Laparoscopic Greater Curvature Plication Research Articles

Postprandial Triglyceride, Glucose and Insulin Levels 10 Years After Bariatric Surgery in Women With Severe Obesity - A Pilot Study: Part 1 - Laparoscopic Greater Curvature Plication.

The long-term effects of bariatric surgery on postprandial profiles in patients with obesity and type 2 diabetes (T2D) have not yet been investigated. Therefore, this study examined postprandial profiles before laparoscopic greater curvature plication (LGCP), and then at 2 and 10 years after surgery.The studied cohort included 10 women (mean age= 54.4±5 years) with obesity (mean BMI= 42.5±7.8 kg/m?) and T2D who underwent LGCP. All subjects underwent a standardized liquid mixed-meal test. For statistical evaluation, ANOVA with Bonferroni multiple comparison was used. Mean postprandial levels were significantly decreased 2 years after surgery. Responses 10 years after the surgery also remained significantly lower than before surgery. Changes observed during the follow-up were significant: glucose: F=34.5, p<0.001; insulin: F=49.3, p<0.001; triglycerides F=9.2, p<0.001. The long-term favorable effects of bariatric surgery on cardiometabolic health may be partly mediated by reductions in postprandial glucose, insulin, and triglyceride levels.

Long-Term Outcomes of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy: Critical Appraisal of the Role of Gastric Plication in Bariatric Surgery.

Background and Objectives: This single-center study aimed to assess the role of laparoscopic greater curvature plication (LGCP) in bariatric surgery. Materials and Methods: Using data from our institution’s prospectively maintained database, we identified adult patients with obesity who underwent either laparoscopic sleeve gastrectomy (LSG) or LGCP between January 2012 and July 2017. In total, 280 patients were enrolled in this study. Results: The body mass index was higher in the LSG group than in the LGCP group (39.3 vs. 33.3, p < 0.001). Both groups achieved significant weight loss during the 3-year follow-up (p < 0.001). The weight-reduction rate was higher in the LSG group than in the LGCP group 6, 12, and 24 months postoperatively (p = 0.001, 0.001, and 0.012, respectively). The reoperation rate of the LGCP group was higher than that of the LSG group (p = 0.001). No deaths were recorded in either group. Conclusions: Although both the LGCP and LSG groups achieved significant weight loss over three years, the LGCP group demonstrated a lower weight-reduction rate and a higher reoperation rate than the LSG group. Thus, it is necessary to reassess the role of LGCP in bariatric surgery, particularly when LSG is a feasible alternative.

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.

Laparoscopic Sleeve Gastrectomy Versus Laparoscopic Greater Curvature Plication: a Long-Term Follow-up Study on the Complications, Body Mass Index Changes, Endoscopic Findings and Causes of Revision.

Bariatric surgery has been increasingly becoming popular due to the advancements in minimally invasive approaches and techniques. The aim of this study was to compare the long-term outcomes and clinical relevance of laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curvature plication (LGCP) in a matched controlled single-bariatric centre study. We collected data from 163 patients who underwent either LSG or LGCP over a period of at least 5years. The outcome parameters included body mass index (BMI) changes, causes of revision surgery, endoscopic findings and effects on obesity-related comorbidities. A total of 79 patients underwent LGCP, while 84 underwent LSG for morbid obesity. At the fifth year of follow-up, a BMI of < 30 was achieved in 1% of patients who underwent LGCP (n = 1) compared with more than 80% of patients who underwent LSG (n = 70). Revision was mainly due to gastroesophageal reflux disease (GERD) or bile reflux in the LSG group and due to weight gain in the LGCP group. LSG was superior in improvements in comorbidities. The most observed endoscopic finding was GERD (grade a, b) in the LSG group and unfolding of part of or the whole stomach in the LGCP group. Early minor postoperative complications occurred at a significantly lower frequency in the LSG group. LGCP has a higher rate of complications, a much less durable effect on weight loss, a higher rate of revision surgery and a higher cost burden to the health care system than LSG.

