Laparoscopic gastric pacing (LGP) is a minimally invasive technique that is performed for the treatment of obesity. LGP was first developed in the early 1990s for gastroparesis, and was also found to be effective in the treatment of obesity. The application of electrical current to the stomach alters gastric myoelectrical activity, without any changes in the gastrointestinal anatomy. The exact mechanism of LGP remains to be elucidated. However, potential mechanisms to assess the success of LGP might include an increased feeling of satiety as the result of reduced gastric emptying, or changes in neuropeptide levels.
LGP is a minimally invasive technique that is potentially safe and effective for treating obesity; nevertheless, the selection of patients for gastric stimulation therapy appears to be an important determinant of the outcome of this treatment.
This article reviews the current status, potential mechanisms of action, operating techniques, complications, postoperative management and outcomes, and possible future applications of gastric stimulation in obesity management.
Gastric pacing Obesity Neuromodulation Surgery Outcomes
This is a preview of subscription content, log in to check access.
The lead of the pacemaker is inserted into the muscle tunnel of the stomach which positions are on the lesser curvature. An adequate length of the tunnel is mandatory, to ensure that both of the electrodes are buried within the tunnel wall. The location of the generator should be on the anterior abdominal wall. The device that controls the settings (wand) is covered with a sterile cover and the system impedance is checked. (MP4 16338 kb)
Cigaina V, Pinato GP, Rigo V, Bevilacqua M, Ferraro F, Ischia S, Saggioro A. Gastric peristalsis control by mono situ electrical stimulation: a preliminary study. Obes Surg. 1996;6:247–9.CrossRefPubMedGoogle Scholar
D’Argent J. Gastric electrical stimulation as therapy of morbid obesity: preliminary results from the frenchstudy. Obes Surg. 2002;12 Suppl 1:21S–5.CrossRefPubMedGoogle Scholar
Favretti F, De Luca M, Segato G, Busetto L, Ceoloni A, Magon A, Enzi G. Treatment of morbid obesity with the Transcend® Implantable Gastric Stimulator (IGS®): a prospective survey. Obes Surg. 2004;14:666–70.CrossRefPubMedGoogle Scholar
Zhang J, Tang M, Chen JD. Gastric electrical stimulation for obesity: the need for a new device using wider pulses. Obesity (Silver Spring). 2009;17(3):474–80.CrossRefGoogle Scholar
Yao SK, Ke MY, Wang ZF, Xu DB, Zhang YL. Visceral response to acute retrograde gastric electrical stimulation in healthy human. World J Gastroenterol. 2005;11(29):4541–6.PubMedCentralPubMedGoogle Scholar
Bohdjalian A, Prager G, Aviv R, Policker S, Schindler K, Kretschmer S, Riener R, Zacherl J, Ludvik B. One-year experience with Tantalus: a new surgical approach to treat morbid obesity. Obes Surg. 2006;16(5):627–34.CrossRefPubMedGoogle Scholar
Miller KA. Implantable electrical gastric stimulation to treat morbid obesity in the human: operative technique. Obes Surg. 2002;12 Suppl 1:17S–20.CrossRefPubMedGoogle Scholar
Miller K, Hoeller E, Aigner F. The implantable gastric stimulator for obesity: an update of the European experience in the LOSS (Laparoscopic Obesity Stimulation Survey) Study. Treat Endocrinol. 2006;5(1):53–8.CrossRefPubMedGoogle Scholar
Callegari A, Michelini I, Squazzin C, Catona A, Klersy C. Efficacy of the SF-36 questionnaire in identifying obese patients with psychological discomfort. Obes Surg. 2005;15(2):254–60.CrossRefPubMedGoogle Scholar
Bohdjalian A, Ludvik B, Guerci B, Bresler L, Renard E, Nocca D, et al. Improvement in glycemic control by gastric electrical stimulation (TANTALUS™) in overweight subjects with type 2 diabetes. Surg Endosc. 2009;23:1955–60.CrossRefPubMedGoogle Scholar