Comparison of Anterior Gastric Wall and Greater Gastric Curvature Invaginations for Weight Loss in Rats

Gastrogastric herniation: An unusual complication following greater curve plication for the treatment of morbid obesity: Case report

Bariatric surgery is the most effective treatment for obese patients. Laparoscopic greater curvature plication (LGCP) is a good, effective and feasible surgical option for the treatment of obese patients. But it has some complications that should be considered such as gastric remnant distention, stomal stenosis and marginal ulcers.

Here, we reported an extremely rare complication “gastro-gastric herniation”. This condition was diagnosed through upper gastrointestinal contrast imaging and treated through laparoscopy. The hernia was invaginated and firm continuous sutures were placed. We followed the patient for one year and the results were great.

Thus, we can add gastro-gastric hernia to the medical literature as a rare complication of laparoscopic greater curvature gastric plication, and It is considered a serious condition that requires immediate treatment and follow-up.

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Obesity is considered as an important risk factor for many serious diseases.

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Bariatric surgery is the most effective treatment for obese patients.

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Laparoscopic greater curvature plication (LGCP) is an effective and feasible surgical option.

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Gastrogastric herniation is a rare complication of greater curve plication.

PRE AND POSTOPERATIVE PH MONITORING AND WEIGHT LOSS ANALYSIS IN PATIENTS UNDERGOING GASTRIC PLICATION IN ASSOCIATION WITH FUNDOPLICATION

BACKGROUND

Obese patients with gastroesophageal reflux disease with pathological pH monitoring result may benefit from surgical treatment which is based on the fundoplication technique in association with laparoscopic gastric plication. The Nissen surgery is the gold standard for surgical treatment of gastroesophageal reflux disease, whereas laparoscopic gastric plication is a restrictive surgery that consists of the invagination of the greater curvature, resulting in weight loss.

AIM

To compare pre and postoperative pHmetry results and to evaluate weight loss in patients submitted to gastroplasty with fundoplication.

METHOD

Sixteen patients with class I body mass index with symptoms of gastroesophageal reflux with changes of stomach pH and/or erosive esophagitis seen in endoscopy were selected The evaluation of the weight and 24-h pH monitoring was performed preoperatively and postoperatively. The weight, body mass index, percentage of excess weight loss and DeMeester score of patients that underwent the surgery were evaluated pre and postoperatively.

RESULTS

Regarding pH monitoring, the average preoperative DeMeester index was 28.7, which was followed by a significant postoperative average reduction to 2.8 (p<0,001). Regarding the weight reduction, the average of weight loss was 13.6 kg and body mass index of 5.3 kg/m2 (p<0.001). Furthermore, the average percentage of excess weight loss was 53.9% (standard deviation=26.2).

CONCLUSION

The combination of Nissen surgery and gastric plication is a viable procedure and appears to be an acceptable option for the treatment of gastroesophageal reflux disease in obese patients, especially patients with obesity class I.

Laparoscopic Greater Curve Plication as an Outpatient Weight Loss Procedure

Background and Objectives:

Laparoscopic greater curve plication is emerging as a weight loss procedure that avoids many of the complications of other surgeries that require gastrointestinal division, amputation, or use of a foreign body. Cost savings and affordability have also been promoted, as plication does not require the use of stapling devices, adjustable gastric bands, or prolonged hospitalization. The ability to predictably perform plication as an outpatient surgery may further define its role as a therapeutic option for treating morbid obesity. We present the 30-day outcomes and supplementary 12-month data in a series of 141 laparoscopic greater curve plication surgeries performed as outpatient procedures.

Methods:

Laparoscopic greater curve plication was performed as outpatient surgery in 141 consecutive patients. Outcomes including perioperative complications, incidental 12-month follow-up for weight loss, and change in diabetic and hypertensive medication are reported.

Results:

Of the 141 plications performed, 138 patients were discharged from the recovery room and 6 were readmitted. There was no conversion to open surgery and no mortality.

Conclusions:

The ability to reliably perform greater curve plication as an outpatient surgery may further define its role as an additional weight loss surgery technique.

