LAPAROSCOPIC GREATER CURVATURE PLICATION IN

MORBID OBESITY

LGCP Restrictive bariatric procedure similar to

vertical sleeve gastrectomy without the need for gastric resection

Reducing risks of complications associated with a permanent implant, such as a gastric band

Minimizing the possibility of leaks from staple lines

the procedure

the stomach’s volume is reduced by dissecting the greater omentum and short gastric vessels, as in VSG

and the greater curvature is invaginated using multiple rows of non-absorbable sutures performed over a bougie or endoscope to ensure a patent lumen.1

Restrictive operation

ADVANTAGE Laparoscopic Conservative Low price Reversible Volume residue: 50 cc EWL: 60% during 6 month Unrelated to technique morbidity: 2% Reoperation: 2% Regain: (10.9%) reoperation with different methods Safe alternative between restrictive operations

RESULT OF METHOD False positive sense of thirsty

Effective volume of stomach: 50 cc

Pain or reflux secondary to more intake

Gradually dilation of remnant volume (2 to 4 years) 50 cc to 200 cc

Psychological control to continue diet

Early results demonstrate that LGCP , a bariatric weight loss procedure, may

have a potentially lower risk profile than other bariatric procedures.1,2,3 Additional studies are needed to assess long-term efficacy.

  1Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: Initial Results of

an Alternative Restrictive Bariatric Procedure. Obes Surg 2010; 20 (7): 913-918. [DSL 10-1229]   2Brethauer SA, Harris JL, Kroh

M et al. Laparoscopic gastric plication for the treatment of severe obesity. Surgery for Obesity and Related Diseases May 2010:6 (3):S16. [DSL-10-0550]

3Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc A

dv Surg Tech A 2007;17(6):793–8. [DSL 09-1251]

 

Has the same result of weight loss as others

Invasiveness of methods

METHOD EFFECTIVE TIME RESULT

Diet & Exercise Permanent <10% EFF

Intra gastric balloon 2 to 6 months 15% EWL, Intolerance in 30%

TVGP 4 years 63% EWL, 2% Complication

GB 4 years 65% EWL, 10-20% Complication, 1% Mortality

GBP 5-7 years 70% EWL, 15% Complication, 1% Mortality

IJB Long term 80% EWL, 1.5% Mortality, 25% Complication

DSB Permanent 85% EWL, 2.5% Mortality,33% Complication

7 YEARS OUTCOME OF TVGP

EWL% NOMBER OF CASES DURATION

60 197 6 MONTHS

64 151 1 YEAR

62 110 2 YEARS

59 68 3 YEARS

56 40 4 YEARS

55 27 5 YEARS

52 17 6 YEARS

50 8 7 YEARS

Obesity surgery Volume20, Number 7, 913-918, DOI: 10.1007/s11695-010-0132-0

Results   All procedures were completed laparoscopically. Mean operative time was 50 min and mean hospital stay was 36 h. Patients returned to their regular activities at an average of 7 days

following surgery. No intra-operative complications occurred. All patients experienced excess weight loss (EWL) of at least 20%

after 1 month. Mean EWL was 62% (45% to 77%) in nine patients after 18 months.

There has been no record of weight regain in any patient to date.

Conclusions   LGCP is feasible, safe, and effective for at least 18 months when

performed on morbidly obese patients. Longer follow-up and prospective comparative trials are needed.

Laparoscopic view

Endoscopic view

Patent lumen after LGCP

Publications

Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure. Obes Surg 2010; 20 (7):913-918. [DSL 10-1229]

Brethauer SA, Harris JL, Kroh M et al. Laparoscopic gastric plication for the treatment of severe obesity. Surgery for Obesity and Related Diseases May 2010:6(3):S16. [DSL 10-0550]

Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A 2007;17(6):793–8. [DSL 09-1251]

Brethauer SA, Harris JL, Chand B, Kroh M, Rogula T, Schauer PR. Initial results of vertical gastric plication for severe obesity. Society of American Gastrointestinal and Endoscopic Surgeons. Phoenix, Arizona. April 22-25, 2009. [DSL 09-1253]

Brethauer S. Gastric Plication as a Bariatric Procedure. Minimally Invasive Surgery Symposium. San Diego, CA. Feb 22-27, 2010. [DSL 10-0256]

Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: An Alternative Restrictive Bariatric Procedure. Bariatric Times. Bariatric Times. May 2010;7(5):8–10.