Laparoscopic Gastric Plication Research Articles

Laparoscopic gastric plication: A long-term follow-up and comparison of outcomes in severe vs. non-severe obesity

BackgroundLGGCP is a non-gastrectomy, restrictive bariatric technique. This study aims to assess its long-term efficacy. MethodsThis is a retrospective cohort study on LGGCP patients (2010–2019) from a single tertiary center, followed for up to 60 months. ResultsNinety-four patients with obesity were included in the study. The mean five-year postoperative BMI was 32.00. Excess weight loss (EWL): 30%–50% and EWL<30% occurred in 16 and 9 cases, respectively. The mean EWL was higher at 3-, 6-, and 12- months post-operation in patients with a BMI<40. Weight regain was 46.3% at the five-year follow-up. Eighty-seven patients had associated comorbidity, and 76 had improved in at least one of their comorbidities. Sixteen patients (17.0%) experienced complications. ConclusionLGGCP is safe and effective, with benefits in patients with BMI<40. Thus, we suggest the usage of LGGCP, especially in this group of patients, due to its less-invasive nature and acceptable cost-benefit. Further studies with larger sample sizes are required for validation.

Twelve-Month Outcomes in Patients with Obesity Following Bariatric Surgery-A Single Centre Experience.

As obesity rates continue to rise worldwide, many surgeons consider bariatric procedures as a possible cure for the upcoming obesity pandemic. Excess weight represents a risk factor for multiple metabolic disorders, especially for type 2 diabetes mellitus (T2DM). There is a strong correlation between the two pathologies. The aim of this study is to highlight the safety and short-term results of laparoscopic sleeve gastrectomy (LSG), Roux-en-Y gastric bypass (RYGB, laparoscopic gastric plication (LGP) and intragastric balloon (IGB) as methods used in the treatment of obesity. We followed the remission or amelioration of comorbidities, tracked metabolic parameters, weight loss curves and hoped to outline the profile of the obese patient in Romania. The target population of this study was represented by patients (n = 488) with severe obesity who qualified for the metabolic surgery criteria. Starting from 2013 to 2019, patients underwent four types of bariatric procedures and were subsequently monitored over the course of 12 months in the 3rd Surgical Clinic at "Sf. Spiridon" Emergency Hospital Iași. Descriptive evaluation indicators, as well as those of analytical evaluation were used as statistical processing methods. A significant decrease in body weight was recorded during monitoring and was more pronounced for patients who underwent LSG and RYGB. T2DM was identified in 24.6% of patients. Partial remission of T2DM was present in 25.3% of cases, and total remission was identified in 61.4% of patients. Mean blood glucose levels, triglycerides, LDL and total cholesterol levels decreased significantly during monitoring. Vitamin D increased significantly regardless of the type of surgery performed, while mean levels of vitamin B12 decreased significantly during monitoring. Post-operative intraperitoneal bleeding occurred in 6 cases (1.22%) and a reintervention for haemostasis was required. All procedures performed were safe and effective methods of weight loss and improved associated comorbidities and metabolic parameters.

LAPAROSCOPIC SLEEVE GASTRECTOMY AND GASTRIC PLICATION: INFLUENCE ON THE MAIN INDICATORS OF HORMONAL HOMEOSTASIS IN METABOLIC SYNDROME

