Short-Term Outcomes of Laparoscopic Gastric Plication in Morbidly Obese Patients: Importance of Postoperative Follow-up
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CLINICAL REPORT
Short-Term Outcomes of Laparoscopic Gastric Plication in Morbidly Obese Patients: Importance of Postoperative Follow-up Mani Niazi & Ali Reza Maleki & Mohammad Talebpour
Published online: 25 September 2012 # Springer Science+Business Media, LLC 2012
Abstract Demand for feasible, safe, and preferably lowcost methods of weight reduction is rising every day. The present study reports findings from laparoscopic gastric plication (LGP), which is a new restrictive bariatric technique, combined with a postoperative follow-up program. A 2-year prospective study was performed following LGP in 53 female morbidly obese patients from Gorgan, Iran, with a mean age of 36.3 years and mean body mass index (BMI) of 42.6 kg/m2 (35.3–62.4). Through a four-port approach, the greater omentum and short gastric vessels were transected and the greater curvature was imbricated into the body of the stomach with two rows of nonabsorbable sutures. After surgery, all patients were scheduled to attend a weekly group meeting for behavioral modification and psychotherapy. The mean operative time and hospital stay was 95 min and 72 h, respectively. No intraoperative complications occurred. Mean percentages of excess weight loss (%EWL)
were 25.6 %, 54.2 %, 70.2 %, and 74.4 % after 1, 6, 12, and 24 months, respectively. Six patients lost >84 % of their excess weight after 24 months. Patients who did not participate in the group meetings had a lower %EWL after 12 (79.5 % vs. 55.6 %) and 24 months (90 % vs. 43.4 %) compared with the patients who regularly participated in the group meetings (P40 kg/m2 or >35 kg/m2 with at least one comorbidity and an absence of psychological conditions that influence his/her perception of the study protocol and postoperative evaluations and recommendations. All recruited patients underwent a presurgical evaluation, including consultations with a cardiologist, psychologist, and nutritionist plus routine laboratory tests. All procedures were performed by the same surgeon (M.N.) at Kapri Surgical Center and Falsafi Hospital in Gorgan, north of Iran. All participants signed informed consent forms. The ethics committee of Golestan University of Medical Sciences approved the study protocol.
OBES SURG (2013) 23:87–92
Surgical Procedure All patients were placed in the supine, 30° reverse Trendelenburg position. Pneumoperitoneum was established by midaxillary, left subcostal insertion of a Veress needle. The first trocar was placed at the left paramedian line 20 cm below the xyphoid angle. The left and right hands of the surgeon's trocars were inserted based on ergonomic assessment at this stage (left middle axillary subcostal line and right midclavicular line 5 cm above the first trocar). The surgeon's assistant's trocar was inserted at the right anterior axillary line. Three 5-mm and one 10-mm trocar were almost always used. Dissection started at the greater curvature of the stomach from the middle of the antrum and continued until 2 cm distal to the angle of His, preserving the anatomy of the angle and th
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