Laparoscopic Gastric Greater Curvature Plication: Results and Complications in a Series of 135 Patients

Abstract

Laparoscopic gastric greater curvature plication (LGGCP) is an emerging restrictive bariatric procedure that successfully reduces the gastric volume by plication of the gastric greater curvature. Its main advantages are the reversibility of the technique as well as the lack of foreign materials or gastrectomy. We present our results, focusing on the effectiveness and complications, and on a new modification of the original technique. One hundred and thirty-five patients underwent LGGCP between April 2008 and December 2009. A five-trocar port technique was used, and following dissection of the greater gastric curvature, single plication of the latter was performed under the guidance of a 36-Fr bougie. Modification of the technique included multiple gastric plications. One hundred and four obese women and 31 obese men (mean age of 36years) underwent LGGCP for weight reduction. Operative time was 40-50min, and mean hospital stay was 1.9days (range 1-6days). After a follow-up of 8-31months (mean 22.59), the mean percentage of excess weight loss (%EWL) was 65.29. Subgroup analyses based on BMI values showed that %EWL was significantly higher for patients with BMI < 45kg/m² (group I) compared with patients with BMI > 45kg/m² (group II) (69.86 vs 55.49, respectively, p = 0.006). Similarly, inadequate weight loss was significantly higher for group II, while the failure of the technique and postoperative complications were comparable. On the other hand, subgroup analysis based on the technique showed that the modification of the technique did not affect the effectiveness or the operative time; however, it reduced early complications dramatically, including prolonged postoperative vomiting and late gastric obstruction, thus affecting the length of hospitalization. Overall complication rate in our series was 8.8% (12/135). Cases of prolonged postoperative vomiting, GI bleeding, and leak were treated conservatively, while one case of portomesenteric thrombosis and three cases of acute gastric obstruction were treated surgically. LGGCP is an emerging technique sparing gastric resection, the use of foreign materials and intestinal bypass. Its effectiveness is satisfactory for patients with BMI < 45kg/m², and the complication rate is acceptable.