phil schauer, md bariatric and metabolic institute

Phil Schauer, MDBariatric and Metabolic Institute

Education and Research Support, Consulting

• NIH/NIDDK• Ethicon Endosurgery • Stryker Corporation• Invacare Corporation• Covidien• Gore Corporation• Bard/Davol Corporation• Baxter Corporation• Cardinal Health• Surgical Excellence• Barosense• ReMedyMD• SurgiQuest• Quadrant

www.ccf.org

Laparoscopic Gastric Plication

No stomach stapling or removal low leak risk, low bleeding risk

No bypass minimal nutritional risk no bowel re-routing

No foreign body (i.e. band) no prolapse or erosion risk

Potentially reversible or modifiable to another procedure if needed

Minimally invasive; short stay

Lower cost

LGCP Normal Endoscopic Appearance

• Invagination of the greater curvature results in decreased intraluminal gastric volume

• Normal, intact plication results in lobular contour abnormalities and intraluminal filling defects on imaging

LSG vs. LGCP

Variations in TechniqueLaparoscopic Greater Curvature

Plication• Suture Type• Suture Pattern• Suture Spacing• Depth of Fold• Calibration• Use of Endoscopy

Video - Technique

Clinical Studies - Outcomes

OUTCOME OF LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION IN MORBID OBESITY

Talebpour M, Amoli B. J Laparo Adv Surg Tech 2007; 17:793-798

5052545658606264666870

6m 1y 2y 3y 4y

%EW

L

TVGP – WEI GHT LOSS

94p

72p 51p

23p10p

57%

61%60%

57%55%

N=150, Mean BMI 47

– N = 100

– Age 15-64 y

– BMI 31.64 - 45.09 kg/m2 Mean=37.47Kg/m2

– Results at 1 year:

– Mean weight loss 26.4 +/- 8.7 kg (13-51 kg)

– Mean %EWL 69.6 +/- 7.44 (6.2 – 95.6)

– No reported complication or mortality

Laparoscopic Greater Curve PlicationRamos et al. Obes Surg 2010 Jul;20(7):913-8

• 42 patients• Mean BMI 41 kg/m2

• Mean operative time 50 minutes• Mean length of stay 36 hours• No major complications• Mean 62% EWL at 18 months

Brethauer SA et al. SOARD 2011 7:15-22

Laparoscopic Gastric Plication for the Treatment of Severe Obesity

METHODS• IRB approval obtained for this investigational

procedure• 15 patients (three male)• Mean preop BMI 43.5 (36.9 – 49.0)• 9 patients underwent anterior surface plication• 6 patients underwent greater curvature plication (gcp)

Brethauer SA et al. SOARD 2011 7:15-22

Anterior Plication6 months 12 months

6 months 12 months

Greater Curvature Plication

Weight Loss

Procedure

Three Months Twelve Months N Δ BMI %EWL N Δ BMI %EWL

Anterior 9 -4.8 +/- 1.4

23.0 +/- 6.4

7* - 4.3 +/- 4.5

19.8 +/- 19.3 **

Greater Curvature

6 -7.8 +/- 1.5 38.9 +/- 8.2

6 -10.9 +/- 5.5

53.9 +/- 22.3

* 2 patients lost to follow-up ** Data from 2 patients collected after scheduled 12 month visit

Comparison to Other Studies

Complications• No bleeding or infectious complications• First GCP patient required reoperation and

plication reduction on POD#2 due to gastric obstruction

• Mild to moderate nausea in all patients (2 severe). • Resolved within two weeks.

• One GCP patient required laparoscopic cholecystectomy 11 months after procedure

Brethauer SA et al. SOARD 2011 7:15-22

Laparoscopic Gastric Greater Curvature Plication: Results and Complications in a Series

of 135 PatientsSkrekas et al. Obes Surg. 2011 Nov;21(11):1657-63.

• April 2008 – December 2009• One or two-layer plication over 36 Fr Bougie• Mean OR time 40-50 minutes• Mean LOS 1.9 days (1-6)• Mean F/U 22 mos (8-31)

Skrekas et al. Obes Surg. 2011

Multicenter Trial Underway• 3 centers• 45 patients• 3 year follow-up• All sutured Greater Curve Plication• Standardized technique• Enrollment complete

Plication with Gastric Banding

Laparoscopic Gastric PlicationSummary

• Anterior Plication safe, but not effective• Greater Curve Plication

– Technically feasible, reproducible– Good short-term weight loss – Low major complication rate– Remains investigational (ASMBS Position Statement)

MISS 2013: Las VegasFEBRUARY 21-23, 2013

Year Venue

2001 Snowbird, UT

2002 Beaver Run, Breckenridge, CO

2003 Squaw Creek, Lake Tahoe, Calif

2004 Whistler, British Columbia

2005 Squaw Creek, Lake Tahoe, Calif

2006 Vail Cascade, CO

2007 Snowbird, UT

2008 Steamboat, CO

2009 Harrah’s, Lake Tahoe, NE

2010 Marriott Marina, San Diego, Calif

2011 Grand America Hotel, Salt Lake City

2012 Grand America Hotel, Salt Lake City

2013

www.miss-cme.org

Thank You