Comparison of gastric fundus invagination and gastric greater curvature plication for weight loss in a rat model of diet-induced obesity

BACKGROUND

Gastric fundus invagination (GFI) is a novel weight loss procedure. The gastric fundus is invaginated inside the gastric lumen and anastomosed to the gastric antrum. In gastric plication (GP), the greater curvature is plicated inside the gastric lumen leaving a narrow gastric channel for food passage. This study compares GFI to GP in a diet-induced obesity rat model.

METHODS

Twenty Long-Evans male rats were fed a 60% high fat diet for 6 weeks. At 14 weeks of age, the rats underwent either GFI (N = 10) or GP (N = 10) surgery. Body weight and food intake were measured for 6 weeks. Serum adipokines and ghrelin hormone were assayed. Six weeks after surgery, all rats were euthanized and the stomachs examined. The two-sample t test was used to compare the results between the two groups.

RESULTS

All GFI rats had an intact fundus invagination at 6 weeks following surgery. The greater curvature plication unfurled in three out of ten GP rats. Part of the fundus herniated through the plication suture line in one GP rat. There was no significant difference between the mean percent weight change for the GFI (4.2 ± 4.1%) and GP (8.8 ± 6.0%) groups. There was no difference in food intake between both groups. GFI was associated with a significant lower fasting ghrelin levels (101.1 ± 13.1 versus 137.3 ± 27.4; p = 0.044) compared with GP.

CONCLUSIONS

GFI offers a more effective and more durable surgical alternative for weight loss than GP.

A systematic review of gastric plication for the treatment of obesity

BACKGROUND

Laparoscopic gastric plication (LGP) is a relatively new restrictive bariatric procedure that requires no gastrectomy or foreign body placement.

OBJECTIVES

The authors' aim in this article is to conduct a systematic review of the currently available literature regarding the outcomes of LGP for the treatment of obesity.

SETTING

University Hospital, China

METHODS

The authors' systematic review yielded 14 studies encompassing 1,450 LGP patients. Perioperative data were collected from each study and recorded.

RESULTS

Mean preoperative body mass index (BMI) ranged from 31.2 to 44.5 kg/m(2), and 80.8% of the patients were female. Operative time ranged from 50 to 117.9 minutes (average 79.2 min). Hospital stay varied from .75 to 5 days (average 2.4 days). The percentage of excessive weight loss (%EWL) for LGP varied from 31.8% to 74.4% with follow-up from 6 months to 24 months. No mortality was reported in these studies and the rate of major complications requiring reoperation ranged from 0% to 15.4% (average 3.7 %).

CONCLUSION

Early reports with LGP are promising with a favorable short-term safety profile. However, it remains unclear if weight loss following LGP is durable in the long term. Additional prospective comparative trials and long-term follow-up are needed to further define the role of LGP in the surgical management of obesity.

Short-term outcomes of laparoscopic gastric plication in morbidly obese patients: importance of postoperative follow-up

Demand for feasible, safe, and preferably low-cost methods of weight reduction is rising every day. The present study reports findings from laparoscopic gastric plication (LGP), which is a new restrictive bariatric technique, combined with a postoperative follow-up program. A 2-year prospective study was performed following LGP in 53 female morbidly obese patients from Gorgan, Iran, with a mean age of 36.3 years and mean body mass index (BMI) of 42.6 kg/m(2) (35.3-62.4). Through a four-port approach, the greater omentum and short gastric vessels were transected and the greater curvature was imbricated into the body of the stomach with two rows of nonabsorbable sutures. After surgery, all patients were scheduled to attend a weekly group meeting for behavioral modification and psychotherapy. The mean operative time and hospital stay was 95 min and 72 h, respectively. No intraoperative complications occurred. Mean percentages of excess weight loss (%EWL) were 25.6 %, 54.2 %, 70.2 %, and 74.4 % after 1, 6, 12, and 24 months, respectively. Six patients lost >84 % of their excess weight after 24 months. Patients who did not participate in the group meetings had a lower %EWL after 12 (79.5 % vs. 55.6 %) and 24 months (90 % vs. 43.4 %) compared with the patients who regularly participated in the group meetings (P < 0.005). LGP is a feasible, safe, and effective surgical method for weight loss for at least 24 months when performed on morbidly obese patients. Postoperative group meetings (POGM) for psychotherapy and behavioral modification helped patients to achieve better results.