Comparison Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication Treatments for Obesity: an Updated Systematic Review and Meta-Analysis.

Bariatric surgery has been widely performed to treat morbid obesity. Our meta-analysis aims to provide an updated comparison between laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curvature plication (LGCP). Medline, EMBASE, Scopus, and Cochrane Central were searched. Ongoing clinical trials were identified from the clinicaltrials.gov website. References of the chosen literatures were manually reviewed for additional relevant studies. As a result, a total of 18 studies involving 1329 patients were selected. We demonstrated a significant higher excess weight loss (%EWL) after LSG at the 1-, 3-, 6-, 12-, and 18-month follow-up time points. However, no significant difference was found at 36 months. Body Mass Index Loss (BMIL) was better after LSG than LGCP at 12 and 24 months. The difference in the improvement of comorbidities (i.e., T2-DM, hypertension, and sleep apnea) did not reach statistical significance. The complications (i.e., bleeding, stenosis, leak, and abdominal pain), operative time, and length of hospital stay were comparable. More patients undergoing LGCP experienced nausea and vomiting. We obtained some different and new results compared to the previously published meta-analysis. Our meta-analysis showed significantly higher %EWL at 24 months (Z=2.08, p=0.04), significantly higher BMIL at 36 months (Z=9.11, p <0.00001), and significantly higher costs (Z=2.87, p=0.004) in the LSG group. In addition, for the first time, complications (i.e., GERD, wound infection, port-site hernia, and mortality) and improvement of dyslipidemia were compared between the two techniques. According to our pooled data, no significant differences were found in any of the above aspects. In conclusion, LSG is superior to LGCP with regard to providing effective weight loss in the short- and mid-term. LSG has a lower rate of minor complications, but was less effective when considering cost. The two procedures are similar in terms of improvement of comorbidities, major complications, operative time, and length of stay.

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.

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.

Endoscopic sleeve gastroplasty, laparoscopic sleeve gastrectomy, and laparoscopic greater curve plication: do they differ at 2 years?

Endoscopic sleeve gastroplasty (ESG) is an effective treatment option for obesity. However, data comparing its efficacy to bariatric surgery are scarce. We aimed to compare the effectiveness and safety of ESG with laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curve plication (LGCP) at 2 years. METHODS : We reviewed 353 patient records and identified 296 patients who underwent ESG (n = 199), LSG (n = 61), and LGCP (n = 36) at four centers in Spain between 2014 and 2016. We compared their total body weight loss (%TBWL) and safety over 2 years. A linear mixed model (LMM) was used to analyze repeated measures of weight loss outcomes at 6, 12, 18, and 24 months to compare the three procedures. RESULTS : Among the 296 patients, 210 (ESG 135, LSG 43, LGCP 32) completed 1 year of follow-up and 102 (ESG 46, LSG 34, LGCP 22) reached 2 years. Their mean (standard deviation [SD]) body mass index (BMI) was 39.6 (4.8) kg/m2. There were no differences in age, sex, or BMI between the groups. In LMM analysis, adjusting for age, sex, and initial BMI, we found ESG had a significantly lower TBWL, %TBWL, and BMI decline compared with LSG and LGCP at all time points (P = 0.001). The adjusted mean %TBWL at 2 years for ESG, LSG, and LGCP were 18.5 %, 28.3 %, and 26.9 %, respectively. However, ESG, when compared with LSG and LGCP, had a shorter inpatient stay (1 vs. 3 vs. 3 days; P < 0.001) and lower complication rate (0.5 % vs. 4.9 % vs. 8.3 %; P = 0.006). CONCLUSION : All three procedures induced significant weight loss in obese patients. Although the weight loss was lower with ESG compared with other techniques, it displayed a better safety profile and shorter hospital stay.

The effect of surgical gastric plication on obesity and diabetes mellitus type 2: a systematic review and meta-analysis.

