Laparoscopic vertical gastric plication as an alternative to sleeve gastrectomy: comparison of postoperative complications and short term outcome. A case control study.

Elie K Chouillard, MD, PhD, Naim Schoucair, MD, Elias Chahine, MD. Paris Poissy Medical Center

Backgroud: Obesity is a major public health problem. Surgery is considered the best treatment for morbid obesity. Laparoscopic sleeve gastrectomy (LSG) is nowadays the most commonly performed bariatric procedure in France. However, newer surgical and endoscopic techniques are emerging. Among these, laparoscopic vertical gastric plication (LVGP) is presented as an alternative for LSG with theoretical advantages including mainly lower postoperative morbidity, higher efficiency, and reversibility. Moreover, published results in terms of weight loss suggest that LSG and LVGP are comparable, at least upon short and mid-term follow-up. The goal of our retrospective, case-control study is to compare early morbidity and mortality as well as short term outcome in two groups of patients with morbid obesity who had LVGP or LSG, respectively.

Methods: In January 2010, we started performing LVGP in patients with morbid obesity. The first 50 procedures were considered as part of the learning and excluded from analysis. From March 2011 to January 2012, 40 consecutive patients had LVGP (Group I) for morbid obesity. During the same period, 280 patients had LSG. Of these, 40 (Group II) were matched with Group I patients according to age, sex, and body mass index (BMI). The primary endpoint was morbidity and mortality rates. Secondary endpoints included operative time, hospital stay, cost, and 6-months and 12-months percentage of excess weight loss (EWL) as well as the outcome of associated comorbidities.

Results: No postoperative mortality was observed in either group. One patient in each groups had postoperative bleeding with conservative management. No reoperation was needed. Overall morbidity rate (including nausea and vomiting) reached 20 % in Group I and 10 % in Group II (P=0.04). The most common complication was nausea occurring in 20 % of patients in Group I and 5 % of patients in Group II, respectively (P<0.001). No clinical or radiological leak occurred. Mean operative time was 91.5 +/- 18.6 min in Group I and 81 min +/- 16.8 min in Group II (P=0.104). Mean hospital stay was 3.2 +/- 1.1 days in Group I and 3.4 +/- 1.2 days Group II (P=0.614). Average total Operating Room (OR) cost was 1736 euros for LVGP compared to 2842 euros for LSG (P<0.001). At 6-months follow-up, comorbidities including hypertension and sleep apnea improved identically in both groups. At 12-months follow-up, mean EWL was 56.5 % +/- 9.8 % in Group I and 71.3 % +/- 10.4 in Group II (P=0.041).

Conclusion: LVGP is a sure and feasible bariatric procedure with low rates of serious complications. As compared to LSG, LVGP is associated to relatively higher postoperative rate of nausea. As for direct OR cost, LVGP is more efficient than LSG, saving more than 1000 euros per procedure. However, LVGP is associated to lower EWL at 12-months follow-up (P=0.041). Additional prospective comparative studies with longer term follow-up data are required.

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