Greater Curvature Plication Research Articles

Laparoscopic Gastric Fundectomy with Greater Curvature Plication: A Feasibility Study for Obese Patients

Laparoscopic Gastric Fundectomy with Greater Curvature Plication: A Feasibility Study for Obese Patients

Metabolic bariatric surgery as a therapeutic option for patients with type 2 diabetes: A meta-analysis and network meta-analysis of randomized controlled trials.

To compare different types of metabolic surgery with non-surgical therapy for the treatment of type 2 diabetes (T2D). The present network meta-analysis (NMA) includes randomized clinical trials (duration ≥ 52 weeks) comparing different surgery techniques with non-surgical therapy in diabetes patients. The primary endpoints were endpoint HbA1c, body mass index (BMI) and diabetes remission. The secondary endpoints included fasting plasma glucose, lipid profile, blood pressure, arterial hypertension and dyslipidaemia remission, quality of life and surgical adverse events. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and the Mantel-Haenzel odds ratio for categorial variables, were calculated. The types of surgical procedure included laparoscopic adjustable gastric banding, Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD), greater curvature plication (GCP), one-anastomosis gastric bypass (OAGB) and Duodeno-Jejunal bypass. Thirty-six trials were included. Metabolic bariatric surgery (MBS) was associated with a significantly higher reduction of HbA1c, diabetes remission and BMI compared with medical therapy. In the NMA, a significant reduction of HbA1c was observed with OAGB and SG. Complete diabetes remission significantly increased with all surgical procedures in comparison with non-surgical therapy, except for GCP. In addition, only BPD, RYGB and OAGB were associated with a significant reduction of BMI. MBS is an effective option for the treatment of T2D in patients with obesity. Further long-term trials of appropriate quality are needed for assessing the risk-benefit ratio in some patient cohorts, such as those with a BMI of less than 35 kg/m2 and aged older than 65 years.

Laparoscopic Sleeve Gastrectomy versus Greater Curve Plication in Management of Morbid Obese Patients with Hiatus Hernia

Introduction and Aim: Laparoscopic sleeve gastrectomy (LSG) considered the gold standard for management of morbid obesity, but, it has serious complications. Laparoscopic greater curvature plication (LGCP) is a restrictive procedure to lower the complications of LSG with the advantage of being a reversible procedure. The current work was designed to compare between Laparoscopic sleeve gastrectomy and greater curve plication in management of morbid obese patients with hiatus hernia.
 Methodology: This study included 40 morbidly obese patients with hiatal hernia, who underwent laparoscopic Nissen Fundoplication with Greater Curvature Plication (Group A) or Laparoscopic Crural Repair with Sleeve Gastrectomy (Group B).
 Results: Vomiting was the most common postoperative complaint. Two out of 20 patients (10%) In cases of LGCP developed prolonged nausea, vomiting and sialorrhea for 5 and 7 days but subsided subsequently with antiemetics, proton pump inhibitors, and prokinetics. Intraoperative hemorrhage in two cases of LGCP, Two out of 20 patients (10%) In cases of LGCP developed prolonged nausea, vomiting and sialorrhea for 5 and 7 days but subsided subsequently with antiemetics, proton pump inhibitors, and prokinetics. Four patients of 20 patients (20%) In cases of LGCP developed weight regain and sleeve gastrectomy revision was obtained by performing re-laparoscopy.
 Conclusion: LSG is a better procedure than LGCP as the most important disadvantage of Laparoscopic gastric plication are that it causes a high rate of recurrence and occurrence of early postoperative complaints.

Efficacy and effects of bariatric surgery in the treatment of obesity: Network meta-analysis of randomized controlled trials

AimsBariatric surgery (BS) is recommended for subjects with a Body Mass Index (BMI) over of 40 kg/m2 or with a BMI between 35 and 40 kg/m2 with obesity-related comorbidities. Aim of the study was to compare different types of BS with medical therapy (MT) for the treatment of obesity. Data synthesisWe conducted a network-meta-analysis (NMA) including randomized clinical trials comparing different BS techniques versus MT in people with obesity, with a duration ≥24 weeks (PROSPERO, #CRD42020160359). Primary endpoint was BMI. Indirect comparisons of different types of surgery were performed by NMA. Types of BS included: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass, sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD); greater curvature plication (GCP); one-anastomosis gastric bypass (OAGB); Laparoscopic Vertical Banded Gastroplasty (LVBG) and duodenal switch (DS). 43 trials were retrieved in this metanalysis. BS was associated with a significant reduction in BMI, systolic blood pressure, triglyceride and fasting glucose, and with a significant increase of HDL cholesterol when compared to MT. In direct comparisons, RYGB was more effective than LAGB, LVBG, and GCP, but less effective than DS, whereas LAGB was less effective than LVBG and SG. In the NMA, DS and BPD appeared to be more effective than other procedures. ConclusionsBS produces a greater weight loss than MT in morbidly obese patients, inducing a greater improvement of obesity-associated metabolic parameters. Available data are insufficient to assess the effect of BS on mortality. Different surgical procedures are heterogeneous for efficacy and safety.

