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IN THE NAME OF GOD

IN THE NAME OF GOD. Dr Mohammad Talebpour Advanced Laparoscopic Fellowship Tehran University of Medical Science. 7 YEARS OUTCOME OF LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION ( tVgp ) IN MORBID OBESITY. Disease Incidence Diet & Exercise: <10% Surgery: Restrictive, Mal absorptive

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. Dr Mohammad Talebpour Advanced Laparoscopic Fellowship Tehran University of Medical Science 7 YEARS OUTCOME OF LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION(tVgp) IN MORBID OBESITY

  3. Disease Incidence Diet & Exercise: <10% Surgery: Restrictive, Mal absorptive New method: TVGP Aim: Report of results after 7 years follow up MORBID OBESITY

  4. RESTRICTIVE: EARLY MORBID OBESITY WITH COOPERATION (320 TVGP) • MIXED: LATE MORBID OBESITY WITH COOPERATION, (24 GB) OMEGA ANASTHOMOSIS CONTINOUS HAND SWEN NYLON 00 • MALABSORPTIVE: MORBID OBESITY WITHOUT COOPERATION (14 ILEOJEJUNAL BYPASS) TECHNIQUE SELECTION

  5. Supine position Trocars: 10 mm (one), 5 mm (three) Ergonomy Greater curvature release by ligature Angle of Hiss preserve Plication at greater curvature by continuous suture 00 nylon From cardia to 5 cm of pylorus METHOD OF TGVP

  6. False positive sense of thirsty Effective volume of stomach: 50 cc Pain or reflux secondary to more intake Gradually dilation of remnant volume (2 to 4 years) 50 cc to 200 cc Psychological control to continue diet RESULT OF METHOD

  7. 320 cases during 7 years 270 cases followed by standard control visits EWL : 28% to 95%, 6 months, wide range result

  8. 7 YEARS OUTCOME OF TVGP

  9. Regain: less than 20% EWL • 12 cases, more than 2 years during 7 years • Total cases more than 2 years 110 (10.9%) • 3 cases, due to pregnancy and feeding • 2 cases heavy drinker • 4 cases psychological drugs • 3 cases increase of appetite • 3 cases replication • 4 cases ileojejunal bypass laparoscopic • 1 case gastric banding • 1 case, is feeding her baby • 3 cases waiting rEGAIN

  10. Morbidity: 4 cases Liver hematoma Jaundice (drug hepatitis, 2 cases) Hypocalcaemia Mortality: zero Re operation: 5 cases Leak of suture line: 2 cases Acute gastric perforation Stricture at suture line Permanent vomiting secondary to adhesion RESULT

  11. BMI>40 or 35 and comorbidity Cases over 70% EWL (until 2 years) included Follow up: Every week (first month) Every two weeks (next 5 months) Every month (next 18 months) 10 factors: Age Sex Marriage, Appetite Job, Relatives Group club Co morbidity Pain during eating Volume residue WHO DOES GET THE BEST RESULT?

  12. Young, Female, Single, Group club • Gaining the best result is not essentially related to the form of operation • It is secondary to some other factors that increase the interest of patient to use diet and exercise (incentive) • The main goal is change of mind IMPORTANT FACTORS

  13. Laparoscopic Conservative Low price Reversible Volume residue: 50 cc EWL: 60% during 6 month Unrelated to technique morbidity: 2% Reoperation: 2% Regain: (10.9%) reoperation with different methods Safe alternative between restrictive operations ADVANTAGE

  14. Invasiveness of methods

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