1
|
A safety study of laparoscopic single-anastomosis duodeno-ileal bypass with gastric plication (SADI-GP) in the management of morbid obesity. Langenbecks Arch Surg 2021; 407:845-860. [PMID: 34402959 PMCID: PMC8369141 DOI: 10.1007/s00423-021-02276-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Accepted: 07/13/2021] [Indexed: 12/02/2022]
Abstract
Background Bariatric surgery is more effective in the management of morbid obesity and related comorbidities than is conservative therapy. Pylorus-preserving single-anastomosis duodeno-ileal bypass with sleeve gastrectomy (SADI-SG) is a modified duodenal switch technique. Gastric plication (GP) is an alternate to SG. Methods Morbidly obese (BMI of > 40, or > 35 in the presence of diabetes or prediabetes) patients were recruited and operated on to perform SADI with GP. Complications related to surgery were recorded to assess the feasibility of the procedure. Weight-loss outcomes were analysed to determine efficacy. Minnesota Multiphasic Personality Inventory 2 (MMPI-2) was recorded after 1 year of follow-up, and test scales were used to describe physiological phenomena. Results Seventeen middle-aged (mean: 40 years) patients were involved in our study; 15 of them were females. The mean duration of surgery was 205 min. There were no complications of conversion, death, bleeding, VTE or 30-day readmission to hospital. We did experience CD4a (pulmonary insufficiency due to chronic lung disease) and a CD3b (anastomosis leakage treated laparoscopically) complications. Vomiting occurred in three cases (CD1). Obesity-related comorbidities showed favourable resolution rates (77.8% for hypertension, 81.2% for dyslipidaemia, 100% for diabetes at the 1-year follow-up). Weight-loss outcomes were favourable (53.20 EWL%, and 35.58 TWL% at 1-year follow-up). Greater weight loss caused significantly higher levels of Depression (t(13.958) = − 2.373; p = 0.00; p < 0.05) and Low Positive Emotions (t(13.301) = − 2.954; p = 0.00; p < 0.05) and Introversion/Low Positive Emotionality (t(13.408) = − 1.914; p = 0.02; p < 0.05) in MMPI-2 data. Conclusion According to our safety study, SADI-GP is a promising malabsorptive procedure, but a long-term high-volume case series or a randomised controlled trial is necessary to evaluate complication rates and weight-loss outcomes. Emotional dysregulation is common among bariatric surgery patients according to personality inventory data; therefore, psychological follow-up and psychotherapeutic support are necessary for weight-loss maintenance. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02276-9.
Collapse
|
2
|
Li H, Wang J, Wang W, Wang X, Xu Z, Li H, Wu H. Comparison Between Laparoscopic Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication Treatments for Obesity: an Updated Systematic Review and Meta-Analysis. Obes Surg 2021; 31:4142-4158. [PMID: 34227019 DOI: 10.1007/s11695-021-05538-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Revised: 06/13/2021] [Accepted: 06/15/2021] [Indexed: 12/12/2022]
Abstract
Bariatric surgery has been widely performed to treat morbid obesity. Our meta-analysis aims to provide an updated comparison between laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curvature plication (LGCP). Medline, EMBASE, Scopus, and Cochrane Central were searched. Ongoing clinical trials were identified from the clinicaltrials.gov website. References of the chosen literatures were manually reviewed for additional relevant studies. As a result, a total of 18 studies involving 1329 patients were selected. We demonstrated a significant higher excess weight loss (%EWL) after LSG at the 1-, 3-, 6-, 12-, and 18-month follow-up time points. However, no significant difference was found at 36 months. Body Mass Index Loss (BMIL) was better after LSG than LGCP at 12 and 24 months. The difference in the improvement of comorbidities (i.e., T2-DM, hypertension, and sleep apnea) did not reach statistical significance. The complications (i.e., bleeding, stenosis, leak, and abdominal pain), operative time, and length of hospital stay were comparable. More patients undergoing LGCP experienced nausea and vomiting. We obtained some different and new results compared to the previously published meta-analysis. Our meta-analysis showed significantly higher %EWL at 24 months (Z=2.08, p=0.04), significantly higher BMIL at 36 months (Z=9.11, p <0.00001), and significantly higher costs (Z=2.87, p=0.004) in the LSG group. In addition, for the first time, complications (i.e., GERD, wound infection, port-site hernia, and mortality) and improvement of dyslipidemia were compared between the two techniques. According to our pooled data, no significant differences were found in any of the above aspects. In conclusion, LSG is superior to LGCP with regard to providing effective weight loss in the short- and mid-term. LSG has a lower rate of minor complications, but was less effective when considering cost. The two procedures are similar in terms of improvement of comorbidities, major complications, operative time, and length of stay.
