Bariatric Times Reports on New Gastric Sleeve Plication Weight Loss Surgery: Better Than Lap Band?
Posted May 20 2010 1:02am
Gastric sleeve plication also referred to as gastric imbricaiton or laparoscopic greater curvature plication (LGCP™), is a restrictive bariatric surgical technique that eliminates the complications associated with adjustable gastric banding and vertical sleeve gastrectomy, by creating restriction without the use of implants and without gastric resection (cutting) and staples.
The Bariatric Times, (reference this link: http://mytinyurl.net/fd8efc) is an online journal that reports the Clinical Developments and Metabolic Insights in Bariatric Patient Care, today reported on surgical results after tracking post-operative outcomes for 66 patients (44 female) who had the gastric sleeve plication procedure from the period of January 2007 through March 2010. Patient age ranged from 23 to 48 years (mean 33.5 years), with a mean BMI of 35. Follow-up visits for the assessment of safety and weight loss were scheduled for 1 week and 1, 3, 6, 12, 18, and 24 months in the postoperative period, and endoscopic evaluations were scheduled for 1, 6, and 12 months postoperatively.
Gastric Sleeve Plication: Filling the Gap
There are two restrictive techniques in bariatric surgery: adjustable gastric banding (Lap Band) and vertical sleeve gastrectomy (gastric sleeve). Gastric sleeve is a restrictive surgical technique that involves resection (cutting, removal) of up to 80% of the stomach by means of stapling the greater curvature of the stomach. Though a smaller proportion of overall weight loss procedures performed are gastric sleeves, it is the fastest growing bariatric procedure, with good results on weight loss. Adjustable gastric banding is less invasive than sleeve gastrectomy, with successful but less rapid weight loss.
Though both band and sleeve are increasingly common (more than 200,000 Americans had weight loss surgery in 2009, a more than 10x increase in just 5 years), they are not without sometimes significant complications, such as erosion or slippage of the gastric band or gastric leaks in VSG. Leaks and fistulas are reported in nearly one percent of cases and can be very difficult to treat; leaks in particular are a difficult challenge and can generate severe clinical conditions that require reoperation.
Gastric banding, while less invasive with fewer risks for complication, achieves what is often deemed unsatisfactory weight loss in more than 20 percent of patients with failure rate requiring surgical revision in up to 25 percent of patients.
Clearly, results of the vertical sleeve gastrectomy and the adjustable gastric band vary widely, so there has always been a gap that exists that can be fulfilled by another procedure.
The authors of Bariatric Times study present gastric sleeve plication as an alternative procedure that can be as restrictive as sleeve gastrectomy with no staple line or prostheses. The stomach is reduced by dissecting the greater omentum and short gastric vessels, as in vertical sleeve gastrectomy; the greater curvature is then” invaginated: using multiple rows of nonabsorbable suture over bougie to ensure a patent lumen.
Outcomes for of Gastric Sleeve Plicaton Initial clinical reports cited in the study demonstrate satisfactory weight loss up to three years, and the study reported in this issue of Bariatric Times has similar findings for weight loss with the lowest early complication rates among all bariatric procedures. No major complications were reported among the 66 patients; endoscopic findings suggest that the greater curvature fold gets smaller over time, potentially due to reduction of initial edema. Weight loss was satisfactory, and favorably compared with results from VSG.
Even More Interesting: Crospon, a medical device company, recently announced the EndoFlip, a device that visually guides surgical sizing of the sleeve duirng the gastric sleve plication procedure in what some are calling the perfect marriage between a new proceudre and a new technology, in which the patient reaps significant benefit with reduced risks of complication and excellent weight loss outcomes.