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Implantable gastric stimulation (IGS)

Transcend™ Implantable gastric stimulation (IGS) system for weight loss is currently available in Europe and Canada and is now a part of Medtronic. This system uses gentle electrical stimulation of the stomach to enhance the normal feeling of fullness (satiety). Patients can expect to lose 30-40% of excess weight over a period of 24 months.

Implantable gastric stimulation (IGS)

Implantable gastric stimulation (IGS) using the Transcend system, is an exciting and revolutionary new development in the treatment of severe obesity. The first IGS procedure was carried out in 1995 1, and since then more than 700 successful implants have taken place in Europe and the USA. Results strongly suggest that IGS has the potential to become a genuine breakthrough in the surgical treatment of obesity. In addition, it has been shown to be by far the safest surgical option for individuals with severe obesity.

How does IGS work?

Early clinical trials showed that gentle electrical stimulation of the stomach enhanced the normal feeling of fullness (satiety), which led to the study subjects eating less food and losing weight. Based on these initial observations the Transcend IGS system was developed. It consists of two main parts; a lead wire and an electrical device about the size of a matchbox – the implantable pulse generator. When the device is switched on it "paces" the stomach by delivering a small current. The resulting stomach contractions send a signal of satiety (fullness) to the appetite centre in the brain, leading to reduced appetite and weight loss.

How is the Transcend IGS system implanted?

A laparoscopic (keyhole) technique is used to attach the lead wire into the stomach wall. The lead is then connected to the pulse generator which is placed under the skin on the abdominal wall (see above). After a period of three weeks or so the IGS system is programmed and switched on. The procedure normally takes no more than 45-60 minutes.

How long will I be in hospital?

At present, the procedure requires an overnight stay, but we expect that it will eventually be possible to offer a day-case option.

When can I return to work?

You will be up and around the following day and you can start walking as soon as you feel comfortable. You should be back at work in about a week.

Eating with the IGS

Because the operation does not involve making the stomach smaller or creating malabsorption, unlike other surgical procedures you do not have to follow a strict post-operative dietary regime. This is one of the great advantages of the IGS system. You can eat a perfectly normal, balanced diet with a wide range of food options, though you will obviously have to limit your calorie intake.

Follow-up

The IGS system is usually switched on about three weeks after surgery. This is done simply by placing a "wand" over the device and programming it with a laptop computer. Depending on the amount of weight los s, you may need to have the signal adjusted from time to time.

This image shows the IGS "wand" used to programme the small pulse generator.

How long does the device last?

At present the pulse generator has a battery life of around 4-5 years after which – depending on the amount of weight loss – it may need to be replaced. This can be done in a few minutes and requires only a local anaesthetic. The lead connecting the pulse generator to the stomach does not require replacing.

Is it safe?

One of the great advantages of the IGS system is that it is by far the safest surgical treatment for obesity. The mortality rate to date is 0% and the complication rates are extremely low 2.

Advantages

In addition to being the safest of the surgical procedures for obesity, the IGS has other distinct advantages, including the following:

  • Unlike gastric bypass or laparoscopic banding, the IGS does not involve making any changes to the anatomy of the digestive tract
  • Because IGS harnesses and enhances a normal physiological mechanism, it is a more natural and gentle form of surgical treatment
  • Following surgery, it is possible to eat normal food almost immediately
  • Adjustments are done by the use of a laptop computer and take only a few minutes

How much weight will I lose?

Although weight loss is less rapid than with gastric bypass or laparoscopic banding, selected patients can expect to lose 30-40% of excess weight over a period of 24 months 3.