IntroductionAll the bariatric procedures have evolved greatly over the past decades and laparoscopic greater curvature plication (LGCP) is one of the quite recently introduced techniques lacking systematic evaluation.AimTo compare and summarize the current data in the literature in regard to the effect of gastric plication on obesity and diabetes mellitus type 2.Material and methodsThe systematic review and meta-analysis was performed according to the PRISMA guidelines and registered at PROSPERO under the registration number CRD42018114314. The literature in English and German was searched using the MEDLINE (PubMed) and BJS databases for studies published in the last 10 years. A meta-analysis was performed focusing on the effects of this operation on weight loss, glycemia control and improvement of comorbidities.ResultsMean preoperative body mass index (BMI) ranged from 34.42 to 46.3 kg/m2. Most of the patients were female. The operation time was in the range from 50 to 192.23 min. Mean follow-up was from one month to 12 years, with most studies having a follow-up of less than 2 years. The postoperative BMI ranged from 28.59 to 38, with reported excess weight loss (EWL%) in the range 20–70%. Glycated hemoglobin (HbA1c) values decreased by up to 5.1% after surgery, ranging from 5.1% to 7.5%.ConclusionsDespite the quality of most of the included studies being low, the present meta-analysis revealed that, in the short term, gastric plication is an effective measure for weight loss, while the effect on diabetes mellitus type 2 is not statistically significant.

Feasibility and Efficacy of Laparoscopic Sleeve Gastrectomy as a Revisional Procedure After Failed Gastric Plication in Morbidly Obese Patients.

Background: Failure of adequate weight loss or weight regain has been reported after laparoscopic greater curve plication (LGCP). The primary aim of this retrospective study is to analyze weight loss outcome after revision of failed LGCP into laparoscopic sleeve gastrectomy (LSG). Patients and Methods: Patients who experienced failure (insufficient weight loss/weight regain) after LGCP performed in our center from 2009 to 2012 were included. LSG was performed for all patients. Results: Among 127 who underwent LGCP, 42 patients (33%) underwent revision. Mean body mass index (BMI) at time of LGCP was 44 ± 6 kg/m2. The highest % total weight loss (%TWL) after LGCP ranged from 11% to 34% (24.1 ± 5) (corresponding to % excess weight loss [%EWL] of 12%-47% [33.5 ± 12]). The time interval between LGCP and LSG ranged from 12 to 25 months (15.4 ± 3.8). After conversion, 2 patients (5%) experienced acute leakage managed by endoscopic stenting. After LSG, mean BMI (kg/m2) was 38, 32, 30, 28, 29, 30.2, and 30.4, while mean %TWL reached 9%, 19%, 24%, 29%, 25%, 25%, and 24% and mean %EWL reached 15%, 51%, 69%, 77%, 68%, 66%, and 64% at 1 month, 6 months, 1, 2, 3, 4, and 5 years, respectively. Except for results at 1 month, all results showed statistical significance (P ≤ .05). After LSG, the incidence of diabetes mellitus and hypertension dropped from 15 (35%) and 13 (30%) to 2 (5%) and 3 (7%) patients, respectively. No follow-up data (0%) were missed. Conclusion: LSG after failed LGCP has promising weight loss outcomes.

Preoperative Circulating Succinate Levels as a Biomarker for Diabetes Remission After Bariatric Surgery.

To determine the potential use of baseline circulating succinate to predict type 2 diabetes remission after bariatric surgery. Forty-five obese patients with diabetes were randomly assigned to Roux-en-Y gastric bypass (RYGB), sleeve gastrectomy (SG), or laparoscopic greater curvature plication. Anthropometric parameters were evaluated, and a complete biochemical analysis including circulating serum succinate concentrations was performed at baseline and 1 year after surgery. The results were externally validated in a second cohort including 88 obese patients with diabetes assigned to RYGB or SG based on clinical criteria. Succinate baseline concentrations were an independent predictor of diabetes remission after bariatric surgery. Patients achieving remission after 1 year had lower levels of baseline succinate (47.8 [37.6-64.6] µmol/L vs. 64.1 [52.5-82.9] µmol/L; P = 0.018). Moreover, succinate concentrations were significantly decreased 1 year after surgery (58.9 [46.4-82.4] µmol/L vs. 46.0 [35.8-65.3] µmol/L, P = 0.005). In multivariate analysis, the best logistic regression model showed that baseline succinate (odds ratio [OR] 11.3, P = 0.031) and the type of surgery (OR 26.4, P = 0.010) were independently associated with remission. The C-statistic for this model was 0.899 (95% CI 0.809-0.989) in the derivation cohort, which significantly improved the prediction of remission compared with current available scores, and 0.729 (95% CI 0.612-0.846) in the validation cohort. Interestingly, patients had a different response to the type of surgery according to baseline succinate, with significant differences in remission rates. Circulating succinate is reduced after bariatric surgery. Baseline succinate levels have predictive value for diabetes remission independently of previously described presurgical factors and improve upon the current available scores to predict remission.

