Transcript Laparoscopic Total Gastric Vertical 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
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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
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Restrictive operation
ADVANTAGE
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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
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False positive sense of thirsty
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Effective volume of stomach: 50 cc
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Pain or reflux secondary to more intake
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Gradually dilation of remnant volume (2
to 4 years) 50 cc to 200 cc
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Psychological control to continue diet
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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]
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2Brethauer
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3Talebpour
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]
M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc A
Surg Tech A 2007;17(6):793–8. [DSL 09-1251]
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dv
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
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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.