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Experience with 458 cases of Gastric Plication Surgery Dr Ariel Ortíz Lagardere ,FACS.

Experience with 458 cases of Gastric Plication Surgery Dr Ariel Ortíz Lagardere ,FACS. Obesity Control Center hospital, México. New procedure?. Similar to sleeve gastrectomy Stomach Sparing Less risk leak No need implant/adjustments/stapling Literature can be found early 1900’s

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Experience with 458 cases of Gastric Plication Surgery Dr Ariel Ortíz Lagardere ,FACS.

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  1. Experience with 458 cases of Gastric Plication Surgery Dr Ariel OrtízLagardere ,FACS. Obesity Control Center hospital, México

  2. New procedure? • Similar to sleeve gastrectomy • Stomach Sparing • Less risk leak • No need implant/adjustments/stapling • Literature can be found early 1900’s • 2001 Dr Talebpour. Ortiz-Lagardere, MISS 2012

  3. Band/Plication per Month Ortiz-Lagardere, MISS 2012 Presented IFSO 2011.

  4. Patients • 458 total (07/2010 to 12/2011) • Primary/Revision : 429/29 • Gender : 370 Female, 88 male • Age: 42.7 years (Range 16-71) Ortiz-Lagardere, MISS 2012

  5. BMI

  6. Gastric Plication Ortiz-Lagardere, MISS 2012 . N=458 Surgical time 41 min. ( 26 to 145 min.) Hospital stay 23 hours ( 6 hrs. to 5 days) 0% mortality 0% conversion 2% Re-operation 8% “Re-plication”

  7. Early Symptoms after Gastric Plication Surgery OCC Ortiz-Lagardere, MISS 2012

  8. Symptoms 1 to 8 weeks after surgery Ortiz-Lagardere. 25.3%

  9. “Acid Reflux” • After 6 month follow-up of 278 patients, 68 (24.4%) of patients reported persistent heartburn 37 patients continuous PPI 27 Intermittent use of PPI or other antacids 4 severe (2 resulted in re-operation) • Disphagia to solids 2%

  10. %EWL Primary Plication 182

  11. % EWL longitudinal assessment Jul/10 to Aug/11 272 patients (Primary Plication) 53.4% 48.5% Patients 7 25 23 31 37 35 41 39 34 Ortiz-Lagardere, Presented in IFSO 2011

  12. Co-morbidities at 6 months Patients diagnosed with: • Type II Diabetes • High blood pressure • Sleep apnea • Asthma

  13. Complications Early • 9 obstructions (6 surgical). • 2 bleeding (short gastric vessels) • 1 Intolerance persistent hiccups' • 1 wall hematoma • 1 sub-diaphragmatic lymphatic collection. Ortiz-Lagardere, MISS 2012

  14. Complications Delayed • 9 Bleeding ulcers (2 to 6 months after surgery) • 5 Transfusion • All: sucralfate and PPI • 2 perforated ulcers • Distal gastrectomy • 1 gastric wall hernia (ischemia, no perforation). • Reversal • No obstruction. Ortiz-Lagardere, MISS 2012

  15. Gastric plication suture line hernia

  16. Large ulcer in plicated antrum

  17. Revisions from LAGB 29 patients • LAGB conversions • 27 female, 2 male • Age 44 years • BMI 38.7 Kg/m² • Surgery time 68 min • Mortality 0% • Morbidity 1 obstruction • 15 (52%) Plication revisions • 1 conversion to LAGB . • %EWL 32% Ortiz-Lagardere, MISS 2012

  18. “Re-plications” • Total 36 patients (34 female/2 male) 15 conversions from LAGB • Chief complaint : loss of restriction • Surgery Time 55 min ( 25 to 220 minutes) • Complication 0% • Hospital stay 22 hours

  19. “Re-plication” 67 patients 218 patients

  20. “Re-plication” 10 patients 16 patients

  21. Surgical Technique Plication of the stomach • Where to start, proximal to distal or distal to proximal? • One, two or three suture planes?. • What are the ideal suture material(s) for each plane? • Size bougie and calibration?

  22. Laplace’s Law The tension on the wall of a sphere is the product of the pressure times the radius of the chamber and the tension is inversely related to the thickness of the wall. Ortiz-Lagardere, IFSO 2011

  23. Sutures in plication surgery OCC

  24. 1st Ethibond Plane 1cm apart

  25. 1st Plication plane 3 to 4 cm apart.

  26. 2nd Plane 1-0 Prolane

  27. Distal anchor polymer clip

  28. Symmetry and sleeve like stomach.

  29. The learning curve Ortiz-Lagardere, IFSO 2011 Aug. 2010- Feb. 2011 150 Plication (18 revision) • Surg. Time: 54 minutes • Hospital stay: 28 hr. • Mortality 0% • Complication • Early 5% • Postoperative nausea and or vomiting 34% • 5 Re-operation for obstruction • 24 Re-plication Mar. 2011-Jul 2011 250 Plication (5 revision) • Surg. time: 37 minutes • Hospital stay: 21 hr. • Mortality 0% • Complication • Early 1% • Postoperative nausea and or vomiting 7% • 1 reoperation for obstruction

  30. Technique Requirements • Symmetrical • Start at the Angle of His • Containment suture • Evenly spaced suture • Even pressure calibration • Distal plication Ortiz-Lagardere, IFSO 2011

  31. complication Ortiz-Lagardere, IFSO 2011

  32. Conclusions • Still experimental • Requires standardization of technique • Requires long term follow-up • Study mechanisms Ortiz-Lagardere, MISS 2012

  33. Conclusions • Low complication rate • Acceptable short term weight-loss • Long learning curve • Surgeon dependent • Patient acceptance Ortiz-Lagardere, MISS 2012

  34. Thank you.

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