Fundectomy with Greater Curvature Plication; New Modification for Patients with Morbid Obesity

Background: Obesity is a global epidemic. Laparoscopic greater curvature plication [LGCP] is a restrictive surgical procedure described for the first time on 1981 by Wilkinson. Fundectomy is a selective resection of the acid-producing segment of the stomach, with removal of peptide hormone-producing cells [the oxyntic mucosa] as a consequence of the fundectomy. Aim of the work: Our aim is to assess the feasibility and advantages of the novel modification for morbidly obese patients which include fundectomy with greater curvature plication. Patients and Methods: Ten patients were included in this study, which carried out at Al-Azhar University Hospital [New Damietta]. Results: Body mass index [BMI] ranged from 30 to 48 kg/m2 [the mean was 38.8 kg/m2]. Operative time ranged from 60 to 120 minutes [Mean time: 93.5 minutes]. The mean hospital stay time was 1.35 days. The mean estimated weight loss percentage [EWL%] was 29.1% at three months, 44.6% at six months, 60.4% at one year, and 72.4% at two years. EWL% was less than 50% for one patient which needs reoperation with Laparoscopic Sleeve Gastrectomy. Two patients [20%] developed heartburn due to gastroesophageal reflux disease [GERD]. Nine patients [90%] presented nausea, and vomiting was present in four patients [40%]. Conclusion: Fundectomy and Greater curvature plication is a feasible, safe, effective as a bariatric operation with avoidance of complications of other bariatric operations. As a new modification for bariatric surgery, this operation needs more investigations and longer periods for follow up.

Role of Gastrointestinal Hormones as a Predictive Factor for Long-Term Diabetes Remission: Randomized Trial Comparing Metabolic Gastric Bypass, Sleeve Gastrectomy, and Greater Curvature Plication.

Long-term studies comparing the mechanisms of different bariatric techniques for T2DM remission are scarce. We aimed to compare type 2 diabetes (T2DM) remission after a gastric bypass with a 200-cm biliopancreatic limb (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP), and to assess if the initial secretion of gastrointestinal hormones may predict metabolic outcomes at 5years. Forty-five patients with mean BMI of 39.4(1.9)kg/m2 and T2DM with HbA1c of 7.7(1.9)% were randomized to mRYGB, SG, or GCP. Anthropometric and biochemical parameters, fasting concentrations of PYY, ghrelin, glucagon, and AUC of GLP-1 after SMT were determined prior to and at months 1 and 12 after surgery. At 5-year follow-up, anthropometrical and biochemical parameters were determined. Total weight loss percentage (TWL%) at year 1 and GLP-1 AUC at months 1 and 12 were higher in the mRYGB than in the SG and GCP. TWL% remained greater at 5years in mRYGB group - 27.32 (7.8) vs. SG - 18.00 (10.6) and GCP - 14.83 (7.8), p= 0.001. At 5years, complete T2DM remission was observed in 46.7% after mRYGB vs. 20.0% after SG and 6.6% after GCP, p< 0.001. In the multivariate analysis, shorter T2DM duration (OR 0.186), p= 0.008, and the GLP-1 AUC at 1month (OR 7.229), p= 0.023, were prognostic factors for complete T2DM remission at 5-year follow-up. Long-term T2DM remission is mostly achieved with hypoabsortive techniques such as mRYGB. Increased secretion of GLP-1 after surgery and shorter disease duration were the main predictors of T2DM remission at 5years.

Laparoscopic Greater Curvature Plication for the Treatment of Obesity: a Systematic Review.

