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Noel P, Olmi S, Gentileschi P, Caiazzo R, Marciniak C, Pintado DGM, Ungson G, Alarcon V, Carandina S, Manos T, Shamoun JM, Zundel N, Lutfi RE, Ponce J, Nedelcu M. Classification of Slippage Following Laparoscopic BariClip Gastroplasty. Obes Surg 2023; 33:3317-3322. [PMID: 37608121 DOI: 10.1007/s11695-023-06780-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2023] [Revised: 08/01/2023] [Accepted: 08/10/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy proposed to minimize the risk of severe complications. Still one of the possible complications described with LBCG is slippage. The purpose of the current manuscript is to analyze different cases of slippage and propose a classification of this complication. METHODS A number of 381 patients who underwent LBCG in 8 different centers were analyzed concerning the risk of slippage. All cases with documented slippage were carefully reviewed in terms of patients' symptomatology (presence of satiety, vomiting), history of weight loss, radiological data, and management of their slippage. A new classification was proposed depending on the anatomy, the symptomatology, and the time of occurrence. RESULTS We have identified a total of 17 cases (4.46%) of slippage following LBCG. In 11 patients, the slippage was symptomatic with repetitive vomiting and nausea, and in the remaining 6 patients, the slippage was identified by radiological studies for insufficient weight loss, weight regain, or routine radiological follow-up. Depending on the interval time, the slippage was classified as either immediate (in first 7 days) in 6 cases, early (in less than 90 days) in 4 cases, and late (after 3 months) in 7 cases. Evaluation of the radiological studies in these cases identified the following: anterosuperior displacement (type A) in 9 cases, posteroinferior displacement (type B) in 6 cases (one case after 3 months), and lateral displacement (type C) in the remaining 2 cases. The management of the slippage consisted of BariClip removal in 7 cases, repositioning in 5 cases, and conservative treatment in the remaining 5 cases. All patients with conservative treatment were recorded at the beginning of the experience. CONCLUSIONS Slippage is a possible complication after LBCG. This classification of the different types of slippage can benefit the surgeon in the management and treatment of this complication of LBCG.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai, UAE
- ELSAN, Clinique Bouchard, Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Stefano Olmi
- Policlinico San Marco, Rio Isolo, Zingonia, Italy
| | | | - Robert Caiazzo
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | - Camille Marciniak
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | | | - John M Shamoun
- Hoag Memorial Hospital Presbyterian, Newport Beach, CA, USA
| | - Natan Zundel
- University at Buffalo, NY, Jackson North Medical Center, Miami, USA
| | | | | | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Marseille, France.
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France.
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Arcudi C, Sensi B, Alicata F, Siragusa L, Procaccini C, Pavoncello D, Zobel LB, Bianciardi E, Gentileschi P. Surgical Technique for Robotic-Assisted Laparoscopic Vertical Clip Gastroplasty (LVCG). Obes Surg 2023; 33:1314-1316. [PMID: 36826679 DOI: 10.1007/s11695-023-06507-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 02/04/2023] [Accepted: 02/07/2023] [Indexed: 02/25/2023]
Affiliation(s)
- Claudio Arcudi
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
| | - Bruno Sensi
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Federica Alicata
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy.
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy.
| | - Leandro Siragusa
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Chiara Procaccini
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - David Pavoncello
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Lorenza Beomonte Zobel
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
| | - Emanuela Bianciardi
- Department of Systems Medicine, Psychiatric Chair, University of Rome Tor Vergata, 00133, Via Montpellier, 1, 81-0133, Rome, Italy
| | - Paolo Gentileschi
- Bariatric and Metabolic Sugery, San Caro di Nancy Hospital, Via Aurelia, 275-00165, Rome, Italy
- Department of Surgery, Università Degli Studi Roma "Tor Vergata", Via Montpellier, 1 - 00133, Rome, Italy
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Noel P, Nedelcu M, Olmi S, Gentileschi P, Caiazzo R, Pintado DGM, Garza MG, Roberto R, Abualsel A, Marchesini C, Boza C, Ungson G, Alarcon V, Carandina S, Zundel N, Ponce J, Lutfi RE. Evolving Technique of Laparoscopic Vertical Gastric Clip Placement. Obes Surg 2023; 33:1012-1016. [PMID: 36754925 DOI: 10.1007/s11695-023-06492-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Revised: 01/22/2023] [Accepted: 01/30/2023] [Indexed: 02/10/2023]
Abstract
INTRODUCTION Laparoscopic BariClip gastroplasty (LBCG) will address a similar tubular restriction than the one achieved with the laparoscopic sleeve gastrectomy (LSG) at the level of the gastric fundus, while maintaining the advantage of simplicity and anatomic preservation. The purpose of the current study was to analyze the risk of slippage and to present the evolving technique by adding gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" between the limbs of the clip. METHODS All patients undergoing LBCG with the evolving technique of gastric plication around the device associated with antral gastroplasty from January 2021 to May 2022 were included in the study group (group A). A control group (group B) was designed with patients who underwent previous LBCG technique between May 2017 and June 2019. This is a case-controlled group with patients matched by gender and BMI. We have analyzed the postoperative complications and more notably the slippage. RESULTS One hundred seventy-six patients (44 male and 132 female) with a mean age of 33 years (± 11) underwent evolving technique of LBCG. A control group of 67 patients who underwent previous technique of LBCG was included. All procedures were completed by laparoscopy with no intraoperative complication. For the study group, we have recorded a number of 5 slippages (2.8%). The diagnosis occurred during the first 6 months after the operation. The management consisted of repositioning-3 cases-and BariClip removal-2 cases. For the control group, we have recorded a number of 3 slippages (4.3%). All three patients underwent BariClip removal, with no repositioning. CONCLUSIONS We reported a new technique of placement of the BariClip with additional gastric plication anterior, posterior, and volume reduction in the antrum to potentially reduce the rate of slippage and improve weight loss outcomes.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai, UAE.