Collapse
Affiliation(s)
- Haoran Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
| | - Junfeng Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China.
| | - Weiqiang Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
| | - Xu Wang
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
| | - Zhichao Xu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
| | - Hanwen Li
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
| | - Hai Wu
- Department of Gastrointestinal Surgery, The First Affiliated Hospital of Wannan Medical College, 2 Zheshan West Road, Wuhu, Anhui Province, China
| |
Collapse
|
3
|
El Soueidy T, Kassir R, Nakhoul M, Balian A, Nunziante M, Safieddine M, Perlemuter G, Lainas P, Dagher I. Laparoscopic Greater Curvature Plication for the Treatment of Obesity: a Systematic Review. Obes Surg 2020; 31:1168-1182. [PMID: 33215360 DOI: 10.1007/s11695-020-05112-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/29/2020] [Accepted: 11/10/2020] [Indexed: 12/19/2022]
Abstract
BACKGROUND During the last decade, laparoscopic greater curvature plication (LGCP) has been used as a bariatric procedure for the treatment of obesity, regarded as less invasive and less expensive than other surgical bariatric procedures. We aimed to systematically review the literature and highlight recent clinical data regarding outcomes of LGCP in the treatment of obesity. METHODS A comprehensive research of Pubmed database on LGCP was performed. The search was conducted on the first of May 2020 and was not limited to any date range. Outcomes of interest were surgical technique, postoperative complications, weight loss outcomes, comorbidities improvement or resolution, and revisional surgeries after technical failure or weight regain. RESULTS Fifty-three articles were eligible for inclusion, with 3103 patients undergoing LGCP (mean age: 13.8-55 years). Mean preoperative body mass index (BMI) ranged from 31.2 to 47.8 kg/m2. Mean operative time ranged from 48 to 193 min. Length of hospital stay ranged from 0.75 to 7.2 days. Most studies provided postoperative follow-up up to 12 months. Mean percentage of excess weight loss (%EWL) ranged from 30.2 to 71.1% and 35 to 77.1% at 6 and 12 months post-LGCP, respectively. Only one study followed patients for more than 10 years and mean %EWL at 1, 5, and 10 years was 67%, 55%, and 42%, respectively. CONCLUSION LGCP seems to be an acceptable surgical procedure for the treatment of obesity, especially in centers having a low medical budget. However, most existing comparative studies report superiority of LSG regarding weight loss.
Collapse
Affiliation(s)
- Toni El Soueidy
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, F-92140, Clamart, France
| | - Radwan Kassir
- Department of Bariatric Surgery, CHU de la Réunion, Saint Denis, de la Réunion, France.
