Medium-term results of laparoscopic gastric plication for the treatment of obesity

Matthew J Davis, MD, Michael Mulcahy, MD, Deanne Nash, RN, Matthew Kroh, MD, Philip Schauer, MD, Ali Aminian, MD, Stacy Brethauer, MD. Cleveland Clinic

Background: Currently, sleeve gastrectomy (SG) is the most common bariatric surgery performed in the U.S., followed by Roux-en-Y gastric bypass (RYGB) and, to an increasingly smaller extent, adjustable gastric banding (AGB). However, not all patients are willing to undergo one of these procedures. Several years ago, gastric volume reduction via greater curvature plication was described by our group and was demonstrated to be both safe and with moderate efficacy in the short-term. The aim of this study is to report our medium-term experience with laparoscopic gastric volume reduction via plication.

Methods: All procedures were performed under an IRB approved protocol at a single academic center. 42 patients who were at least 1 year removed from laparoscopic gastric plication (LGP) were identified. Surgeries were performed between November 2008 and October 2012. Demographic characteristics, pre- and post-operative data, and outcomes were collected and analyzed.

Results: Mean age for the cohort was 41 ± 11 years. 81% of patients were female. Mean pre-operative BMI was 43 ± 4 kg/m² (range, 33 – 53). Mean operative time and estimated blood loss was 117 ± 35 minutes and 29 ± 50 cc, respectively.

At a mean follow-up of 42 ± 20 months (range, 12 – 76), patients had an average BMI decrease of 7.1 ± 4.8 kg/m². Percent excess body weight loss (%EWL) was 28 ± 21%. Percent total body weight loss (%TWL) was 14 ± 10%.

Post-operatively, there were 4 complications (9.5%). This included 1 leak, 2 gastric obstructions and 1 intra-abdominal abscess. 2 of these patients underwent reoperation in the early post-operative period. Of the total cohort, two patients subsequently underwent conversion for failed weight loss, one to SG and one to RYGB. There were no 30-day post-operative mortalities.

Conclusions: Gastric plication may be a reasonable alternative for some patients who are not interested in more standard procedures, but medium-term weight loss is generally insufficient for higher BMI patients.