Gastric plication for morbid obesity: a systematic review

BACKGROUND

Gastric plication is a new bariatric procedure. Controversies exist regarding this emerging surgery. We herein present a comprehensive review of the literature regarding gastric plication approach.

METHODS

Advanced Pub Med search combining the MeSH terms "Gastric plication", OR "Gastric greater curvature plication" yielded 213 abstracts. Abstracts were screened for articles in English and articles on human subjects yielding 130. Further searches revealed 121 titles to be unrelated to gastric plication. The remaining nine abstracts were analyzed for their full texts. Two articles were excluded because, one was a commentary on another article, and the other was a released ASMBS policy on gastric plication. In the end, there were seven articles published on gastric plication.

RESULTS

A total of 307 patients had undergone gastric plication. The mean operative time range was 40 to 150 min. The median length of hospital stay ranged between 1.3 and 1.9 days. In respect to excess weight loss (EWL), at 6 months, it ranged from 54 to 51 %, while at 12 months 67-53.4 %. The longest follow-up was 3 years with a mean of 57 % EWL.

CONCLUSION

Laparoscopic gastric plication is still in its infancy. Prospective randomized studies comparing gastric plication to other well established bariatric procedures are needed to prove the reliability and metabolic effectiveness of such new procedure.

Laparoscopic greater curvature plication (LGCP) for treatment of morbid obesity in a series of 244 patients

BACKGROUND

Laparoscopic greater curvature plication (LGCP) is a new metabolic/bariatric surgical procedure that requires no resection, bypass, or implantable device. We report LGCP outcomes in 244 morbidly obese patients.

METHODS

Between 2010 and 2011, patients underwent LGCP. Body mass index (BMI, kilogram per square meter) evolution, excess BMI loss (%EBMIL), excess weight loss (%EWL), complications, and type 2 diabetes mellitus (T2DM) changes were recorded. Repeated-measures analysis of variance (ANOVA) was used to assess weight change at 6, 12, and 18 months. Subgroup analyses were conducted to provide benchmark outcomes at 6 months. Logistic regression was used to identify characteristics predictive of suboptimal weight loss.

RESULTS

Mean baseline BMI (±SD) was 41.4 ± 5.5 (80.7 % women, mean age 46.1 ± 11.0 years, 68 [27.9 %] patients had T2DM). Mean operative time was 70.6 min; mean hospitalization, 36 h (24-72). Sixty-eight patients (27.9 %) experienced postoperative nausea and/or vomiting that was controlled within 36 h. There was no mortality. Major complication rate was 1.2 % (n = 3). Repeated-measures ANOVA indicated significant weight loss across time points (p < 0.001). At 6 months (n = 105), BMI, %EBMIL, and %EWL were 36.1 ± 4.7, 34.8 ± 17.3, and 31.8 ± 15.9. Preoperative BMI was the only predictor of weight loss. Patients with BMI <40 lost more weight than those ≥40, although by 9 months, differences were no longer significant. In patients with preoperative BMI <40, 18-month %EWL approached 50 % and %EBMIL exceeded 50 %. At 6 months, 96.9 % of patients' T2DM was significantly improved/resolved.

CONCLUSIONS

Over the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.