- ELSAN, Clinique Bouchard, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France.
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, Clinique Bouchard, 77 Rue de Dr. Escat, 13006, Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Stefano Olmi
- Policlinico San Marco Zingonia, Vita E Salute San Raffaele University Milan, Milan, Italy
| | - Paolo Gentileschi
- San Carlo of Nancy Hospital, University of Rome Tor Vergata, Rome, Italy
| | - Robert Caiazzo
- Endocrine and General Surgery Department, Lille University Hospital, Lille, France
| | | | | | | | | | | | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
| | - Natan Zundel
- University at Buffalo, Buffalo, NY, USA
- Jackson North Medical Center, Miami, USA
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Safety and Efficacy of Laparoscopic Vertical Clip Gastroplasty: Early Results of an Italian Multicenter Study. Obes Surg 2023; 33:303-312. [PMID: 36459357 DOI: 10.1007/s11695-022-06364-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 10/28/2022] [Accepted: 11/18/2022] [Indexed: 12/03/2022]
Abstract
PURPOSE Sleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip. MATERIALS AND METHODS Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution. RESULTS Patients had a mean age of 44 years and mean BMI of 37 kg/m2 ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases. CONCLUSION The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG.
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Noel P, Layani L, Manos T, Adala M, Carandina S, Nedelcu A, Nedelcu M. The Reflux and BariClip: Initial Results and Mechanism of Action. J Clin Med 2022; 11:jcm11226698. [PMID: 36431175 PMCID: PMC9696891 DOI: 10.3390/jcm11226698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Revised: 11/07/2022] [Accepted: 11/07/2022] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION Laparoscopic BariClip Gastroplasty (LBCG) represents a new bariatric procedure that mimics the principle of the Laparoscopic Sleeve Gastrectomy (LSG), but using a completely reversible mechanism, which is essential for gastroesophageal reflux disease (GERD). The purpose of our study was to evaluate the evolution of GERD following the initial experience with LBCG. METHODS The first 43 obese patients who underwent LBCG performed by the same surgeon in two different medical centers in May 2018-December 2019 were included in the current study. Twelve patients had issues of reflux, regularly receiving PPIs (proton pump inhibitors) treatment in eight cases, and occasionally in four cases. Thirty-two patients completed the follow-up at one year and the GERD was evaluated using the PPI medications and the GerdQ. RESULTS The median preoperative GerdQ score was (14.58 ± 1.9). Three patients out of the twelve who had complained about preoperative GERD did not consent to the one year follow-up form. For the rest of nine patients, the median post-operative GerdQ score was (10.11 ± 3.2). The PPIs were used at one year follow-up in six patients: four with occasional use, one patient with regular use showing no improvement, and one who experienced de novo GERD symptomatology (3.1%). No statistically significant difference between the groups was recorded in terms of GERD. We recorded no intraoperative complications. No case of erosion occurred in the post-operative period, but we encountered two cases of slippage. One additional BariClip was removed at 14 months. CONCLUSION LBCG represents a new bariatric procedure that mimics the principle of the laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. Even with limited cases, our experience reports several mechanisms of action that will be evaluated and discussed in further prospective clinical trials. After this preliminary clinical study, LBCG's effects on GERD and its safety are highly encouraging.
