Is TOGA the Future of Weight Loss Surgery?

TOGA or Transoral Gastroplasty is one of the new kids on the block when it comes to bariatric or weight loss surgery. In fact, it’s not even on the block yet. The pioneers of the procedure are still recruiting patients for a Phase III clinical trial as of March 2009. However, if results continue to be positive, Transoral Gastroplasty, or TOGA, promises to give obese patients a form of weight loss surgery that does not require any surgical incisions.

During a TOGA procedure, the patient is sedated under general anesthesia and breathing is aided by a respirator—similar to other surgeries. The physician places a flexible device into the patient’s mouth and guides it down the esophagus and into the patient’s stomach. The doctor visualizes the stomach anatomy at certain points during the procedure using a tiny camera at the end of a thin tube called an endoscope. Once the TOGA device is in place, it is opened and creates a vacuum, bringing the folds of the stomach into itself. The cylindrical TOGA device forms a small tube which is held together by a series of titanium staples.

 

What remains after the surgery is a gastric sleeve, of sorts. Even small amounts of food that enter the sleeve push against its walls and give the sensation of fullness. The idea is that this sense of fullness will encourage the patient to stop eating after only a modest amount of food.

Obviously the major benefit to this surgery is that can be done from within the stomach instead of approaching from outside as is done in traditional bariatric surgeries. TOGA promises to speed recovery because no surgical incisions are made--even laparoscopic procedures require a few small incisions to be made in the abdomen and underlying fascia.

TOGA surgery is intended for obese patients with a body mass index (BMI) between 35 and 55. Patients that are undergoing the study must be obese for at least two and a half years prior to the procedure and weight must be relatively stable for at least a year. Also, patients must have seriously attempted a non-surgical weight loss method and be able to understand and accept the risks associated with the surgery. Because it is a clinical trial, up to a third of all patients enrolled in the TOGA trial may receive what is known as a sham surgery, which is the control part of the trial. In the sham surgery, the study participant (patient) is put under anesthesia, the device is lowered into the stomach but the sleeve is not stapled closed. Unfortunately, in order to maintain the integrity of the trial, the patient will not know if they had the actual or sham surgery until the study has ended. It is possible, however, that those patients that only got a sham surgery will be eligible to get the real surgery at some later point, after the degree of weight loss is measured for a reasonable period of time.

Bariatric surgery without incisions may be the future of weight loss surgery and, if it is, TOGA or Transoral Gastroplasty is poised to be the pioneering procedure.