phil schauer, md bariatric and metabolic institute
TRANSCRIPT
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