Elsevier

Surgery for Obesity and Related Diseases

Volume 7, Issue 1, January–February 2011, Pages 15-22
Surgery for Obesity and Related Diseases

Original article
Laparoscopic gastric plication for treatment of severe obesity

https://doi.org/10.1016/j.soard.2010.09.023Get rights and content

Abstract

Background

Current gastric restrictive procedures include either a prosthetic device or gastric resection. We present the results of a feasibility study using laparoscopic gastric plication for weight loss achieved without stapling or banding.

Methods

After institutional review board approval, 2 methods were used to achieve laparoscopic gastric volume reduction. In the first group (anterior plication [AP]), the anterior gastric wall was folded inward from the fundus to the antrum using 2 rows of running sutures. The greater and lesser curvatures were approximated to create an intraluminal fold of the stomach. In the second group (greater curvature plication [GCP]), the short gastric vessels were divided, and the greater curvature was folded inward, with 2 suture lines to reduce the gastric capacity by a large intraluminal gastric fold.

Results

The average preoperative body mass index was 43.3 kg/m2 (range 36.9–49.0), and 3 patients were men. Of the 15 patients, 9 underwent AP. For the 9 patients who underwent AP, the 6- and 12-month endoscopic evaluations demonstrated comparable-size plications over time, except for in 1 patient, who had a partially disrupted fold. Of the 6 patients who underwent GCP, the 6- and 12-month follow-up endoscopic examinations demonstrated a durable intraluminal fold, except for in 1 patient, with a partial disruption at the distal fold owing to a broken suture. For patients completing 1 year of follow-up, the percentage of excess weight loss was 23.3% ± 24.8% in the AP group (n = 5) and 53.4% ± 22.7% in the GCP group (n = 6). No bleeding or infectious complications developed. The first patient in the GCP group required reoperation and plication reduction owing to gastric obstruction.

Conclusion

Our initial experience has suggested that a reduction in gastric capacity can be achieved by way of plication of the anterior stomach and greater curvature. The early weight loss results have been encouraging, with better weight loss in patients who underwent GCP. The use of laparoscopic GCP warrants additional investigation as a primary bariatric procedure.

Section snippets

Methods

The present study was a prospective, nonrandomized feasibility study of 2 gastric plication techniques. The institutional review board approved the present study, and the patients were screened and recruited for enrollment from our standard outpatient population. The study was registered with www.clinicaltrials.gov (clinicaltrials.gov identifier NCT00721227) before patient enrollment. The consent process was conducted by a research nurse coordinator assigned to the study full time and

Results

A total of 15 patients (3 men) were enrolled in the present study. Their mean age was 42 years (range 26–58), and the average preoperative BMI was 43.3 ± 4.1 kg/m2 (range 36.9–49.0). No significant differences were present in age or BMI between the AP and GCP groups.

The mean procedure duration for the AP group was 89 minutes (range 68–147). Of the 9 patients in the AP group, 2 required 3 rows of sutures to complete the procedure and 7 required 2 rows of sutures to complete the procedure.

The

Discussion

The field of bariatric surgery is continually evolving. Since the introduction of surgical procedures to induce weight loss, many different operations have been tried and abandoned owing to the poor long-term weight loss and/or metabolic or mechanical complications. During the past decade, the use of sleeve gastrectomy has gained popularity, and it has become widely accepted as a primary bariatric operation, as well as a first-stage operation for high-risk patients. Five-year data are now

Conclusion

Our initial experience has suggested that a reduction in gastric capacity can be achieved using plication of either the anterior stomach or greater curvature. The early weight loss results were encouraging, with better weight loss for the patients who underwent GCP. GCP is promising from a risk/benefit standpoint and warrants additional investigation. A multicenter prospective trial is ongoing.

Disclosures

S. A. Brethauer, M. Kroh, and P. R. Schauer are consultants and speakers for Ethicon Endo-Surgery, and J. L. Harris is an engineer for Ethicon Endo-Surgery and contributed to the protocol and technique development and data analysis.

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Funded by Ethicon Endo-Surgery, Cincinnati, Ohio.

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