Abstract
Background
Vertical sleeve gastrectomy (VSG) is a surgical technique that involves resection of a significant portion of the stomach. This surgery is sometimes associated with gastric leaks, which can be difficult to treat. The present study reports findings from laparoscopic greater curvature plication (LGCP), which is an alternative bariatric procedure similar to VSG but without the need for gastric resection.
Methods
A prospective study was carried out, following LGCP in 42 morbidly obese patients (30 female/12 male) with a mean age of 33.5 years (23 to 48) and mean BMI of 41 kg/m² (35 to 46). Through a five-port approach, the stomach was reduced by dissecting the greater omentum and short gastric vessels, as in VSG, and the greater curvature was then invaginated using multiple rows of non-absorbable suture performed over a 32-Fr bougie to ensure a patent lumen.
Results
All procedures were completed laparoscopically. Mean operative time was 50 min (40 to 100 min) and mean hospital stay was 36 h (24 to 96). Patients returned to their regular activities at an average of 7 days (4 to 13) following surgery. No intra-operative complications occurred. All patients experienced excess weight loss (EWL) of at least 20% after 1 month. Mean EWL was 62% (45% to 77%) in nine patients after 18 months. There has been no record of weight regain in any patient to date.
Conclusions
LGCP is feasible, safe, and effective for at least 18 months when performed on morbidly obese patients. Longer follow-up and prospective comparative trials are needed.
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References
Prentice AM. The emerging epidemic of obesity in developing countries. Int J Epidemiol. 2006;35(1):93–9.
Sjostrom L, Narbro K, Sjostrom CD, et al. Effects of bariatric surgery on mortality in Swedish obese subjects. N Engl J Med. 2007;357(8):741–52.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.
DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med. 2007;356(21):2176–83.
Nocca D, Frering V, Gallix B, et al. Migration of adjustable gastric banding from a cohort study of 4236 patients. Surg Endosc. 2005;19(7):947–50.
Baltasar A, Bou R, Bengochea M, et al. Use of a Roux limb to correct esophagogastric junction fistulas after sleeve gastrectomy. Obes Surg. 2007;17(10):1408–10.
Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A. 2007;17(6):793–8.
Sales Puccini CE. Surset gástrico de Sales: una alternative para cirugía bariátrica restrictive. Rev Colomb Cir. 2008;23(3):131–5.
Brethauer SA, Harris JL, Chand B, Kroh M, Rogula T, Schauer PR. Initial results of vertical gastric plication for severe obesity. Society of American Gastrointestinal and Endoscopic Surgeons. Phoenix, Arizona. April 22–25, 2009.
Gastrointestinal surgery for severe obesity. National Institutes of Health Consensus Development Conference Statement. Am J Clin Nutr. 1992;55(2 Suppl):615S-9S.
O'Brien PE. Laparoscopic adjustable gastric banding: a real option for a real problem. ANZ J Surg. 2003;73(8):562.
Martin LF, Smits GJ, Greenstein RJ. Treating morbid obesity with laparoscopic adjustable gastric banding. Am J Surg. 2007;194(3):333–43.
Galvao M, Ramos AC, Campos JM et al. Endoscopic removal of eroded adjustable gastric band. Lessons learned after 5 years and 78 cases. Surg Obes Relat Dis. (in press). (doi:10.1016/j.soard.2009.09.016).
Campos J, Ramos A, Galvao NM, et al. Hypovolemic shock due to intragastric migration of an adjustable gastric band. Obes Surg. 2007;17(4):562–4.
Tice JA, Karliner L, Walsh J, et al. Gastric banding or bypass? A systematic review comparing the two most popular bariatric procedures. Am J Med. 2008;121(10):885–93.
Gumbs AA, Gagner M, Dakin G, et al. Sleeve gastrectomy for morbid obesity. Obes Surg. 2007;17(7):962–9.
Silecchia G, Boru C, Pecchia A, et al. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg. 2006;16(9):1138–44.
Campos JM, Siqueira LT, Meira MR, et al. Gastrobronchial fistula as a rare complication of gastroplasty for obesity: a report of two cases. J Bras Pneumol. 2007;33(4):475–9.
Toouli J, Kow L, Ramos AC, et al. International multicenter study of safety and effectiveness of Swedish Adjustable Gastric Band in 1-, 3-, and 5-year follow-up cohorts. Surg Obes Relat Dis. 2009;5:598–609.
Fusco PE, Poggetti RS, Younes RN, et al. Evaluation of gastric greater curvature invagination for weight loss in rats. Obes Surg. 2006;16(2):172–7.
Fusco PE, Poggetti RS, Younes RN, et al. Comparison of anterior gastric wall and greater gastric curvature invaginations for weight loss in rats. Obes Surg. 2007;17(10):1340–5.
Acknowledgements
The authors are grateful for the contribution of Mr. Jason Harris, Mr. Ted Stephens, Mr. Tom Albrecht, and Mr. Ed Anton of Ethicon EndoSurgery, Inc., for providing depictions of the procedure.
Disclosures
Dr. Almino Ramos and Dr. Manoel Galvao Neto are international consultants for Ethicon EndoSurgery, Inc. No direct funding was allocated to this specific study and paper.
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Ramos, A., Galvao Neto, M., Galvao, M. et al. Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure. OBES SURG 20, 913–918 (2010). https://doi.org/10.1007/s11695-010-0132-0
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DOI: https://doi.org/10.1007/s11695-010-0132-0