IB2006054598 2006-12-05
IBPCT/IB2006/054598 2006-12-05

Publications (2)

Publication Number Publication Date
WO2008068715A2 true WO2008068715A2 (fr) 2008-06-12
WO2008068715A3 WO2008068715A3 (fr) 2009-04-30

Family

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Family Applications (1)

Application Number Title Priority Date Filing Date
PCT/IB2007/054920 WO2008068715A2 (fr) 2006-12-05 2007-12-04 Procédure de restriction gastrique pour le traitement de l'obésité et des co-morbidités associées

Country Status (1)

Country Link
WO (1) WO2008068715A2 (fr)

Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020169464A1 (en) * 1999-09-14 2002-11-14 Surgical Diffusion Sa Gastric band
US20040148034A1 (en) * 2002-11-01 2004-07-29 Jonathan Kagan Apparatus and methods for treatment of morbid obesity

Patent Citations (2)

* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
US20020169464A1 (en) * 1999-09-14 2002-11-14 Surgical Diffusion Sa Gastric band
US20040148034A1 (en) * 2002-11-01 2004-07-29 Jonathan Kagan Apparatus and methods for treatment of morbid obesity

Non-Patent Citations (1)

* Cited by examiner, † Cited by third party
Title
SMITH ET AL.: 'Radiology of Gastric Restrictive Surgery' RADIOGRAPHICS vol. 5, no. 2, March 1985, page 195, 196 *

Also Published As

Publication number Publication date
WO2008068715A3 (fr) 2009-04-30

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