Improvements in living standards have led to an increase in the annual global incidence of obesity to 13% among adults in 2021.&#x0D; Laparoscopic gastroplication is safe to perform, essentially organ-preserving and relatively inexpensive from an economic point of view.&#x0D; Among the advantages of gastroplication should be included its simplicity in performance, which makes a wider circle of its use. It should also be noted that during gastroplication there is no crossing of the organ cavity (stomach), which makes such complications as failure of the suture line, bleeding from the suture line impossible. However, it remains relevant to determine the effect of this type of intervention on the level of orexogenic and anorexigenic hormones in the postoperative period.&#x0D; Aim of the research: to evaluate the influence of sleeve-gastrectomy and gastric plication on the main indicators of hormonal homeostasis in metabolic syndrome.&#x0D; The Goal is to evaluate the influence of sleeve gastrectomy and gastroplication on the main indicators of hormonal homeostasis in metabolic syndrome.&#x0D; Materials and methods. The work is based on the materials of clinical examination and surgical treatment of 12 patients with metabolic syndrome, 4 men and 8 women aged 45±3.75 years with a body mass index &gt;40 kg/m2. Depending on the chosen surgical intervention, all patients included in the study were divided into two groups: laparoscopic sleeve gastrectomy - 5 patients, laparoscopic gastric plication - 7 patients.&#x0D; Results. A decrease in ghrelin concentration was established 4 weeks after sleeve-1 surgery by 35.06% (p=0.0595), while after 3 months this indicator decreased by 58.57% (p=0.0065), and after 6 months by 60.31% (p=0.0057 ). Gastric plication also demonstrated a decrease in the ghrelin level (1 month – 22.17% (p=0.1290), 3 months – 32.82% (p=0.0245), however, this type of surgical intervention did not cause its significant decrease in the corresponding time periods. The use of surgical sleeve-1 and sleeve-2 methods showed a significant decrease in the level of leptin, which is evidence of a decrease in the degree of resistance. Thus, after sleeve-1 in terms of 1, 3 and 6 months, a decrease in its serum level by 38.47% was noted (p=0.0342), 54.67% (p=0.0056), 56.95% (p=0.0069), respectively. And in patients after word-2 in terms of 1, 3 and 6 months, a decrease in its serum level by 24.67% (p =0.1230), 35.68% (p=0.0193), 48.29% (p=0.0028), respectively.&#x0D; On the other hand, the used bariatric surgical interventions caused an increase in the concentration of adiponectin. Its level increased by 7.14% (p=0.9124) after 1 month, by 30.63% (p=0.5741) after 3 months, and by 36.64% (p=0.4093) six months after sleeve-1 surgery. After gastric plication, an increase of 7.71% (p=0.8731), 16.71% (p=0.6198) and 30.89% (p=0.4304) was registered in the respective observation periods.&#x0D; Conclusions. Significant changes in the levels of adipokines after bariatric surgery, such as an increase in adiponectin and a decrease in leptin, indicate a high potential in reducing the manifestations of metabolic syndrome and the risk of developing type 2 diabetes. And the decrease in the level of ghrelin, which interacts with these hormones in a feedback type, is the trigger for the regulation of hormonal homeostasis, which can be achieved by bariatric surgery.

Long-Term Outcomes of Laparoscopic Gastric Plication for Treatment of Morbid Obesity: a Single-Center Experience

BackgroundAlthough laparoscopic gastric plication (LGP) has been mentioned in many studies, its practice has not yet been standardized. In addition, the outcomes remain conflicting, especially long-term ones. This study was conducted to elucidate the long-term consequences of LGP.MethodsRetrospective analysis of patients with obesity underwent LGP at our institution between March 2010 and September 2014. Data were prospectively collected from our database.ResultsOf the 88 consecutive patients in the study period between 2010 and 2014, follow-up data out to 6 years was available in 60 LGP patients (68.18%). The mean age of the included patients was 41.3 ± 10 years. A total of 81.7% were females. We observed a significant BMI reduction out to 2 years (p < 0.001), a plateau at 3 and 4 years, and a significant BMI increase at 6 years (p < 0.01). %TWL at 2 years was 21.14% and 12.08% at 6 years. Weight regain was observed in 35 patients at 6 years to reach a rate of 58.3%. Predictors for weight regain at 6 years were disrupted plication fold, increased hunger, and non-adherence to regular exercise. The diabetes improvement rate was 66.6% at 6 years. There were 14 re-operations (23.3%): 1 emergency (1.6%) and 13 (21.6%) elective. There was no mortality.ConclusionAt the 6-year follow-up visit, LGP has a much less durable effect on weight loss with a % EWL of 32% and a weight regain of 58.3% resulting in a high rate of revisions.Graphical abstract