During the last decade, laparoscopic greater curvature plication (LGCP) has been used as a bariatric procedure for the treatment of obesity, regarded as less invasive and less expensive than other surgical bariatric procedures. We aimed to systematically review the literature and highlight recent clinical data regarding outcomes of LGCP in the treatment of obesity. A comprehensive research of Pubmed database on LGCP was performed. The search was conducted on the first of May 2020 and was not limited to any date range. Outcomes of interest were surgical technique, postoperative complications, weight loss outcomes, comorbidities improvement or resolution, and revisional surgeries after technical failure or weight regain. Fifty-three articles were eligible for inclusion, with 3103 patients undergoing LGCP (mean age: 13.8-55years). Mean preoperative body mass index (BMI) ranged from 31.2 to 47.8kg/m2. Mean operative time ranged from 48 to 193min. Length of hospital stay ranged from 0.75 to 7.2days. Most studies provided postoperative follow-up up to 12months. Mean percentage of excess weight loss (%EWL) ranged from 30.2 to 71.1% and 35 to 77.1% at 6 and 12months post-LGCP, respectively. Only one study followed patients for more than 10years and mean %EWL at 1, 5, and 10years was 67%, 55%, and 42%, respectively. LGCP seems to be an acceptable surgical procedure for the treatment of obesity, especially in centers having a low medical budget. However, most existing comparative studies report superiority of LSG regarding weight loss.

Long-Term Effects in Bone Mineral Density after Different Bariatric Procedures in Patients with Type 2 Diabetes: Outcomes of a Randomized Clinical Trial.

There is scant evidence of the long-term effects of bariatric surgery on bone mineral density (BMD). We compared BMD changes in patients with severe obesity and type 2 diabetes (T2D) 5 years after randomization to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG) and greater curvature plication (GCP). We studied the influence of first year gastrointestinal hormone changes on final bone outcomes. Forty-five patients, averaging 49.4 (7.8) years old and body mass index (BMI) 39.4 (1.9) kg/m2, were included. BMD at lumbar spine (LS) was lower after mRYGB compared to SG and GCP: 0.89 [0.82;0.94] vs. 1.04 [0.91;1.16] vs. 0.99 [0.89;1.12], p = 0.020. A higher percentage of LS osteopenia was present after mRYGB 78.6% vs. 33.3% vs. 50.0%, respectively. BMD reduction was greater in T2D remitters vs. non-remitters. Weight at fifth year predicted BMD changes at the femoral neck (FN) (adjusted R2: 0.3218; p = 0.002), and type of surgery (mRYGB) and menopause predicted BMD changes at LS (adjusted R2: 0.2507; p < 0.015). In conclusion, mRYGB produces higher deleterious effects on bone at LS compared to SG and GCP in the long-term. Women in menopause undergoing mRYGB are at highest risk of bone deterioration. Gastrointestinal hormone changes after surgery do not play a major role in BMD outcomes.

Metabolic surgery for the treatment of type 2 diabetes: A network meta-analysis of randomized controlled trials.

To compare different types of metabolic surgery (MS) with medical therapy (MT) for the treatment of type 2 diabetes (T2D). We conducted a network-meta-analysis (NMA) including randomized clinical trials comparing different MS techniques versus MT in people with T2D, with a duration of ≥24 weeks. Primary endpoints were glycated haemoglobin (HbA1c), fasting plasma glucose (FPG) and diabetes remission. Indirect comparisons of different types of surgery were performed by NMA. Mean and 95% confidence intervals for continuous variables, and Mantel-Haenzel odds ratios for categorial variables, were calculated using random effect models. Types of MS included: laparoscopic adjustable gastric banding (LAGB), Roux-en-Y gastric bypass, sleeve gastrectomy (SG), bilio-pancreatic diversion (BPD); greater curvature plication (GCP); one-anastomosis gastric bypass (OAGB); and duodenojejunal bypass. The 24 retrieved trials included 1351 patients (1014 with MS and 337 with MT). The mean baseline BMI was 36.8 kg/m2 . MS was associated with significantly greater reductions in HbA1c and FPG and greater diabetes remission when compared to MT. In the NMA, a significant reduction in HbA1c was observed with OAGB and SG. All surgical procedures were associated with a significant increase in diabetes remission, except GCP and LAGB. All procedures were associated with a reduction of body mass index (BMI). Metabolic surgery is an interesting option for the treatment of T2D, although further data are needed to demonstrate its long-term efficacy and safety. Present data are not sufficient to modify current recommendations, which consider MS a possible treatment for T2D in those with a BMI >35 kg/m2 .

