Prospective Trial Comparing Laparoscopic Gastric Banding With Plication Versus Laparoscopic Gastric Banding Alone.

Arif Ahmad, MD, FACS, FRCS, Ashish Agarwala, DO, Zoha Ahmad, Jason Arellano, MD, Anna Marie Braslow, RN, BS, EMBA, CCRN, CBN, Lisa Messineo, RD, CDN. JOHN T. MATHER MEMORIAL HOSPITAL

Background:

The concept of combining Gastric Plication to banding arose from the expectation that this would enhance the weight loss by introducing an additional element of gastric restriction as well as provide hormonal effects similar to Sleeve Gastrectomy. The present study conducted under IRB approval examines the outcomes of 100 consecutive Laparoscopic Banded Gastric Plication (LBGP) and Laparoscopic Adjustable Gastric band (LAGP) patients in a prospective trial. We studied %EWL, # of band adjustments, operative time and complications.

Methods:

99 consecutive LBGP and 95 LAGB patients were studied prospectively from August 2011 to April 2014. LBGP group consisted of 24 males and 75 females with a mean age of 42 and mean initial BMI of 44.2. LAGB group consisted of 36 males and 59 females with a mean age of 42 and mean initial BMI of 44.7. The data was collected at 3 months, 6 months, and 12 months interval. Data collected included %EWL, mean operative time, # of band fills, and complications. Follow up was performed by surgeons and registered dieticians.

Results:

Mean % EWL is significantly higher in the LBGP group as compared to LAGB at 3 months (29.0% vs. 24.5%, p<0.05) and 6 months (36.6% vs. 30.0%, p<0.05) and 12 months (41.7% vs. 35.8%, p<0.05). LBGP group received a mean of 3.0 band fills at 12 months. LAGB group received a mean of 3.9 fills at 12 months. Number of band fills was significantly lower in the LBGP group at 12 months (3.0 vs. 3.9, P<0.05). Mean operative time was 92 minutes for LBGP and 57 minutes for LAGB. In the LAGB group, 2 bands were removed due to patient’s wishes and 2 bands were replaced due to slippage. In the LBGP group 2 bands were removed due to patient’s wishes and there were no slips. There was no 30 day mortality in either group.

Conclusion:

The addition of plication to adjustable banding results in significantly increased %EWL at 3, 6, and 12 months. There is significantly reduced slippage in the LBGP group. LBGP group needed significantly less band adjustment. There is significantly increased operative time in the LBGP group. There is no difference in peri operative complications.