A recent study finds that laparoscopic greater curvature plication, compared to other restrictive bariatric procedures, is a feasible, safe, and effective procedure for short-term excess weight loss with low complication rates.
The laparoscopic greater curvature plication (LGCP) procedure, also known as gastric plication, is a new restrictive bariatric surgical technique that reduces stomach capacity by more than two-thirds to increase the feeling of fullness with a smaller amount of food, reduce food intake, and enable weight loss.
Unlike other types of bariatric surgery, gastric plication does not involve the use of a medical device or gastric resection to reduce stomach volume. Rather, the procedure involves folding the stomach inside itself and then stitching it up along the greater curvature. The procedure is minimally-invasive and can be reversed.
This study followed the first 120 patients to undergo LGCP at Abou Jaoude Hospital in Beirut, Lebanon. The researchers monitored patients for initial results as well as early complications.
The surgeries, which took place from December 2010 to June 2011, involved 80 women and 40 men with a mean age of 36 years (range 18 to 58 years) and mean BMI of 40.4 (range 30 to 63).
For surgery, patients were placed under anesthesia and the procedure was performed laparoscopically, a minimally invasive surgical technique performed through a series of small openings, using either a five-trocar port (most patients) or four-trocar port (patients with small left liver). One patient was converted to laparotomy (open surgery), a surgical technique involving a large incision through the abdominal wall.
The mean operative time was 65 minutes (range from 45 to 90 minutes) and the mean hospital stay was 36 hours. Out of the 120 treated patients, 112 patients left the hospital after 24 hours; six patients were kept more than one day due to fold edema (swelling); one patient was kept more than one day due to gastric leak; and one patient who underwent open surgery was released from the hospital on postoperative day 4.
The following results were observed in the study:
- The majority of the complications that occurred during surgery were due to laparoscopy and not specific to gastric plication; the primary intraoperative complication was bleeding.
- Early postoperative complications (occurred during the first month after surgery) involved obstruction and leak, specifically related to gastric plication; one patient developed a gastric obstruction that required reoperation, one patient developed a gastric leak that required reoperation, and 6 patients experienced gastric fold edema (swelling), with one that required reoperation and 5 that spontaneously resolved within a few days.
- Some patients experienced nausea (40% of patients), vomiting (25% of patients), excess saliva (22% of patients), and minor vomiting of blood (15% of patients); the symptoms disappeared spontaneously within 4 to 5 days.
- Most patients returned to normal activities 5 to 7 days after surgery.
- None of the patients had any major complications, such as death or blood clots.
- Mean total weight loss (TWL) at one month was 11.2% , at three months was 16%, at six months was 23%.
- Mean percentage of excess weight loss at one month was 30.24% , at three months was 43.9% , at six months was 48.58%.
The researchers conclusion based on study data is that LGCP results in satisfactory short-term weight loss and the complications observed in the study occurred less frequently and were less severe than other bariatric procedures. Long-term results are needed to determine patient outcomes over time and answer questions about weight gain after LGCP.
The study “Early Complications of 120 Laparoscopic Greater Curvature Plication Procedures” by Youssef Andraos, MD; Dany Ziade, MD; Rana Achcouty, MD; and Mariette Awad, PhD was published in Bariatric Times, 2011;8(9):10–15.
The information to date highlights the promise of gastric plication as a safe and effective, minimally-invasive, cost-efficient, restrictive bariatric procedure. At this time it is performed by only a limited amount of bariatric surgeons, but studies are ongoing to learn more about this technique. If you are looking into bariatric surgery, you should discuss all of the available surgical weight loss procedures with your surgeon and determine whether this new procedure or one of the more common options is best for you.