Comparative effectiveness of bariatric surgeries in patients with obesity and type 2 diabetes mellitus: A network meta‐analysis of randomized controlled trials

SummaryA network meta‐analysis of randomized controlled trials (RCTs) was performed to determine the hierarchies of different bariatric surgeries in patients with obesity and type 2 diabetes mellitus (T2DM), in terms of diabetes remission and cardiometabolic outcomes. Seventeen RCTs and six bariatric surgeries, including single anastomosis (mini) gastric bypass (mini‐GBP), biliopancreatic diversion without duodenal switch (BPD), laparoscopic‐adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), Roux‐en‐Y gastric bypass (RYGBP), greater curvature plication (GCP) and nonsurgical treatments (NST) were included. Mini‐GBP, BPD, LSG, RYGBP and LAGB (from best to worst), as compared with NST, were all significantly associated with the remission of T2DM. For the follow‐up period > 3 years, BPD, mini‐GBP, RYGBP and LSG (from best to worst) were significantly superior to NST in achieving the remission of T2DM. For secondary outcomes, the overall ranking for bariatric surgeries was RYGBP > BPD > LSG > LAGB after comprehensively weighting glucose, weight, systolic and diastolic pressure, total cholesterol, triglycerides, high‐density lipoprotein cholesterol (HDL‐C) and low‐density lipoprotein cholesterol (LDL‐C). Mini‐GBP has the greatest probability of achieving diabetes remission in adults with obesity and T2DM, yet BPD was the most effective in long‐term diabetes remission. RYGBP appears to be the most favourable alternative treatment to manage patients with cardiometabolic conditions.

Cholelithiasis after bariatric surgery, incidence, and prophylaxis: randomized controlled trial.

Rapid weight loss is associated with a high incidence of cholelithiasis. To identify the incidence of gallstone formation after weight loss surgery and to detect the efficacy of 6 months regimen of prophylactic Ursodeoxycholic acid (UDCA). RCT included a total of 1530 morbid obese patients who were subjected to either laparoscopic one anastomosis gastric bypass (OAGB), sleeve gastrectomy (SG), or greater curve plication (GCP). Patients with previous or concomitant cholecystectomy and missed follow-up were excluded, leaving 1432 patients to analyze. They were randomly allocated into two groups receiving either UDCA or placebo with a minimum follow-up of one year for assessment of cholelithiasis and weight loss. The overall incidence of cholelithiasis after surgery was 9.7%. There was a significant decrease in the incidence of gallstone formation from 22% in placebo to 6.5% in treated group with UDCA. The mean percentage of excess weight loss (%EWL) was significantly higher in those who develop gallstones than others. Of those developing gallstones, there was 64.7 % with SG versus 28.1% and 7.2% in OAGB and GCP, respectively, which is statistically significant. NNT to prevent cholelithiasis is six, AR% is 70.4%, and RR is 3.4%. Cholelithiasis after SG and OAGB was higher than GCP. %EWL was rapid and higher in OAGB and SG contributing to the higher rate of symptomatic cholelithiasis and could be predictive for post-bariatric cholelithiasis. A 6-month use of UDCA is an effective prophylaxis decreasing gallstone formation after bariatric surgery at short-term follow-up.

Changes in Bone Mineral Density in Patients with Type 2 Diabetes After Different Bariatric Surgery Procedures and the Role of Gastrointestinal Hormones.

To compare changes in bone mineral density (BMD) in patients with morbid obesity and type 2 diabetes (T2D) a year after being randomized to metabolic gastric bypass (mRYGB), sleeve gastrectomy (SG), and greater curvature plication (GCP). We also analyzed the association of gastrointestinal hormones with skeletal metabolism. Forty-five patients with T2D (mean BMI 39.4 ± 1.9kg/m2) were randomly assigned to mRYGB, SG, or GCP. Before and 12months after surgery, anthropometric, body composition, biochemical parameters, fasting plasma glucagon, ghrelin, and PYY as well as GLP-1, GLP-2, and insulin after a standard meal were determined. After surgery, the decrease at femoral neck (FN) was similar but at lumbar spine (LS), it was greater in the mRYGB group compared with SG and GCP - 7.29 (4.6) vs. - 0.48 (3.9) vs. - 1.2 (2.7)%, p < 0.001. Osteocalcin and alkaline phosphatase increased more after mRYGB. Bone mineral content (BMC) at the LS after surgery correlated with fasting ghrelin (r = - 0.412, p = 0.01) and AUC for GLP-1 (r = - 0.402, p = 0.017). FN BMD at 12months correlated with post-surgical fasting glucagon (r = 0.498, p = 0.04) and insulin AUC (r = 0.384, p = 0.030) and at LS with the AUC for GLP-1 in the same time period (r = - 0.335, p = 0.049). However, in the multiple regression analysis after adjusting for age, sex, and BMI, the type of surgery (mRYGB) remained the only factor associated with BMD reduction at LS and FN. mRYGB induces greater deleterious effects on the bone at LS compared with SG and GCP, and gastrointestinal hormones do not play a major role in bone changes.