Quality of life after surgical operations

The aim of the work is to study the quality of life in patients who underwent gastric plication for morbid obesity. A prospective study of 37 patients aged 28 to 59 years, who underwent gastroplication according to the original technique, was conducted on the basis of the Clinic of the Bashkir State Medical University. The indication for surgery was morbid obesity (body mass index 40 kg/m² or more). The quality of life of patients who underwent laparoscopic gastric plication for morbid obesity was studied by comparing the results of questionnaires and special research methods. Weight loss achieved as a result of laparoscopic gastric plication, correction of concomitant disorders in organs and systems, and normalization of metabolic parameters allow us to consider the intervention effective, and the results obtained good. Long-term results of treatment were monitored for up to 2 years. The assessment of the parameters of the quality of life of patients indicates that after bariatric interventions, positive changes are more related to the physical indicators of the quality of life and health status in general. At the same time, changes in mental health indicators, such as vitality, social and emotional functioning, were not statistically significant. In addition to the ongoing surgical correction, obviously essential in achieving stabilization of the psycho-emotional sphere of patients should be given a multidisciplinary approach using developed diets snd psychotherapeutic techniques. The study highlights the features of the regimen and structure of nutrition in patients after bariatric surgery, which can improve long-term results and improve the quality of life in patients with morbid obesity.

Revision of Gastric Plication to Gastric Bypass (Indications and Solutions)

BACKGROUND: Laparoscopic gastric plication (LGP) has gained increased acceptance as initial weight loss operation, but as with any other procedures, insufficient weight loss, early and late complications such as early and late strictures, gastroesophageal reflux and leak and others have been announced as an indication for revision to gastric bypass surgery as the correct solution. AIM: The aim of the study was to recognize the common indications for revision of gastric plication (GP) to RYGP and OAGB in our centers and to evaluate the outcome of treating weight regain, complications, and comorbidities. METHODS: A retrospective study conducted on 54 cases of undesirable results following gastric plication in other centers that were revised to gastric bypass procedures (RYGB and OAGB) from June 2015 to June 2018. Weight regain, gastroesophageal reflux disease not responding to medical treatment, undiagnosed hiatal hernia at surgery, post-operative leak, and strictures are the main categories included as indications for revision to gastric bypass in this study for a period of follow up to 2–5 years regarding weight loss, improvement of GERD and hiatal hernia, improvement of leak, stricture, and axial rotation of stomach. RESULTS: 54 consecutive patients included in this study previously subjected for LPG few years ago. 13 (24%) male and 41 (76%) female patients with mean age of 39.5 years ranging from (21–58) years and BMI from (41–48) Kg/m2. The main indication for revision surgery in the form of gastric bypass procedure (RYGB and OAGB) was weight regain in about 69% of cases. In addition to non-responding GERD to medical treatment (13%), hiatus hernia with plicated stomach migration to the mediastinum (3.7%), local collection secondary to leak (1.85%), stricture at site of plication (1.85%), and one case of axial rotation of the stomach (1.85%). Patient postoperatively done well and a follow-up for up to 3 years after revision surgery was uneventful. Most of our patients have good improvement regarding the inclusion criteria in our study (100% cured GERD, 90% cured leak site, about 90% cured symptomatic and radiological hiatal hernia, 100% cured after early, late strictures, and axial rotation while regarding loss of weight and least comorbidities about 88%). CONCLUSION: Although GP is an established bariatric procedure in treating and solving obesity and its complications, there are certain restrictions and difficulties that makes RYGB superior to GP.

Reoperative bariatric surgery after primary laparoscopic gastric plication for morbid obesity: a systematic review and meta-analysis.

Laparoscopic gastric plication (LGP) often requires reoperative bariatric surgery (RBS) due to complications and insufficient weight loss. The aim of our study was to assess perioperative morbidity and weight loss during follow-up in patients undergoing RBS after primary LGP for morbid obesity. A search of PubMed, Web of Science, Cochrane Library, and Google Scholar was performed according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines using ("conversion"OR "revision*""OR "reoperat*")AND("gastric"OR "curvatur*")AND "plication." Studies were deemed eligible if data on RBS after LGP were provided. For each study, data were extracted and analyzed. In the literature review, 291 articles were screened and 7 included. The studies covered a total of 367 patients, of whom 119 received a sleeve gastrectomy (SG), 85 a Roux-en-y gastric bypass (RYGB), 75 a one anastomosis-gastric bypass (OAGB), 45 a re-LGP, and 25 a jejuno-ileal bypass. After RBS, excess weight loss was 50.8 ± 6.5% at 6months, 71.0 ± 7.7% at 12months, and 89.0 ± 7.8% at 24months. Operative time was 101.3 ± 14.6min. Postoperatively, 18/255 patients (7.1%) had a complication, and leakage and reoperations were reported in 6/255 (2.4%) and 5/255 (2.0%) patients, respectively. Length of hospital stay was 3.1 ± 2.4days. The quality of evidence was rated as "very low." Despite limitations, this systematic review and meta-analysis showed that RBS after LGP has an acceptable rate of complications and is effective in terms of excess weight loss during follow-up. No specific operation (e.g., SG, RYGB, OAGB) can be suggested over another due to the lack of evidence.

