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LGCP

Laparoscopic GreaterCurvature Plication (LGCP)LGCP is an emerging procedure that requires additional studies to assesslong-term efficacy. Initial studies suggest that LGCP may provide effective surgicalweight loss with a potentially lower risk profile than other bariatric procedures.

According to the CDC, there are about 72 million adults1 Only 1% of the clinically eligible population is being treated for morbid obesity through bariatric surgery2.

Some patient constraints to bariatric surgery include:

• Risks associated with current procedures

• Invasiveness of current procedures

• Costs of current procedures

What is LGCP?Laparoscopic Greater Curvature Plication (LGCP) is an emerging bariatric weight loss procedure similar to vertical sleeve gastrectomy (VSG) but without the need for gastric resection or disruption to normal anatomy.

According to Ramos et al, it is a bariatric procedure that brings together the benefits of food restriction without the possible complications associated with a permanent implant while also minimizing the possibility of leaks from the rupture of staple lines.3

In the procedure, the stomach is reduced by dissecting the greater omentum and short gastric vessels, as in VSG, and the greater curvature is invaginated using multiple rows of non-absorbable sutures performed over a bougie or endoscope to ensure a patent lumen.3

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LGCP Procedure Overview• During LGCP, a laparoscope is inserted to visualize the surgical area and confirm absence of iatrogenic injury to any surrounding organ or structure. Based upon surgeon discretion, a flexible endoscope may be passed into the gastric lumen for inspection and to provide gastric

• The greater curvature of the stomach is separated from the greater omentum. Mobilization of the stomach permits access to both the anterior and posterior surfaces of the stomach. Adhesions to the posterior surface of the stomach may be transected as needed.

• At least two rows of stitches are placed laparoscopically about the greater curvature of the stomach starting at or near the angle of His and ending in the antrum.

• An endoscope or bougie can be used during the procedure to ensure lumen patency.

LEARN MORE ABOUT LGCPTo learn more about LGCP, view a case, and review publications, visit www.EESadvancements.com.

REFERENCES1. United States. Department of Health and Human Services. Center for Disease Control and Prevention. Halting the Epidemic by Making Health Easier. Atlanta, GA. Revised February 2009. Print.

2. American Society for Bariatric and Metabolic Surgery (ASMBS) Fact Sheet. June 2010. Web. Sep 2, 2010.

3. Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure. Obes Surg 2010; 20 (7): 913-918.

4. Brethauer SA, Harris JL, Kroh M et al. Laparoscopic gastric plication for the treatment of severe obesity, Abstract. Surgery for Obesity and Related Diseases May 2010:6(3):S16.

5. Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A 2007;17(6):793–8. [DSL 09-1251]

6. Brethauer SA, Harris JL, Chand B, Kroh M, Rogula T, Schauer PR. Initial results of vertical gastric plication for severe obesity. Society of American Gastrointestinal and Endoscopic Surgeons. Phoenix, Arizona. April 22-25, 2009. [DSL 09-1253]

7. Brethauer S. Gastric Plication as a Bariatric Procedure. Minimally Invasive Surgery Symposium. San Diego, CA. Feb 22-27. [DSL 10-0256]

The fold creates a narrowed gastric lumen to accommodate smaller bolus of food.

Patient PopulationClinical studies for LGCP to date include patients who met American Society for Metabolic and Bariatric Surgery (ASMBS) and National Institutes of Health (NIH) guidelines for other surgical weight loss procedures. Studies referenced in this overview include 42 patients with a mean BMI of 35 to 463, nine patients with an average BMI of 43.54, and 100 patients with an average BMI of 475.

Potential AdvantagesLGCP is a promising bariatric procedure. Early clinical studies demonstrate LGCP to

term when applied to morbidly obese patients.

POSSIBLE ADVANTAGES INCLUDE:

• Reduced risk of gastric leaks3,5, when compared with bariatric procedures that include gastric resection, gastric banding, or gastric transection

• 3,4,5,6,7

• Potentially lower cost, compared to other bariatric weight loss procedures

• Potential to reduce length of stay after procedure, compared to RYGB and sleeve gastrectomy

• Potential for fewer follow-up visits, compared to gastric band patients

LGCP

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