Scintigraphic evaluation of gastric emptying after greater curvature plication in comparison with sleeve gastrectomy

Introduction: Laparoscopic gastric plication (LGP) is a relatively new restrictive bariatric procedure that emerged to avoid the problems and to reduce the cost of laparoscopic sleeve gastrectomy. In this study we present the initial short-term outcome of LGP and its effect on gastric emptying and compare it with the results of laparoscopic sleeve gastrectomy (LSG). Methods: From May 2016 to April 2017, a total of 50 patients were allocated to undergo either LGP (n = 25) or LSG (n = 25). Data on the operative time, complications, hospital stay, overall cost of LSG and LGCP, body mass index loss (BMIL), post-operative gastric emptying (the first study to asses gastric emptying after LGP), percentage of excess weight loss (%EWL), and improvement of comorbidities were collected during the follow-up examinations. Results: All procedures were completed laparoscopically. The mean operative time was significantly higher for the LGP group. The mean hospital stay, cost and %EWL were significantly higher in the LSG group. The mean gastric emptying t1/2 was 40 ± 13 minutes for LGP group and 28.3 ± 8.31 minutes for LSG group (P = 0.001). Conclusion: There is significant acceleration of gastric emptying after LSG more than after LGP with significant effect on weight loss.

Role of adipose tissue GLP-1R expression in metabolic improvement after bariatric surgery in patients with type 2 diabetes

We aimed to explore the relationship between GLP-1 receptor (GLP-1R) expression in adipose tissue (AT) and incretin secretion, glucose homeostasis and weight loss, in patients with morbid obesity and type 2 diabetes undergoing bariatric surgery. RNA was extracted from subcutaneous (SAT) and visceral (VAT) AT biopsies from 40 patients randomized to metabolic gastric bypass, sleeve gastrectomy or greater curvature plication. Biochemical parameters, fasting plasma insulin, glucagon and area under the curve (AUC) of GLP-1 following a standard meal test were determined before and 1 year after bariatric surgery. GLP-1R expression was higher in VAT than in SAT. GLP-1R expression in VAT correlated with weight (r = −0.453, p = 0.008), waist circumference (r = −0.494, p = 0.004), plasma insulin (r = −0.466, p = 0.007), and systolic blood pressure (BP) (r = −0.410, p = 0.018). At 1 year, GLP-1R expression in VAT was negatively associated with diastolic BP (r = −0.361, p = 0.039) and, following metabolic gastric bypass, with the increase of GLP-1 AUC, (R2 = 0.46, p = 0.038). Finally, GLP-1R in AT was similar independently of diabetes outcomes and was not associated with weight loss after surgery. Thus, GLP-1R expression in AT is of limited value to predict incretin response and does not play a role in metabolic outcomes after bariatric surgery.

The role of bariatric surgery and appetite-related hormones metabolism in obesity treatment: a literature review

The most frequently performed surgical interventions in the treatment of obesity are the laparoscopic sleeve gastrectomy (LSG), laparoscopic greater curve plication (LGCP), laparoscopic Roux-en-Y gastric bypass (RYGB). Along with effective weight loss, these operations lead to changes in the production of appetite-related hormones that play an important role in the endocrine regulation of energy metabolism. Our aim was to learn the role and interaction of the above-mentioned bariatric operations (LSG, LGCP and RYGB) and appetite-related hormones (ghrelin, leptin, adiponectin) metabolism in obesity treatment using scientific literature data with considering famous obesity surgeons’ point of view. Materials and Methods. The current review was conducted by searching the following databases in Internet: PubMed, Scopus and Google Scholar, using combination of keywords for the bariatric surgery and appetite-related hormones metabolism. Results. Our review shows that the above-mentioned surgeries (LSG, LGCP, RYGB), aimed to the treatment of obesity, directly lead to a decrease in body mass index and weight loss and, indirectly, through the adipose tissue function, have different significant effects on energy balance and appetite-related hormones levels. The anatomical and physiological changes described in the review are most likely caused by the above-mentioned surgical procedures. Conclusions. Nowadays LSG, LGCP and RYGB are the most effective operations in obesity treatment with a strong similarity. There is a close interaction between BMI and fat tissue loss, caused by above-mentioned bariatric surgery, with appetite-related hormones levels. However, the surgical effects on this process in each case have been not enough studied and requires further work in this direction.

