Anastomotic outlet revision

Abstract

A method is provided that involves endoscopically repairing or revising an anastomotic outlet previously formed in a portion of a patient's stomach as part of an earlier bariatric surgical procedure. The method may allow a surgeon to alter gastric functionality, such as gastric emptying or gastric dumping, by revising an existing anastomotic outlet. In this manner, the size of the outlet may be adjusted to change the rate at which contents pass from the stomach through the outlet. A surgical device may be inserted transorally through the patient's mouth, down through the esophagus and into the stomach or gastric pouch where it may be positioned in the vicinity of the anastomotic outlet. The surgical device may then be employed to revise the outlet to achieve a desired outlet configuration. The anastomotic outlet may be revised using an endoscopic fastening device that is configured to place a fastener in tissue. The fastening device may include an endoscopic suturing device to place one or more sutures in tissue in the region of the anastomotic outlet. One or more plications may be formed in the region of the outlet to narrow or reduce the opening of the anastomotic outlet.

1 . A gastric surgical method comprising an act of:
 (a) following a gastric surgical procedure, endoscopically revising a gastric pouch previously formed in a portion of a stomach of a patient as part of the gastric surgical procedure, wherein the gastric pouch is revised by endoluminally suturing a portion of the gastric pouch.   
   
   
       2 . The gastric surgical method according to  claim 1 , wherein act (a) includes forming at least one tissue plication in the gastric pouch. 
   
   
       3 . The gastric surgical method according to  claim 1 , wherein act (a) includes reducing a portion of the gastric pouch. 
   
   
       4 . The gastric surgical method according to  claim 1 , further comprising act (b) of transorally inserting an endoscopic suturing device into the gastric pouch. 
   
   
       5 . The gastric surgical method according to  claim 4 , wherein act (a) includes capturing tissue with the suturing device. 
   
   
       6 . The gastric surgical method according to  claim 5 , wherein the act of capturing includes applying a vacuum to the tissue. 
   
   
       7 . The method according to  claim 1 , wherein the gastric pouch includes an outlet created as part of the gastric surgical procedure, and wherein act (a) includes suturing tissue in the region of the outlet. 
   
   
       8 . The method according to  claim 7 , wherein the outlet was created as part of a gastrojejunostomy performed during the gastric surgical procedure. 
   
   
       9 . A method of treating obesity comprising an act of:
 (a) following a gastric bypass procedure, endoscopically revising a gastric pouch previously formed in a stomach portion of a patient as part of the gastric bypass procedure, wherein the gastric pouch is revised by endoluminally suturing a portion of the gastric pouch.   
   
   
       10 . The gastric surgical method according to  claim 9 , wherein act (a) includes forming at least one tissue plication in the gastric pouch. 
   
   
       11 . The gastric surgical method according to  claim 9 , wherein act (a) includes reducing a portion of the gastric pouch. 
   
   
       12 . The gastric surgical method according to  claim 9 , further comprising act (b) of transorally inserting an endoscopic suturing device into the gastric pouch. 
   
   
       13 . The gastric surgical method according to  claim 12 , wherein act (a) includes capturing tissue with the suturing device. 
   
   
       14 . The gastric surgical method according to  claim 13 , wherein the act of capturing includes applying a vacuum to the tissue. 
   
   
       15 . The method according to  claim 9 , wherein the gastric pouch includes an outlet created as part of the gastric bypass procedure, and wherein act (a) includes suturing tissue in the region of the outlet. 
   
   
       16 . The method according to  claim 15 , wherein the outlet was created as part of a gastrojejunostomy performed during the gastric bypass procedure. 
   
   
       17 . The method according to  claim 15 , wherein the gastric bypass procedure is a Roux-En-Y gastric bypass and the gastric pouch is separated from the remainder of the stomach.