Bariatric Times report of clincial trials in Brazil reports gastric sleeve plication is ‘feasible, safe, and effective in the short term as a promising bariatric procedure’.Gastric sleeve plication is the most recent innovation in bariatric surgery. As the results on the vertical sleeve gastrectomy and the adjustable gastric band vary, there is still a gap that can be fulfilled by another procedure, and results of clinical trials suggest that gastric sleeve plication will fill this gap
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, 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 was 41kg/m2 (ranging from 35 to 46kg/m). The study applied the National Institute of Health’s (NIH) inclusion criteria for bariatric surgery – BMI >40kg/m[2] or BMI over 35kg/m[2] with at least one comorbidity. All patients underwent a multidisciplinary evaluation (endocrinologist, cardiologist, psychologist, and nutritionist), blood tests, abdominal ultrasonography, and upper endoscopy to establish baseline.
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. 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.
Although these procedures have proven to be good therapeutic options for some patients, they are not without significant complications, such as erosion or slippage of the gastric band or gastric leaks in VSG. VSG as a primary bariatric procedure shows medium-term results to be adequate with improvements in comorbidities. These promising results are associated with some complications, however, such as esophagites, stenosis, fistulas, and gastric leaks near the angle of His. These leaks and fistulas are reported in nearly one percent of cases and can be very difficult to treat. Leaks in VSG pose a particularly difficult challenge when they occur near the angle of His, potentially generating severe clinical conditions that require reoperation and may even cause death.
Additionally, results of the vertical sleeve gastrectomy and the adjustable gastric band vary, there is still a gap that can be fulfilled by another procedure. Gastric banding 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.
The authors of this 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
Gastric Sleeve plication is described by the authors/surgeons as notably similar to a VSG in that it generates a gastric tube and eliminates the greater curvature of the stomach, but does so without gastric resection. 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.