Network meta-analysis of the relative efficacy of bariatric surgeries for diabetes remission.

Bariatric surgery leads to a higher remission rate for type 2 diabetes mellitus than non-surgical treatment. However, it remains unsolved which surgical procedure is the most efficacious. This network meta-analysis aimed to rank surgical procedures in terms of diabetes remission. We electronically searched for randomized controlled trials in which at least one surgical treatment was included among multiple arms and the diabetes remission rate was included in study outcomes. A random-effects network meta-analysis was performed within a frequentist framework. The hierarchy of treatments was expressed as the surface under the cumulative ranking curve value. Results of the analysis of 25 eligible randomized controlled trials that covered non-surgical treatments and eight surgical procedures (biliopancreatic diversion [BPD], BPD with duodenal switch, Roux-en Y gastric bypass, mini gastric bypass [mini-GBP], laparoscopic adjustable gastric banding, laparoscopic sleeve gastrectomy, greater curvature plication and duodenal-jejunal bypass) showed that BPD and mini-GBP had the highest surface under the cumulative ranking curve values among the eight surgical treatments. Current network meta-analysis indicated that BPD or mini-GBP achieved higher diabetes remission rates than the other procedures. However, the result needs to be interpreted with caution considering that these procedures were in the minority of bariatric surgeries.

Clinical Outcomes of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy: a Case-Matched Control Study

BackgroundLaparoscopic greater curvature plication (LGCP) is a new bariatric procedure that is similar to laparoscopic sleeve gastrectomy (LSG) in that it uses a restrictive mechanism. Comparative studies between LGCP and LSG were still limited. The aim of this study was to compare the clinical outcomes of the two procedures based on the same clinical conditions.MethodsFrom January 2012 to December 2015, 260 patients with morbid obesity underwent LGCP and LSG in a single center. Data on patient demography, operation time, complications, hospital stay, body mass index loss, percentage of excess weight loss (%EWL), and improvement in comorbidities were collected. A propensity-matched analysis, incorporating pre-operative variables, was used to compare the short-term outcomes between LGCP and LSG.ResultsPropensity matching produced 48 patients in each group. Patients who underwent LGCP were predominately female (75.5%, 41.1% of the LSG patients were female, p = 0.028). Baseline BMI and excess weight were significantly lower in the LGCP group (p < 0.001). The LSG group showed a greater decrease in excess body weight than the LGCP group (LSG, 47.36 ± 12.95% in 3 months, 57.97 ± 19.28% in 6 months, 66.28 ± 25.42% in 12 months; LGCP, 39.67 ± 12.58% in 3 months, 47.40 ± 19.30% in 6 months, 48.02 ± 20.17% in 12 months, p = 0.008, 0.032, 0.010). Perioperative complications and resolution of obesity-related comorbidities were not significantly different between the two groups.ConclusionLGCP and LSG are both feasible and safe procedures for surgical weight reduction. In short-term follow-ups, LSG demonstrates a better excess body weight reduction while having perioperative complications similar to LGCP.

Evaluation of Weight Reduction, Diabetic State and Satiety Hormones After Laparoscopic Greater Curvature Plication in Morbidly Obese Diabetic Patients

