Nathan Roberts, MD, Matthew Musielak, MD, Lisa Longshore, CNP, Trace Curry, MD. Jewish Hospital
With an estimated 15 million Americans morbidly obese and the numbers growing, bariatric surgery’s role will continue. The primary mechanisms through which bariatric surgery achieves its outcomes are through the mechanical restriction of food intake, reduction in the absorption of ingested foods, or a combination of both. In addition to these malabsorptive and restrictive mechanisms, hormonal changes also play a role. Roux-en-Y Gastric Bypass (RYGB) and Vertical sleeve gastrectomy (VSG) are approaches commonly used in bariatric practice. Although these procedures have proven to be good therapeutic options for some patients, they are not without complications. Laparoscopic greater curvature plication (LGCP) offers a restrictive procedure similar to VSG, with the potential of fewer complications.
Methods & Procedure:
A retrospective review was performed on patients undergoing (LGCP) from March 2011 – December 2011. A two layer plication was performed. The initial plication row was created starting 2 cm distal to the gastro esophageal junction taking seromuscular bites with 2-0 silk suture spaced 2 cm apart ending 5 cm proximal to the pylorus. The second plication was created over a 40 F Bougie using a running 2-0 Prolene. Repairs were inspected and a tension free plication ensured. Postoperative visits assed complications, weight loss and overall satisfaction with their results.
A total of 11 female patients underwent (LGCP) with an average age of 41 and BMI of 39. One patient was excluded as they never returned for follow up. A second patient was included for 1 month follow up, however due to the fact of leaving the country they were lost to long term follow up. Overall we had an 18% loss of long term follow up. Zero patients required reoperation and there was zero thirty day morbidity or mortality. Average hospital stay was 24-36 hrs. At 1 month follow up the average excess weight loss (%EWL) was 17.3 (12.8-35.1). At 3 month follow up the average %EWL was 19.5 and at 36 months the average %EWL was 39.5. The most common complaints were nausea, reflux and epigastric pain, all self-resolving.
In recent years there has been an increasing trend in the number of VSG performed. LGCP promotes weight loss via a restrictive approach in a similar fashion to VSG without resection or creation of a staple line. VSG as a primary bariatric procedure shows comparable results to RYGB in regards to weight loss, with improvements in comorbidities. These results are not without associated risks; wound infections, leak, stricture, re-operation or mortality. LGCP is notably similar to VSG in that it generates a gastric tube, but does so without gastric resection and with a reduced risk profile. In our series LGCP provided an average %EWL of 39.5 at 3 year follow up without associated morbidity. Although relatively new in its surgical life in the United States, LGCP offers an alternative restrictive procedure. Further randomized trials will be needed for adequate assessment and comparison to current bariatric techniques.