76 Many Forms of Bariatric Surgery Can Be Used to Treat Obese Patients. Is Laparoscopic Gastric Plication the Next Gold Standard?

Abstract Aim Obesity is growing in prevalence in today’s world. Conservative treatment methods often fail; however, bariatric procedures have been developed to help patients lose weight. While bariatric surgery takes various forms, these are often highly invasive or have high rates of complication, leading to further development by surgeons of new procedures. One of the more recently developed procedures is laparoscopic gastric plication- a surgery involving imbrication of the greater curvature of the stomach to narrow the gastric lumen. It has been hypothesised that this could be the next gold standard in the management of obesity. This paper seeks to address such hypotheses by comparing laparoscopic gastric plication with the already established laparoscopic gastric sleeve in the treatment of patients and their comorbidities. Method By analysing meta-analyses, systematic reviews and case studies on both laparoscopic gastric plication and laparoscopic gastric sleeve, it has been possible to compare the safety, efficacy, and cost of the two procedures. Results The results of the literature review undertaken indicate no significant difference when the efficacy and cost of the two procedures is compared. Laparoscopic gastric sleeve is, however, a safer procedure with fewer postoperative complications than laparoscopic gastric plication. Conclusions In conclusion, it is unlikely that laparoscopic gastric plication will be the next gold standard in bariatric surgery unless the procedure is standardised, and its safety record is improved.

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.&#x0D; 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).&#x0D; 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.&#x0D; 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.

Prevention and treatment of gerd in patients with obesity undergoing gastroplication

The aim of the study was to study the advantages and disadvantages of laparoscopic gastric plication with the prevention and treatment of gastroesophageal reflux disease in the treatment of patients with overweight and obesity. From 2018 to the present, 24 patients have been observed who underwent laparoscopic gastric plication with the prevention and treatment of gastroesophageal reflux disease, of which 19 (79.2 %) women and 5 (20.8 %) men. The average age of patients is 41 ± 3.5 years. Indication for surgery: BMI &gt; 35 kg/m² and the presence of GERD with unsuccessful conservative treatment or BMI &gt; 35 kg/m² and the presence of HH with symptoms of GERD. The experience of surgical treatment of these 24 patients allows us to speak about the effectiveness of the use of gastroplication surgery with the prevention and treatment of gastroesophageal reflux disease with a combination of obesity and GERD. Dyspeptic symptoms are expected in some patients and are stopped in the early postoperative period with medication. The return of BMI to baseline in 3 (12.5 %) patients requires further study.