| | - Mary Nakhoul
- Department of Gastroenterology, Saint-Joseph Hospital, Paris, France
| | - Axel Balian
- Department of Hepatogastroenterology, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, F-92140, Clamart, France
| | - Marco Nunziante
- Department of Bariatric Surgery, CHU de la Réunion, Saint Denis, de la Réunion, France
| | - Maissa Safieddine
- Methodological Support Unit, INSERM, CIC1410, CHU Felix-Guyon, St-Denis, La Réunion, France
| | - Gabriel Perlemuter
- Department of Hepatogastroenterology, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Panagiotis Lainas
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| | - Ibrahim Dagher
- Department of Minimally Invasive Digestive Surgery, Antoine-Beclere Hospital, Assistance Publique - Hôpitaux de Paris, F-92140, Clamart, France.,Paris-Saclay University, F-91405, Orsay, France
| |
Collapse
|
4
|
How Bad Is "Bad"? A Cost Consideration and Review of Laparoscopic Gastric Plication Versus Laparoscopic Sleeve Gastrectomy. Obes Surg 2020; 31:307-316. [PMID: 33098054 DOI: 10.1007/s11695-020-05018-w] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Revised: 09/15/2020] [Accepted: 09/15/2020] [Indexed: 02/07/2023]
Abstract
BACKGROUND Recent large-scale studies have concluded that laparoscopic sleeve gastrectomy (LSG) is superior to laparoscopic gastric greater curve plication (LGP) in weight loss outcomes and post-operative complications, but LGP is still being performed due to its purported financial advantage. Our analysis provides an investigation of cost at the time of operation, and a consideration of the financial implications of the complications and percentage of reoperation associated with each procedure. METHODS A systematic literature search was performed on the electronic medical databases PubMed and Embase. Extraction of data was performed using a pre-made form which included number of subjects, minor complications and rates, major complications and rates, reoperation rate, percent end weight loss, length of operating time, and length of hospital stay. RESULTS Twenty-eight records were included after screening for inclusion criteria, representing data from 3242 patients (2668 with LGP and 574 with LSG). Minor and major complications of LGP were documented in 28.7% and 7.2% of cases, respectively, and the rate of reoperation was 10.2%. Minor and major complications of LSG were 19.4% and 4.1%, respectively, and the rate of reoperation was 3.3%. Based on analysis of operating time and length of hospital stay means, each LGP operation was calculated to cost $10,730 USD, and LSG cost $14,074. CONCLUSIONS LGP has higher rates of complications and reoperation, and less %EWL compared with LSG. Despite modest initial cost benefit of LGP, when considering costs associated with the complications and reoperations, we conclude that LSG is superior to LGP in outcome and cost-effectiveness.
Collapse
|
5
|
Chahine E, Alkandari M, De Simone B, Dirani M, D'alessandro A, Saikaly E, Gumbs A, Cartillone MC, Crispo L, Chouillard MA, Kassir R, Chouillard E. Weight Regain After Gastric Plication: Reoperative Sleeve Gastrectomy or Roux-en-Y Gastric Bypass?-Analysis of 116 Consecutive Cases. Obes Surg 2020; 30:3982-3987. [PMID: 32557390 DOI: 10.1007/s11695-020-04767-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Revised: 06/02/2020] [Accepted: 06/04/2020] [Indexed: 01/14/2023]
Abstract
PURPOSE In France, laparoscopic gastric plication (GP) has rarely been utilized as a weight loss procedure. Although relatively safe and efficient, its long-term results are still controversial. The goal of this study is to assess the indications and outcomes of revisional surgery post-GP. MATERIALS AND METHODS Between February 2010 and September 2017, patient characteristics undergoing GP were prospectively collected from our database. Failure of conservative treatment or presence of anatomical anomaly explaining weight loss insufficiency was an indication for revisional surgery (RS). RESULTS A total of 300 patients were included, 41 patients were lost to follow-up (13.7%), 124 patients (41.3%) had total weight loss (TWL) > 30%, and 116 patients (38.7%) underwent RS. Revisional procedures were laparoscopic Roux-en-Y gastric bypass (RYGB) in 72 patients (62.1%) and sleeve gastrectomy (SG) in 44 patients (37.9%). The median interval to RS was 29 months. The mean operative time was 60 min for the SG and 125 min for the RYGB (p < 0.0001). Mortality was nil. Significant morbidity occurred in eight patients (6.9%) including 4 non-abdominal complications, 1 gastric leak, 1 case of hemorrhage, 1 case of hematoma, and 1 intra-abdominal abscess. The mean length of hospital stay (LOS) was 2.9 days (range, 1-11) for the SG group vs 3.2 days (range, 2-8) for the RYGB group (p = 0.608). CONCLUSION GP is associated with a relatively high rate of weight regain or insufficient weight loss. When compared to SG, RYGB seems to be the safer revisional procedure with fewer surgical complications.
