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Phil Schauer, MD Bariatric and Metabolic Institute

Phil Schauer, MD Bariatric and Metabolic Institute. Laparoscopic Gastric Plication. Education and Research Support, Consulting. NIH/NIDDK Ethicon Endosurgery Stryker Corporation Invacare Corporation Covidien Gore Corporation Bard/Davol Corporation Baxter Corporation Cardinal Health

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Phil Schauer, MD Bariatric and Metabolic Institute

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  1. Phil Schauer, MD Bariatric and Metabolic Institute Laparoscopic Gastric Plication

  2. 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

  3. 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

  4. 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

  5. LSG vs. LGCP

  6. Variations in TechniqueLaparoscopic Greater Curvature Plication • Suture Type • Suture Pattern • Suture Spacing • Depth of Fold • Calibration • Use of Endoscopy

  7. Video - Technique

  8. Clinical Studies - Outcomes

  9. OUTCOME OF LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION IN MORBID OBESITYTalebpour M, Amoli B. J Laparo Adv Surg Tech 2007; 17:793-798 N=150, Mean BMI 47 61% 60% 57% 57% 72p 51p 55% 94p 23p 10p

  10. 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

  11. 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

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

  13. Laparoscopic Gastric Plication for the Treatment of Severe ObesityMETHODS • 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

  14. Anterior Plication

  15. Greater Curvature Plication

  16. Anterior Plication 6 months 12 months

  17. 6 months Greater Curvature Plication 12 months

  18. Weight Loss

  19. Comparison to Other Studies

  20. 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

  21. 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)

  22. Skrekas et al. Obes Surg. 2011

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

  24. Plication with Gastric Banding

  25. 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)

  26. MISS 2013: Las VegasFEBRUARY 21-23, 2013 2013 www.miss-cme.org

  27. Thank You

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