Laparoscopic gastric greater curvature plication: results and complications in a series of 135 patients

Laparoscopic gastric greater curvature plication (LGGCP) is an emerging restrictive bariatric procedure that successfully reduces the gastric volume by plication of the gastric greater curvature. Its main advantages are the reversibility of the technique as well as the lack of foreign materials or gastrectomy. We present our results, focusing on the effectiveness and complications, and on a new modification of the original technique. One hundred and thirty-five patients underwent LGGCP between April 2008 and December 2009. A five-trocar port technique was used, and following dissection of the greater gastric curvature, single plication of the latter was performed under the guidance of a 36-Fr bougie. Modification of the technique included multiple gastric plications. One hundred and four obese women and 31 obese men (mean age of 36 years) underwent LGGCP for weight reduction. Operative time was 40-50 min, and mean hospital stay was 1.9 days (range 1-6 days). After a follow-up of 8-31 months (mean 22.59), the mean percentage of excess weight loss (%EWL) was 65.29. Subgroup analyses based on BMI values showed that %EWL was significantly higher for patients with BMI < 45 kg/m² (group I) compared with patients with BMI > 45 kg/m² (group II) (69.86 vs 55.49, respectively, p = 0.006). Similarly, inadequate weight loss was significantly higher for group II, while the failure of the technique and postoperative complications were comparable. On the other hand, subgroup analysis based on the technique showed that the modification of the technique did not affect the effectiveness or the operative time; however, it reduced early complications dramatically, including prolonged postoperative vomiting and late gastric obstruction, thus affecting the length of hospitalization. Overall complication rate in our series was 8.8% (12/135). Cases of prolonged postoperative vomiting, GI bleeding, and leak were treated conservatively, while one case of portomesenteric thrombosis and three cases of acute gastric obstruction were treated surgically. LGGCP is an emerging technique sparing gastric resection, the use of foreign materials and intestinal bypass. Its effectiveness is satisfactory for patients with BMI < 45 kg/m², and the complication rate is acceptable.

An update on less invasive and endoscopic techniques mimicking the effect of bariatric surgery

Obesity (BMI 30-35 kg/m(2)) and its associated disorders such as type 2 diabetes, nonalcoholic fatty liver disease, and cardiovascular disease have reached pandemic proportions worldwide. For the morbidly obese population (BMI 35-50 kg/m(2)), bariatric surgery has proven to be the most effective treatment to achieve significant and sustained weight loss, with concomitant positive effects on the metabolic syndrome. However, only a minor percentage of eligible candidates are treated by means of bariatric surgery. In addition, the expanding obesity epidemic consists mostly of relatively less obese patients who are not (yet) eligible for bariatric surgery. Hence, less invasive techniques and devices are rapidly being developed. These novel entities mimic several aspects of bariatric surgery either by gastric restriction (gastric balloons, gastric plication), by influencing gastric function (gastric botulinum injections, gastric pacing, and vagal nerve stimulation), or by partial exclusion of the small intestine (duodenal-jejunal sleeve). In the last decade, several novel less invasive techniques have been introduced and some have been abandoned again. The aim of this paper is to discuss the safety, efficacy, complications, reversibility, and long-term results of these latest developments in the treatment of obesity.

[Laparoscopic Gastric Plication: a new surgery for the treatment of morbid obesity]

INTRODUCTION

Laparoscopic Gastric Plication is a new technique derived from sleeve gastrectomy. Plication of the greater curvature produces a restrictive mechanism that causes weight loss. The results of the first cases where this technique has been applied in this hospital are presented.

METHODS

A review was made of patients operated on in our hospital between November 2009 and December 2010. Plication of the gastric greater curvature was performed under general anaesthetic and by laparoscopy using 3 lines of sutures and with an orogastric probe as a guide. The results of the morbidity, mortality and weight loss are presented.

RESULTS

A total of 13 patients were operated on (7 women). The maximum body mass index (BMI) varied between 37.11 kg/m² and 51.22 kg/m² at the time of the operation. The most frequently found morbidity was nausea and vomiting. Two patients required further surgery due intractable vomiting and total dysphagia; in one the plication unfolded, and in the second it was converted into vertical gastrectomy.

CONCLUSIONS

Laparoscopic Gastric Plication is a new surgical technique which gives equivalent short-term results as vertical gastrectomy. It is a reproducible and reversible technique with results and indications still to be validated.

Laparoscopic greater curvature plication: initial results of an alternative restrictive bariatric procedure

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/m(2) (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.