Collapse
Affiliation(s)
- Elias Chahine
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France.
| | - Mubarak Alkandari
- Department of General Surgery, AlSabah Hospital, Kuwait City, Kuwait
| | - Belinda De Simone
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Mazen Dirani
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Antonio D'alessandro
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Elias Saikaly
- Saint George Hospital University Medical Center, University of Balamand, Beirut, Lebanon
| | - Andrew Gumbs
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Maria Cristina Cartillone
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Luigi Crispo
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Marc Anthony Chouillard
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| | - Radwan Kassir
- Department of General Surgery, CHU Felix-Guyon, St-Denis, La Reunion, France
| | - Elie Chouillard
- Department of Minimally Invasive Surgery, Poissy Saint Germain Medical Center, 10 rue du Champ Gaillard, 78300, Poissy, France
| |
Collapse
|
6
|
Aguiluz Cornejo G, Jelen N, Gangemi A. Robot-Assisted Revisional Surgery of Gastric Greater Curvature Plication to Roux-en-Y Gastric Bypass. Obes Surg 2020; 29:1434-1435. [PMID: 30771150 DOI: 10.1007/s11695-019-03721-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Laparoscopic gastric greater curvature plication (LGGCP) has been presented as an alternative to laparoscopic sleeve gastrectomy (LSG) for reversible reduction of stomach capacity without gastric reduction or stapling. We present a case of a 51-year-old Hispanic female with a BMI of 41.91 kg/m2, who underwent (LGGCP) 5 years previously at another institution. Despite multiple interventions, the patient was unable to successfully lose weight, and the decision was made to reverse the procedure with a robot-assisted Roux-en-Y gastric bypass. The plication was intact extending from the fundus to the antrum, with the sutures incorporated by scarring and fibrotic tissue. Sutures were delicately removed to form a 30-cc pouch, followed by jejuno-jejunal and gastrojejunal anastomosis. The patient tolerated the surgery well and control fluoroscopy was negative for anastomotic leaks, patient was discharged home on POD 2. At the 40-day follow-up, the patient had lost 22 lb., reducing her BMI to 37.64 kg/m2. The 3D vision of the robotic camera and the six degrees of freedom of the robotic instruments seemed to facilitate the challenging dissection of the embedded sutures used for the LGGCP and its overall undoing. However, further volume and data on the robotic approach for this specific revisional procedure are necessary before drawing any definitive conclusions.
Collapse
Affiliation(s)
- Gabriela Aguiluz Cornejo
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA.
| | - Natalia Jelen
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| | - Antonio Gangemi
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, 840 S. Wood Street, Suite 435E (MC 958), Chicago, IL, 60612, USA
| |
Collapse
|
7
|
Li YH, Wang BY, Huang YC, Tsao LC, Chan CP, Huang CY, Chang HC. Clinical Outcomes of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy: a Case-Matched Control Study. Obes Surg 2019; 29:387-393. [PMID: 30251090 DOI: 10.1007/s11695-018-3527-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Laparoscopic greater curvature plication (LGCP) is a new bariatric procedure that is similar to laparoscopic sleeve gastrectomy (LSG) in that it uses a restrictive mechanism. Comparative studies between LGCP and LSG were still limited. The aim of this study was to compare the clinical outcomes of the two procedures based on the same clinical conditions. METHODS From January 2012 to December 2015, 260 patients with morbid obesity underwent LGCP and LSG in a single center. Data on patient demography, operation time, complications, hospital stay, body mass index loss, percentage of excess weight loss (%EWL), and improvement in comorbidities were collected. A propensity-matched analysis, incorporating pre-operative variables, was used to compare the short-term outcomes between LGCP and LSG. RESULTS Propensity matching produced 48 patients in each group. Patients who underwent LGCP were predominately female (75.5%, 41.1% of the LSG patients were female, p = 0.028). Baseline BMI and excess weight were significantly lower in the LGCP group (p < 0.001). The LSG group showed a greater decrease in excess body weight than the LGCP group (LSG, 47.36 ± 12.95% in 3 months, 57.97 ± 19.28% in 6 months, 66.28 ± 25.42% in 12 months; LGCP, 39.67 ± 12.58% in 3 months, 47.40 ± 19.30% in 6 months, 48.02 ± 20.17% in 12 months, p = 0.008, 0.032, 0.010). Perioperative complications and resolution of obesity-related comorbidities were not significantly different between the two groups. CONCLUSION LGCP and LSG are both feasible and safe procedures for surgical weight reduction. In short-term follow-ups, LSG demonstrates a better excess body weight reduction while having perioperative complications similar to LGCP.