Portomesenteric thrombosis after bariatric surgery in the Pan-Arab region

Background: Bariatric surgery has been shown to be the most effective method to treat morbid obesity and obesity-related comorbidities compared to intensive medical therapy. However, bariatric surgery is not without complications. Some rare complications after bariatric surgery are underestimated. One of these rare complications is portomesenteric thrombosis (PMT). We herein examine the prevalence of PMT after bariatric surgery in the Pan-Arab region. Methods: We sent a questionnaire to the members of the Pan-Arab Bariatric Society for Metabolic and Bariatric Surgery in 2014. This is a group that started on social media in 2012, that represents surgeons practicing in the following countries: United Arab Emirates (UAE), Kingdom of Saudi Arabia (KSA), Qatar, Bahrain, Oman, Kuwait, Egypt, Iraq, Palestine, Jordan, and Lebanon. The questionnaires were sent by email and placed on a link on the Facebook page of the group, and reminders were sent through social media to the members of the group and in our monthly Tele-video conference meeting. All data of procedures carried out in the Pan-Arab region were included. Any procedures performed outside the region were excluded. Results: We sent 77 and received back 18 completed questionnaires (23.4%). The data represent 21 surgeons from 13 hospitals in 9 countries (Iraq, Palestine, UAE, Qatar, Lebanon, Jordan, KSA, Egypt, Kuwait). Data for patients operated in Austria and in the United States were excluded. We received no responses from Bahrain, Iraq, or Oman. The total number of cases performed was 13,274, 9% laparoscopic adjustable gastric banding, 68% laparoscopic sleeve gastrectomy (LSG), 17% laparoscopic Roux-en-Y gastric bypass, 3% one anastomosis gastric bypass/mini gastric bypass, 1% laparoscopic greater curvature plication, 1% biliopancreatic diversion, and 2% others. Our surgeons encountered 30 PMT cases (0.23%). PMT was in both the portal and mesenteric veins in 57% of patients. The rest was observed in either the portal or mesenteric veins. History of travel was found to be associated with PMT in 7/30 [23%]. PMT cases were observed after all procedures, however, mostly after LSG 25/30 (83%). Our practice of deep vein thrombosis prophylaxis is quite variable before and after surgery in different countries. However, most patients with PMT received anticoagulation for less than a week (1–6 days and most of them were on unfractionated heparin 2–3 times/day, or low molecular weight heparin 40 mg once daily during their hospital stay). All patients with PMT complained of abdominal pain in the first 1 to 4 weeks after surgery. Computed tomography scan detected PMT in all except one patient, who was diagnosed by abdominal ultrasound. Two patients required surgical resection of the small bowel and all others were treated medically with anticoagulation. There were no mortalities. Conclusion: PMT is an uncommon complication after bariatric surgery. However, a high index of suspicion is needed to detect this complication. It is most commonly observed after LSG outcome with appropriate intervention is favorable. Majority of patients can be treated without surgical intervention.

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.