GASTRO-ESOPHAGEAL REFLUX DISEASE BEFORE AND AFTER BARIATRIC SURGERIES

Background: The relationship between obesity and gastro esophageal reflux disease (GERD) risk has been well established. Many authors suggest performing esophagogastroduodenoscopy (OGD) in all patients before bariatric procedures. On the other hand, many other investigators advocate a selective approach for asymptomatic patients. Laparoscopic Roux-en-Y gastric bypass (LRYGB) is considered by most experts the procedure of choice for the management of GERD in obese patients; however, the effect of LSG on GERD is still unclear. Objective: To identify presences or absences of GERD in patients undergoing different types of bariatric surgery and the effect of this surgery on GERD status post operatively. Patients and Methods: This study included forty successive morbidly obese patients who present to Surgery Department of Al-Azhar University Hospitals seeking for bariatric surgery, during the period from January 2018 to April 2020. Seventeen (42.5%) of the patients were males, while twenty-three (57.5%) were females. Upper endoscopy was performed preoperatively in all cases. Full history, physical examination and special investigations were taking, Patients was classified into laparoscopic sleeve gastrostomy (LSG) group (14 cases), laparoscopic greater curvature gastric plication (LGCGP) group, (3 cases), LRYGB group, (19 cases), and laparoscopic mini gastric bypass (LMGB) group, (4 case). OGD was done preoperatively in all patient and yearly postoperatively for two successive year. Result: In LSG group (14 cases), post-operatively with follow up by OGD, there was five cases (35.7%) have GERD sings and the rest of cases, nine cases (64.3%) have normal esophageal mucosa. In LRYGB group, all patients have normal esophageal mucosa after operation. In LGCGP group, three cases, post-operatively with follow up by OGD, there was one case (33.3%) have GERD signs, and the rest of cases, two cases (66.7%) have normal esophageal mucosa. In LMGB group, two case 50% improved in the 2nd year, one (25%) improved from the 1st year, and one case (25%) has increased GERD symptoms, signs, and biliary reflux. Conclusion: OGD should be done before bariatric procedures routinely or selectively, Laparoscopic Roux-en-Y gastric bypass (LRYGB) was considered the procedure of choice for the management of GERD in obese patients, However LSG still unclear on obese patient with GERD.

Laparoscopic Gastric Plication; Comparative Study between Modified Enteric Bypass and Loop Bipartition

Background: Laparoscopic gastric plication (LGP) is emerging as a safe and effective bariatric procedure. A comparative study between the efficacy and complications of LGP with modified enteric bypass and LGP with loop bipartition, which are still an investigational bariatric procedure. The objective of this study to compare safety and efficacy of LGP with enteric bypass and LGP with loop bipartition in the treatment of morbid obesity in a one-year follow-up study. Methods: A prospective study between February 2016 to December 2017, conducted on 80 morbid obese patients who were candidates for laparoscopic gastric plication, with either loop bipartition or modified enteric bypass surgery were randomly assigned to receive either LGP modified enteric bypass (n = 40) or LGP with loop bipartition (n = 40). Early and late complications, body mass index (BMI), excess weight loss, and obesityrelated co-morbidities were determined at the 1-year follow-up. Results: Operative time and mean length of hospitalization were shorter in the LGP with modified enteric bypass group than LGP with loop bipartition; (110 minutes versus 120 minutes, P<.001, and 2 days versus 3 days; P<.001, respectively). The mean percentage of excess weight loss (%EWL) at 12 months follow-up was (79.5%) in the LGB with modified enteric bypass group and (74.1%) in the LGP group (P = 0.03). Improvement was observed in all co-morbidities in both groups. Conclusion: Both LGP and LGB are effective weight loss procedures. LGP enteric bypass proved to be a simpler and less costly procedure compared with LGP with loop bipartition with a lower risk of stomal ulcer during one year follow up.

A novel description of converting a gastric plication to sleeve gastrectomy for weight loss: A case report.

IntroductionBariatric surgery is a rapidly growing field with trends and standards of care changing more rapidly than most. Gastric plication was once an exciting novel procedure which showed promise, however it has fallen out of favor for other procedures such as the sleeve gastrectomy. Existing literature on the surgical conversion of a gastric plication to a sleeve gastrectomy does not provide specific details on the operative technique of this rarely encountered operation.Case reportIn this case report we describe a morbidly obese female who presented weight gain after laparoscopic gastric plication and gastric banding. We provide the operative technique involved in conversion to a laparoscopic sleeve gastrectomy.ConclusionThis case provides specific operative technique with detailed media for the conversion of gastric plication to LSG.