Bariatric surgery proved effective in the treatment of morbid obesity and its associated comorbidities. The aim of this study was to assess weight loss and changes in glucose homeostasis and satiety hormones and to evaluate improvement in diabetic status in morbidly obese patients with type two diabetes mellitus (T2DM) at 6 and 12 months after laparoscopic greater curvature plication (LGCP). Twenty patients with morbid obesity with T2DM were operated upon with LGCP. Weight loss was assessed by the decrease in BMI and percentage of excess weight loss at 6 and 12 months after LGCP. Fasting and postprandial blood glucose levels, HbA1c, fasting serum insulin, serum ghrelin and glucagon-like peptide 1 (GLP-1) levels were measured before and at 6 and 12 months postoperatively. The mean age of patients was 37.6 years. There was significant decrease in BMI from 45.4 to 40.1 at 6 months (p= 0.0008) and then to 36.4 at 12 month (p< 0.0001). The mean fasting blood glucose decreased significantly from 134.8 preoperatively to 120.8 at 6 months (p< 0.0001) and then to 109.5 at 12 months (p< 0.0001). The mean preoperative HbA1c declined from 6.8 before LGCO to 6.3 at 6 months (p< 0.0001) then to 5.9 at 12 months (p< 0.0001). The mean fasting insulin level decreased from 20.5 preoperatively to 17.4 at 6 months (p< 0.0001) then to 16.7 at 12 months (p< 0.0001). The mean baseline ghrelin level decreased significantly from 551.7 preoperatively to 441.5 at 6 months (p< 0.0001) then to 422.5 at 12 months (p< 0.0001). The mean GLP-1 declined from 33.7 before surgery to 33.5 at 6 months (p= 0.76) then to 33.1 at 12 months (p= 0.36). LGCP is an effective bariatric procedure that achieved satisfactory weight loss and significant improvement in the glycemic control as demonstrated by improvement in laboratory markers as serum glucose, insulin, and ghrelin hormone levels.

Greater Curvature Plication with Duodenal-Jejunal Bypass: a Novel Metabolic Surgery for Type 2 Diabetes Mellitus.

The study investigated the use of great curvature plication with duodenal-jejunal bypass (GCP-DJB) in a type 2 diabetic with obesity rat model. Twenty-two Sprague-Dawley rats were given a high fat and sugar diet with subsequent intraperitoneal injection of a small dosage of streptozotocin (30mg/kg) and randomly assigned to either GCP-DJB (n = 12) or Sham surgery (n = 10). Body weight, peripheral blood glucose, and fasting serum insulin were assayed, and insulin resistance index (IRI) was calculated, before and at 1, 2, 4, and 8weeks after surgery. No differences were found in the preoperative characteristics of the two groups (P > 0.05). At week 1, the body weights decreased significantly, but there was no significant difference between the two groups (P > 0.05).The fasting blood glucose was significantly lower in the GCP-DJB than in the Sham group (P < 0.05), serum insulin levels were higher (P < 0.05), and IRI began to decline (P < 0.05). From 2 to 8weeks, the body weight of Sham group gradually recovered and continued to rise, while the GCP-DJB group remained at a relatively lower state. Compared to the Sham group, the body weight, fasting blood glucose as well as IRI of GCP-DJB rats had significantly decreased (P < 0.05). But, the fasting insulin concentrations had significantly increased (P < 0.05). This novel GCP-DJB procedure established a stable animal model for the study of metabolic surgery to treat type 2 diabetes mellitus (T2DM).

Cholelithiasis after Weight Loss Surgery: Challenge and Prophylaxis

Background: Rapid loss of weight after bariatric surgery is associated with a high incidence of gallstone formation. This study was carried out to detect the efficacy of six months regimen of prophylactic Ursodeoxycholic acid in the prevention of gallstones and to identify the predictive factors for gallstone formation after weight loss surgery. Methods: A randomized controlled trial was carried out involving 108 patients with a preoperative diagnosis of morbid obesity were subjected to either laparoscopic sleeve gastrectomy (LSG) or greater curve plication (LGCP) with follow-up for a minimum one year; they were divided into two groups; (group A; receiving Ursodeoxycholic acid) and (group B; receiving placebo). Data were collected about: Patient clinical history, baseline characteristics and postoperative follow-up. Results: The demographic parameters were comparable in the two groups. The incidence of cholelithiasis after surgery was 14.3% (13 cases). The mean %EWL was significantly higher in those who develop gallstones than others (P= 0.045). Also, there was a significant increased cholelithiasis post-LSG than LGCP (P=0.036). There was a significant decrease in the incidence of gallstone formation from 22% in placebo to 6.5% in treated group with Ursodeoxycholic acid (P = 0.041). Conclusions: The percentage of excess weight loss was the only predictive postoperative factor for gallstone formation. A six months use of Ursodeoxycholic acid is an effective prophylaxis for gallstone formation after weight loss procedures although a larger study is required to reach a definitive conclusion.