Collapse
Affiliation(s)
- Yu-Hsien Li
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Bing-Yen Wang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- School of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
- Institute of Genomics and Bioinformatics, National Chung Hsing University, Taichung, Taiwan
- Center for General Education, MingDao University, Changhua, Taiwan
- Ph.D. Program in Translational Medicine,National Chung Hsing University, Taichung, Taiwan
| | - Yu-Ching Huang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Lien-Cheng Tsao
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Chien-Pin Chan
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Cheng-Yen Huang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan
| | - Hung-Chi Chang
- Department of Surgery, Changhua Christian Hospital, No. 135 Nanxiao St., Changhua City, Changhua County, 500, Taiwan.
| |
Collapse
|
8
|
Perivoliotis K, Sioka E, Katsogridaki G, Zacharoulis D. Laparoscopic Gastric Plication versus Laparoscopic Sleeve Gastrectomy: An Up-to-Date Systematic Review and Meta-Analysis. J Obes 2018; 2018:3617458. [PMID: 30402281 PMCID: PMC6198571 DOI: 10.1155/2018/3617458] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Revised: 08/26/2018] [Accepted: 09/09/2018] [Indexed: 12/26/2022] Open
Abstract
Introduction A meta-analysis was conducted in order to provide an up-to-date comparison of laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric plication (LGP) for morbid obesity. Materials and Methods The PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions were used for the conduction of this study. A systematic literature search was performed in the electronic databases (MEDLINE, CENTRAL, and Web of Science and Scopus). The fixed effects or random effects model was used according to the Cochran Q test. Results Totally, 12 eligible studies were extracted. LSG displayed a statistically significant lower rate of overall complications (OR: 0.35; 95% CI: 0.17, 0.68; p=0.002) and a sustainable higher %EWL through all time endpoints (OR: 4.86, p=0.04; OR: 7.57, p < 0.00001; and OR: 13.74; p < 0.00001). There was no difference between the two techniques in terms of length of hospital stay (p=0.16), operative duration (p=0.81), reoperation rate (p=0.51), and cost (p=0.06). Conclusions LSG was demonstrated to have a lower overall complications and a higher weight loss rate, when compared to LGP. Further RCTs of a higher methodological quality level, with a larger sample size, are required in order to validate these findings.
Collapse
Affiliation(s)
| | - Eleni Sioka
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
| | - Georgia Katsogridaki
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
| | - Dimitrios Zacharoulis
- Department of Surgery, University Hospital of Larissa, Mezourlo, 41110 Larissa, Greece
| |
Collapse
|
9
|
Weight loss and metabolic improvements in obese patients undergoing gastric banding and gastric banded plication: A comparison. Nutrition 2018; 57:290-299. [PMID: 30219686 DOI: 10.1016/j.nut.2018.05.024] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 05/16/2018] [Accepted: 05/25/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVES Obesity is a pandemic health problem. Bariatric surgery is the only efficient method for long-term effective weight loss in subjects with severe obesity. Laparoscopic adjustable gastric banding (LAGB) has been widely applied for weight loss. However, a novel technique called laparoscopic adjustable gastric banded plication (LAGBP) has been proposed as an alternative to LAGB. Surgeons generally consider LAGBP to have a relative advantage on weight loss than that derived from LAGB. This initial study applied various biostatistical models and considered a relative longer observation period to compare the effects of LAGB and LAGBP. METHODS A total of 340 obese patients (290 who underwent LAGB and 50 who underwent LAGBP) with a body mass index of ≥35 kg/m2 and ages 20 to 55 y were recruited from the Division of General Surgery, Taipei Medical University Hospital in Taipei, Taiwan and observed for 24 to 36 mo postoperatively. RESULTS Both surgical procedures resulted in significant weight loss, amelioration of poor glucose metabolism, and decreased serum triacylglycerol levels. However, the trend analysis showed no significant differences between the postoperative effects of LAGB and LAGBP (P for trend = 0.21 for body mass index reduction, 0.13 for total body fat percentage reduction, 0.25-0.29 for glucose metabolism amelioration, and 0.10-0.29 for blood pressure improvement). Improvements in serum total cholesterol and high-density lipoprotein cholesterol levels were observed after LAGB only and LAGBP only, respectively, at 24 mo postoperatively. The Framingham Coronary Heart Disease Risk score also showed significant decrease for patients who underwent LAGB and LAGBP. CONCLUSIONS Both LAGB and LAGBP demonstrated comparable efficacy in reducing body weight and improving metabolic parameters in a 24 to 36 mo follow-up period. LABG showed the ability to reduce systolic blood pressure and LAGBP exhibited triacylglycerol-lowering effects. A longer observational period is needed in future studies.