History, Recent Advancements, and Prospects in Bariatric/Metabolic Surgery

Bariatric/metabolic surgery is the most effective method to treat morbid obesity and its complications. Tracing its origin back to jejunoileal bypass in 1950s, bariatric/metabolic surgery has been continuously improved after more than 60 years of development. At present, the mainstream surgical procedures include sleeve gastrectomy, Roux-en-Y gastric bypass, biliopancreatic diversion/duodenal switch, and mini gastric bypass. In addition, new procedures such as single-anastomosis duodenal switch, duodenal-jejunal bypass with sleeve gastrectomy, laparoscopic greater curvature plication and endoscopic surgeries have been developed. This article reviews the history, status quo, and prospects of bariatric/metabolic surgery.

Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy Treatments for Obesity: Systematic Review and Meta-Analysis of Short- and Mid-Term Results.

Laparoscopic greater curvature plication (LGP) has recently emerged as a new bariatric procedure. This surgery provides gastric restriction without resection, which could potentially provide a lower risk alternative, with fewer complications. The real benefit of this technique in the short and long term is unknown. This systematic review aims to compare laparoscopic gastric plication and laparoscopic sleeve gastrectomy for obesity treatment. Clinical trials were identified in MEDLINE, Embase, Cochrane, LILACS, BVS, SCOPUS, and CINAHL databases. Comparison of LGP and laparoscopic sleeve gastrectomy (SG) included hospital stay, operative time, loss of hunger feeling, body mass index loss (BMIL), percentage of excess weight loss (%EWL), complications, symptoms in the postoperative period, and comorbidity remission or improvement. This systematic review search included 17,423 records. Eight studies were selected for meta-analysis. There is no difference in operative time, hospital stay, and complications. Patients in the SG group had improved loss of hunger feeling. BMIL was better in the SG group at 12 and 24months [mean difference (MD) - 2.19, 95% confidence interval (CI) - 3.10 to - 1.28, and MD - 4.59, 95% CI - 5.55 to - 3.63, respectively]. SG showed improved %EWL compared with gastric plication in 3, 6, 12, and 24months. However, no difference was found in %EWL long-term results (24 and 36months). Patients who underwent LGP had more sialorrhea. SG showed better results in diabetes remission. SG showed improved weight loss when compared with LGP, with better satiety, fewer symptoms in the postoperative period, and improved diabetes remission.

Laparoscopic greater curvature plication as a stomach sparing gastric sleeve: is it a worthy weight losing procedure for morbid obesity?

Background: Although laparoscopic sleeve gastrectomy (SLG) considered a gold standard way of management of morbid obesity, it still has serious complications as bleeding and staple line leak. Laparoscopic greater curvature plication (LGCP) was introduced as a trial gastric restrictive procedure and recently modified and standardized to obtain a gastric sleeve without resection and hence lower complications rates with the advantage of being a reversible procedure.Methods: 28 patients suffered from morbid obesity with body mass indices less than 50 kg/m2 filling the selection criteria of the study were prepared for Stomach Sparing Gastric Sleeve (SSGS). After devascularization of the greater curvature, double in-folding of the greater curvature using non-absorbable 2-0 sutures starting at the angle of His to 3-4 cm proximal to the pylorus, were done.Results: 28 patients with preoperative mean total body weight (TBW) of 118.7±15.5 kg and a mean BMI of 38±6.5 kg/m2 were the target of this study. The mean operative time was 103±11 min. Early minor postoperative complications were detected in 18 patients (64%) and included nausea, vomiting and sialorrhea. Postoperative reflux esophagitis was detected in 2 patients (7%). Postoperative % EWL (excess weight loss) was 32.2% at 1 month, 48.9% at 3 months, 53.3% at 6 months, 66.7% at 12 months and 70.2% at 15 months. The improvement of the pre-existent co-morbidities occurred in 7 patients (53.8%).Conclusions: SSGS is a promising low cost restrictive bariatric operation. It is reversible and effective weight losing procedure in the short term.

The efficacy of selected bariatric surgery methods on lipid and glucose metabolism: a retrospective 12-month study.