Effect of bariatric surgery on fatty liver disease in obese patients: A prospective one year follow-up study

Non-alcoholic fatty liver disease (NAFLD), often associated with obesity and metabolic syndrome, manifests itself as steatosis, hepatic fibrosis, cirrhosis, or even end-stage liver disease. NAFLD causes inflammation, insulin resistance and cardiovascular complications. The current study aimed to evaluate the beneficial effects of bariatric surgery on biochemical parameters of hepatic functions in obese patients by comparing them before and one-year after the surgery. A total of 72 morbidly obese patients underwent bariatric surgery between 2016 and 2018. The incidence of diabetes mellitus in this group was 29%, median body weight was 124.5 kg (109.0-140.0) and mean body mass index (BMI) was 44.38 ± 6.770 kg/m2. The used surgical procedures included gastric bypass, sleeve gastrectomy, laparoscopic gastric plication, and single anastomosis duodeno-ileal bypass-sleeve gastrectomy. Biochemical parameters including ALT/AST ratio (AAR), NAFLD fibrosis score (NFS), hepatic fibrosis index (FIB-4) and Fatty Liver Index (FLI) were evaluated in all patients at the time of surgery and one year after the intervention. Significant improvement after the intervention was observed in 64 patients. A significant reduction in body weight (P<0.0001), waist circumference (P<0.0001), and body mass index (P<0.0001) were observed. NAFLD liver fibrosis index changed significantly (P<0.0001), suggesting a trend of improvement from advanced fibrosis towards stages 0-2. The FIB-4 fibrosis index indicated significant improvement (P=0.0136). Besides, a significant decline in hepatic steatosis (P<0.0001) was observed after bariatric surgery as compared to the pre-surgery fatty liver conditions. Among the strategies to overcome NAFLD-associated impediments, bariatric surgery can be considered effective in reducing obesity and metabolic co-morbidities. ClinicalTrials.gov (NCT04569396).

Comparing the Effectiveness of Laparoscopic Gastric Plication in Younger and Older Patients: a 3-Year Prospective Longitudinal Evaluation

Comparing the Effectiveness of Laparoscopic Gastric Plication in Younger and Older Patients: a 3-Year Prospective Longitudinal Evaluation

How Bad Is "Bad"? A Cost Consideration and Review of Laparoscopic Gastric Plication Versus Laparoscopic Sleeve Gastrectomy.

Recent large-scale studies have concluded that laparoscopic sleeve gastrectomy (LSG) is superior to laparoscopic gastric greater curve plication (LGP) in weight loss outcomes and post-operative complications, but LGP is still being performed due to its purported financial advantage. Our analysis provides an investigation of cost at the time of operation, and a consideration of the financial implications of the complications and percentage of reoperation associated with each procedure. A systematic literature search was performed on the electronic medical databases PubMed and Embase. Extraction of data was performed using a pre-made form which included number of subjects, minor complications and rates, major complications and rates, reoperation rate, percent end weight loss, length of operating time, and length of hospital stay. Twenty-eight records were included after screening for inclusion criteria, representing data from 3242 patients (2668 with LGP and 574 with LSG). Minor and major complications of LGP were documented in 28.7% and 7.2% of cases, respectively, and the rate of reoperation was 10.2%. Minor and major complications of LSG were 19.4% and 4.1%, respectively, and the rate of reoperation was 3.3%. Based on analysis of operating time and length of hospital stay means, each LGP operation was calculated to cost $10,730 USD, and LSG cost $14,074. LGP has higher rates of complications and reoperation, and less %EWL compared with LSG. Despite modest initial cost benefit of LGP, when considering costs associated with the complications and reoperations, we conclude that LSG is superior to LGP in outcome and cost-effectiveness.

Laparoscopic one anastomosis gastric bypass as revisional surgery for failed laparoscopic gastric plication

Introduction Laparoscopic gastric plication (LGP) had been widely used in Egypt as being less expensive and safe bariatric surgery as compared with sleeve gastrectomy. However, it carries unsatisfactory long-term weight loss. Aim The aim of this study is to present and asses our technique and the results of laparoscopic one anastomosis gastric bypass (LOAGB) as revisional surgery for failed LGP. Patients and methods This study included 37 patients with failed LGP done at least 24 months earlier. LOAGB was used as revisional surgery for those patients. This prospective randomized study was conducted between January 2016 and February 2019. Patients were followed up for 18 months after revisional surgery. Results Mean BMI decreased from 45.1±7 to 27.2±2.3 kg/m2. Mean percentage of excess weight loss was 72.9. The mean operative time was 168±22 min. The mean hospital stay was 3 days. Complications occurred in the form of anastomotic leakage (one patient), intraoperative bleeding (two patients), postoperative hematemesis (one patient), and conversion to open procedure (one patient). There were no mortalities during this study. Conclusion LOAGB is a safe and effective revisional surgery for failed LGP.

Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?-Analysis of 116 Consecutive Cases.

In France, laparoscopic gastric plication (GP) has rarely been utilized as a weight loss procedure. Although relatively safe and efficient, its long-term results are still controversial. The goal of this study is to assess the indications and outcomes of revisional surgery post-GP. Between February 2010 and September 2017, patient characteristics undergoing GP were prospectively collected from our database. Failure of conservative treatment or presence of anatomical anomaly explaining weight loss insufficiency was an indication for revisional surgery (RS). A total of 300 patients were included, 41 patients were lost to follow-up (13.7%), 124 patients (41.3%) had total weight loss (TWL) > 30%, and 116 patients (38.7%) underwent RS. Revisional procedures were laparoscopic Roux-en-Y gastric bypass (RYGB) in 72 patients (62.1%) and sleeve gastrectomy (SG) in 44 patients (37.9%). The median interval to RS was 29months. The mean operative time was 60min for the SG and 125min for the RYGB (p < 0.0001). Mortality was nil. Significant morbidity occurred in eight patients (6.9%) including 4 non-abdominal complications, 1 gastric leak, 1 case of hemorrhage, 1 case of hematoma, and 1 intra-abdominal abscess. The mean length of hospital stay (LOS) was 2.9days (range, 1-11) for the SG group vs 3.2days (range, 2-8) for the RYGB group (p = 0.608). GP is associated with a relatively high rate of weight regain or insufficient weight loss. When compared to SG, RYGB seems to be the safer revisional procedure with fewer surgical complications.

Role of Ketamine in Multimodal Analgesia Protocol for Bariatric Surgery

Background and Objectives: Acute postoperative pain is one of the most undesirable experiences for a patient in the postoperative period. Many options are available for the treatment of postoperative pain. One of the methods of multimodal analgesia is a combination of opioids and adjuvant agents, such as ketamine. The aim of this study was to evaluate the effect of a pre-incisional single injection of low-dose ketamine on postoperative pain after remifentanil infusion in patients undergoing laparoscopic gastric bypass or gastric plication surgery. Materials and Methods: The prospective, randomized, double-blinded and placebo-controlled trial took place at the Hospital of the Lithuanian University of Health sciences KaunoKlinikos in 2015–2017. A total of 32 bariatric patients (9 men and 23 women) were randomly assigned to receive a single pre-incisional injection of ketamine (0.15 mg/kg (LBM)) (ketamine, K group) or saline (placebo, S group). Standardized protocol of anesthesia and postoperative pain management was followed for all patients. Postoperative pain intensity, postoperative morphine requirements, incidence of side effects and patients’ satisfaction with postoperative analgesia were recorded. Results: Thirty-two patients undergoing bariatric surgery: 18 (56.25%; gastric bypass) and 14 (43.75%; gastric plication) were examined. Both groups did not differ in demographic values, duration of surgery and anesthesia and intraoperative drug consumption. Postoperative pain scores were similar in both groups (p = 0.105–0.941). Morphine consumption was 10.0 (7.0–12.5 mg) in group S and 9.0 (3.0–15.0 mg) in group K (p = 0.022). The incidence of side effects was similar in both groups (p = 0.412). Both groups demonstrated very high satisfaction with postoperative analgesia. Conclusions: Pre-incisional single dose ketamine reduces postoperative opioids consumption, but does not have an effect of postoperative pain intensity and side effects after remifentanil infusions. Very high patient satisfaction is achieved if standard multimodal analgesia protocol with an individual assessment of pain and dosage of medications is followed.

Application value of laparoscopic gastric plication combined with duodeno-jejunal omega switch in modified adjustable gastric banding

Objective To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding. Methods The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers. Results (1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS. (2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP, and decreased to 37.2 kg/m2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux. Conclusion LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m2, which offers a safer surgical procedure option for patients after gastric binding. Key words: Obesity; Sleeve gastrectomy; Gastric plication; Biliopancreatic diversion; Adjustable gastric banding; Gastric bypass; Omega anastomosis; Bariatric and metabolic surgery