Collapse
|
10
|
Müller V, Fikatas P, Gül S, Noesser M, Fuehrer KT, Sauer I, Pratschke J, Zorron R. NEW TECHNIQUE FOR OBESITY SURGERY: INTERNAL GASTRIC PLICATION TECHNIQUE USING INTRAGASTRIC SINGLE-PORT (IGS-IGP) IN EXPERIMENTAL MODEL. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2018; 30:60-64. [PMID: 28489173 PMCID: PMC5424691 DOI: 10.1590/0102-6720201700010017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/18/2016] [Accepted: 01/10/2017] [Indexed: 12/16/2022]
Abstract
Background: Bariatric surgery is currently the most effective method to ameliorate co-morbidities as consequence of morbidly obese patients with BMI over 35 kg/m2. Endoscopic techniques have been developed to treat patients with mild obesity and ameliorate comorbidities, but endoscopic skills are needed, beside the costs of the devices. Aim: To report a new technique for internal gastric plication using an intragastric single port device in an experimental swine model. Methods: Twenty experiments using fresh pig cadaver stomachs in a laparoscopic trainer were performed. The procedure was performed as follow in ten pigs: 1) volume measure; 2) insufflation of the stomach with CO2; 3) extroversion of the stomach through the simulator and installation of the single port device (Gelpoint Applied Mini) through a gastrotomy close to the pylorus; 4) performance of four intragastric handsewn 4-point sutures with Prolene 2-0, from the gastric fundus to the antrum; 5) after the performance, the residual volume was measured. Sleeve gastrectomy was also performed in further ten pigs and pre- and post-procedure gastric volume were measured. Results: The internal gastric plication technique was performed successfully in the ten swine experiments. The mean procedure time was 27±4 min. It produced a reduction of gastric volume of a mean of 51%, and sleeve gastrectomy, a mean of 90% in this swine model. Conclusion: The internal gastric plication technique using an intragastric single port device required few skills to perform, had low operative time and achieved good reduction (51%) of gastric volume in an in vitro experimental model.