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Affiliation(s)
- Patrick Noel
- Emirates Specialty Hospital, Dubai 505240, United Arab Emirates
- Mediclinic Airport Road Hospital, Abu Dhabi 48481, United Arab Emirates
- ELSAN, Clinique Bouchard, 13000 Marseille, France
| | | | | | | | - Sergio Carandina
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83100 Toulon, France
| | - Anamaria Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83100 Toulon, France
| | - Marius Nedelcu
- ELSAN, Clinique Bouchard, 13000 Marseille, France
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l’Óbesite, 83100 Toulon, France
- Correspondence: ; Tel.: +33-695-950-965
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Wang Y, Kassab GS. Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices. Front Physiol 2021; 12:761481. [PMID: 34777019 PMCID: PMC8585502 DOI: 10.3389/fphys.2021.761481] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 10/07/2021] [Indexed: 12/27/2022] Open
Abstract
Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.
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Affiliation(s)
- Yanmin Wang
- California Medical Innovations Institute, San Diego, CA, United States
| | - Ghassan S Kassab
- California Medical Innovations Institute, San Diego, CA, United States
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Patrick Noel, FACS, FASMBS, Mediclinic Middle East, Dubai. Obes Surg 2021; 31:2357-2358. [PMID: 33880745 DOI: 10.1007/s11695-021-05425-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Abstract
Having the advantages of the reversibility by clipping and not cutting the stomach, the BariClip procedure reproduces the effect of the SG [1, 2] without adding the risk of leaks, and minimizes the occurrence of postoperative GERD by decreasing the intragastric pressure [3]. We present an edited video on the placement of a BariClip with the main steps of the procedure for a female patient with a BMI 41 kg/sqm. A 36 F bougie is placed to calibrate the size of the pouch. Using a laparoscopic approach, the BariClip is placed into the peritoneal cavity through a 12 mm trocar. The BariClip is then closed around the stomach parallel to the lesser curvature, creating a small medial pouch and an excluded large lateral segment. To prevent slippage (rate is approximately 3%), the BariClip is sutured to the gastric wall both anteriorly and posteriorly at various levels of the stomach, as shown in the video. Despite the possibility to suture on either side of the BariClip, the left indentations are preferred in order to avoid vessels of the lesser curvature which are closer to the right indentations. The recovery was uneventful, and 4 h after the surgery, the patient was tolerating liquids. She was discharged the following day with a prescription of PPI (pantoprazole 40 mg) for 30 days and of clexane 0.4 IM for 5 days. As with most bariatric procedures, she was started on 2 weeks of liquids, followed by 2 weeks of soft diet, before experiencing solid food. At 1 month after surgery, the patient had lost 10% of her TBW, and at 1-year follow-up, she had lost 31% of her TBW. She had no reflux, pain, or any other complaints and was very happy. The closing of the BariClip has been designed to be a low-pressure system, and in addition, it has a wide inferior outlet (2.5 cm), which does not create high intraluminal pressure. Both of these factors result in a low risk of erosion and of GERD. The rate of erosion in the original series was 1.3% with up to a 7-year history of implantation. The most common complication encountered at the beginning of our experience has been a slippage of the BariClip, and with the learning curve, this rate dropped to 3%. The QOL has been studied on a first series of patients and showed good results comparable with those given with the LSG and the RYGB [4]. In conclusion, the BariClip accomplishes almost similar weight loss as a SG, without a gastrectomy, without risks of leaks, and without causing reflux, and at the same ,time the BariClip is reversible [5].
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Affiliation(s)
- Patrick Noel
- Mediclinic Parkview Hospital, Dubai, United Arab Emirates. .,ELSAN, Clinique Bouchard, Marseille, France. .,Emirates Specialty Hospital, Dubai, United Arab Emirates.
| | - Imane Eddbali
- Emirates Specialty Hospital, Dubai, United Arab Emirates
| | - Marius Nedelcu
- ELSAN, Clinique Saint Michel, Centre Chirurgical de l'Obésité, Toulon, France
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de la Plaza Llamas R, Díaz Candelas DA, Ramia JM. Laparoscopic Removal of a Displaced Vertical Gastric Clip Causing Gastric Outlet Obstruction. Obes Surg 2020; 30:2856-2857. [PMID: 32314251 DOI: 10.1007/s11695-020-04606-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date. METHODS A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m2 underwent a laparoscopic calibrated tubular gastroplasty at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination: BMI 28.9 kg/m2, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located medially to the esophagogastric junction, the lesser curvature, and the antropyloric region. RESULTS A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no postoperative complications. CONCLUSION This video demonstrates a form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using a laparoscopic approach.
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Affiliation(s)
- Roberto de la Plaza Llamas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n., 19002, Guadalajara, Spain.
| | - Daniel A Díaz Candelas
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n., 19002, Guadalajara, Spain
| | - José M Ramia
- Department of General and Digestive Surgery, Hospital Universitario de Guadalajara, Calle Donante de sangre s/n., 19002, Guadalajara, Spain
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