Approximately 25% of the Czech population is currently obese. Obesity rates are expected to increase in the future. Obesity not only raises the risk of health complications for individuals, but increasing rates also represent a significant and steadily growing economic burden for healthcare systems and society as a whole. The aim of this study was to evaluate the therapeutic efficacy of three methods of bariatric surgery: laparoscopic greater curve plication (LGCP), laparoscopic sleeve gastrectomy (LSG), and Roux-en-Y gastric bypass (RYBG) in patients with type 2 diabetes mellitus (DM). This study examined the influence of bariatric surgery on body weight and BMI, changes in serum glucose and markers of lipid metabolism. This study evaluated outcomes in 74 patients with type 2 DM who underwent LGCP, LSG or RYGB. Patient selection followed guidelines of the International Federation for the Surgery of Obesity, i.e. BMI≥40 kg/m2 or BMI≥35 kg/m2 with associated comorbidities or BMI<35 kg/m2. For each of the procedures, the hypotheses were tested with the Bonferroni method. Statistically significant weight loss, 20.2±9.3 kg on average, occurred by 12 months after surgery, with maximum weight reduction of 38 kg. Over the 12-month period, average fasting glycaemia decreased by 2.58 mmol/L after LGCP, by 2.01 mmol/L after LSG, and by 4.64 mmol/L after RYGB. Triacylglycerol (TGC) values decreased significantly with all procedures. The mean decrease was 1.35 mmol/L after LGCP and 1.06 mmol/L after LSG. The greatest TGC concentration decrease, 1.92 mmol/L, occurred after RYGB. Average concentrations decreased below 1.7 mmol/L. There was a statistically significant difference in body weight and BMI reduction between LGCP and LSG groups, as well as between LGCP and RYGB groups. A significant difference in the glucose decrease was observed between the LSG and RYGB groups, which can be explained by the fact that glycaemia and HbA1c levels were different between these groups prior to surgery. The best results from the carbohydrate metabolism point reached the malabsorption method RYGB. However, the other two restrictive methods also achieved very good results. In particular, the LGCP method has not only the effect on weight reduction but also on metabolic functions and consequently points to potential healthcare expenditure savings.

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.

A5315 - Laparoscopic Greater Curvature Plication (LGCP) vs. Endoscopic Sleeve Gastroplasty (ESG): Similar Efficacy with Different Physiology

A5315 - Laparoscopic Greater Curvature Plication (LGCP) vs. Endoscopic Sleeve Gastroplasty (ESG): Similar Efficacy with Different Physiology

Metabolic Effects of Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication: an 18-Month Prospective, Observational, Open-Label Study.

Laparoscopic greater curvature plication (LGCP) is an innovative restrictive technique designed to reduce gastric volume by plication at the region of greater curvature. The long-term efficacy, safety, and the metabolic effects of this procedure are the subject of this study. One hundred twenty-seven patients were enrolled; 84 underwent laparoscopic sleeve gastrectomy (LSG) and 43, LGCP. LSG and LGCP were then compared during long-term follow-ups in terms of glycemic control, hormone and lipid secretion, and changes in body composition. Measured parameters included serum glucose, triglycerides, high- and low-density lipoprotein cholesterol, testosterone, estradiol, leptin, adiponectin, ghrelin, fatmass, and lean body mass. Significant weight-loss and a reduced body composition resulted from either procedure vs. baseline (i.e., pre-surgery), with levels of fasting glucose and glycated hemoglobin also showing statistically significant reductions (at 3 and 18months for either surgery). Intergroup comparisons for glycemic parameters yielded no statistically significant differences. However, a dramatic reduction in ghrelin was detected following LSG, falling from pre-surgery levels of 140.7 to 69.6ng/L by 6months (P<0.001). Subsequently, ghrelin levels increased, reaching 107.8ng/L by month 12. Conversely, after LGCP, a statistically significant increase in ghrelin was seen, rising from 130.0ng/L before surgery to 169.0ng/L by month 12, followed by a slow decline. Good metabolic outcomes were obtained following LGCP, which might be mediated via altered glucose metabolism and GI hormones. Nevertheless, this method is less effective than LSG, possibly due to its preservation of the entire stomach, including secretory regions.