Collapse
Affiliation(s)
- Verena Müller
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Panagiotis Fikatas
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Safak Gül
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Maximilian Noesser
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Kirs Ten Fuehrer
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Igor Sauer
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Johann Pratschke
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| | - Ricardo Zorron
- Center for Innovative Surgery (ZIC), Center for Bariatric and Metabolic Surgery, Department of General, Visceral and Transplant Surgery, Campus Virchow Klinikum and Department of General, Visceral, Vascular and Thoracic Surgery, Campus Mitte, Charité-Universitätsmedizin, Berlin, Germany
| |
Collapse
|
11
|
Metabolic Effects of Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication: an 18-Month Prospective, Observational, Open-Label Study. Obes Surg 2018; 27:3258-3266. [PMID: 28674838 DOI: 10.1007/s11695-017-2779-2] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND Laparoscopic greater curvature plication (LGCP) is an innovative restrictive technique designed to reduce gastric volume by plication at the region of greater curvature. The long-term efficacy, safety, and the metabolic effects of this procedure are the subject of this study. METHODS One hundred twenty-seven patients were enrolled; 84 underwent laparoscopic sleeve gastrectomy (LSG) and 43, LGCP. LSG and LGCP were then compared during long-term follow-ups in terms of glycemic control, hormone and lipid secretion, and changes in body composition. Measured parameters included serum glucose, triglycerides, high- and low-density lipoprotein cholesterol, testosterone, estradiol, leptin, adiponectin, ghrelin, fatmass, and lean body mass. RESULTS Significant weight-loss and a reduced body composition resulted from either procedure vs. baseline (i.e., pre-surgery), with levels of fasting glucose and glycated hemoglobin also showing statistically significant reductions (at 3 and 18 months for either surgery). Intergroup comparisons for glycemic parameters yielded no statistically significant differences. However, a dramatic reduction in ghrelin was detected following LSG, falling from pre-surgery levels of 140.7 to 69.6 ng/L by 6 months (P < 0.001). Subsequently, ghrelin levels increased, reaching 107.8 ng/L by month 12. Conversely, after LGCP, a statistically significant increase in ghrelin was seen, rising from 130.0 ng/L before surgery to 169.0 ng/L by month 12, followed by a slow decline. CONCLUSIONS Good metabolic outcomes were obtained following LGCP, which might be mediated via altered glucose metabolism and GI hormones. Nevertheless, this method is less effective than LSG, possibly due to its preservation of the entire stomach, including secretory regions.
Collapse
|
12
|
Noun R, Slim R, Chakhtoura G, Gharios J, Chouillard E, Tohmé-Noun C. Resectional One Anastomosis Gastric Bypass/Mini Gastric Bypass as a Novel Option for Revision of Restrictive Procedures: Preliminary Results. J Obes 2018; 2018:4049136. [PMID: 30319821 PMCID: PMC6167600 DOI: 10.1155/2018/4049136] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/27/2018] [Accepted: 07/16/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Revisional surgery is becoming a common and challenging practice in bariatric centers. The aim of this study was to evaluate resectional one anastomosis gastric bypass/mini gastric bypass (R-OAGB/MGB) as a revisional procedure. METHODS From January 2016 to February 2017, data on 21 consecutive patients undergoing R-OAGB/MGB for weight loss failure after primary restrictive procedures were prospectively collected and analysed. RESULTS Mean age was 39 ± 12 years (18-65), and 11 (52.3%) were women. The mean operative time was 96.4 ± 20.9 min (range, 122-80), and the mean postoperative stay was 47.8 ± 7.4 hours (range, 36-73). There were no deaths and no procedure-related complications. The mean body mass index (BMI) decreased from 42.9 ± 6.5 at the time of R-OAGB/MGB to 28.5 ± 4 at the 12-month follow-up. At that time point, the mean percentage of BMI loss (%EBL) and the mean percentage of total body weight loss (%TWL) reached 81.6 ± 0.17% and 35 ± 0.01%, respectively. CONCLUSION R-OAGB/MGB was technically straightforward, effective, and safe in this at-surgical risk population. R-OAGB/MGB should be added to the armamentarium of revisional bariatric procedures considering its technical aspects and the potential advantage on weight loss.
Collapse
Affiliation(s)
- Roger Noun
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, University Saint Joseph Medical School, Beirut 166830, Lebanon
| | - Rita Slim
- Dapartment of Gastroenterology, Hôtel-Dieu de France Hospital, University Saint Joseph Medical School, Beirut 166830, Lebanon
| | - Ghassan Chakhtoura
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, University Saint Joseph Medical School, Beirut 166830, Lebanon
| | - Joseph Gharios
- Department of Digestive Surgery, Hôtel-Dieu de France Hospital, University Saint Joseph Medical School, Beirut 166830, Lebanon
| | - Elie Chouillard
- Department of Digestive Surgery, Poissy/Saint-Germain Medical Center, Université de Versailles/Saint-Quentin en Yvelines, Poissy, France
| | - Carla Tohmé-Noun
- Department of Imaging, Clinique du Levant, University Saint Joseph Medical School, Beirut 50226, Lebanon
| |
Collapse
|
13
|
Ye Q, Chen Y, Zhan X, Wang Y, Zhu J. Comparison of Laparoscopic Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication Regarding Efficacy and Safety: a Meta-Analysis. Obes Surg 2017; 27:1358-1364. [PMID: 28281232 DOI: 10.1007/s11695-017-2630-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Laparoscopic sleeve gastrectomy (LSG) and laparoscopic greater curvature plication (LGCP) are two restrictive bariatric procedures. Eight studies (three randomized, controlled trials, four retrospective studies, and one prospective study) with 536 patients on LSG and LGCP were included by searching PUBMED, EMBASE, and the Cochrane Library. The software Review Manager 5.3 was used to evaluate operation time, adverse events, percent excess weight loss (%EWL), resolution of obesity-related comorbidities, and postoperative hospital stay. Despite the limitations, this meta-analysis suggests that LSG is superior to LGCP in terms of providing greater %EWL at the follow-up of 3, 6, and 12 months and 3 years. LSG gains shorter postoperative hospital stay than LGCP. No significant difference was found in operation time, adverse events, and the resolution of obesity-related comorbidities.
Collapse
Affiliation(s)
- Qinghuang Ye
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yan Chen
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Xiaoli Zhan
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Yuedong Wang
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China
| | - Jinhui Zhu
- Department of General Surgery and Laparoscopic Center, Second Affiliated Hospital, Zhejiang University School of Medicine, 88 Jiefang Road, Hangzhou, 310009, China.
| |
Collapse
|
14
|
Ye M, Huang R, Min Z, Zhang P, Wang T, Yu B. Comparison of the effect by which gastric plication and sleeve gastrectomy procedures alter metabolic and physical parameters in an obese type 2 diabetes rodent model. Surg Obes Relat Dis 2017. [DOI: 10.1016/j.soard.2017.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
|
15
|
Park YH, Kim SM. Short-Term Outcomes of Laparoscopic Greater Curvature Plication and Laparoscopic Sleeve Gastrectomy in Patients with a Body Mass Index of 30 to 35 kg/m². Yonsei Med J 2017; 58:1025-1030. [PMID: 28792149 PMCID: PMC5552630 DOI: 10.3349/ymj.2017.58.5.1025] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2017] [Revised: 03/29/2017] [Accepted: 04/26/2017] [Indexed: 01/08/2023] Open
Abstract
PURPOSE The aim of this study was the compare the midterm outcomes of laparoscopic greater curvature plication (LGCP) and laparoscopic sleeve gastrectomy (LSG) in obese patients with a body mass index (BMI) of 30 to 35 kg/m². MATERIALS AND METHODS This single center, retrospective review of prospectively collected data was conducted for obese patients that underwent LGCP or LSG from March 2013 to February 2016. These two patient groups were compared in terms of demographics, perioperative outcomes, weight loss [percent excess weight loss (%EWL)], comorbidity resolution, and immediate and long-term complications. RESULTS A total of 149 patients were eligible for the study. Seventy-five patients underwent LGCP (group A) and 74 LSG (group B). These two groups were matched for age, gender, and baseline BMI. Three patients in each group were readmitted for complications within 30 days postoperatively. %EWL in groups A and B were 51.1±16.9 and 47.8±20.8 at 3 months (p=0.084), 71.1±20.2 and 74.5±21.8 at 6 months (p=0.165), 77.1±18.4 and 87.8±25.1 at 12 months (p=0.002), 70.5±18.5 and 83.4±28.7 at 24 months (p=0.005), and 67.3±15.3 and 78.6±31.7 at 36 months (p=0.054), respectively. Intergroup differences in resolution rates of metabolic comorbidities between the two groups were not significant. CONCLUSION Although mean weight loss after LGCP was inferior to that after LSG, especially after six months postoperatively, it was acceptable, and LGCP had an excellent metabolic comorbidity resolution rate in patients with BMIs, ranging from 30 to 35 kg/m².
Collapse
Affiliation(s)
- Yeon Ho Park
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea
| | - Seong Min Kim
- Department of Surgery, Gil Medical Center, Gachon University of Medicine and Science, Incheon, Korea.
| |
Collapse
|
16
|
Talebpour M, Ghiasnejad Omrani N, Imani F, Shariat Moharari R, Pourfakhr P, Khajavi MR. Comparison Effect of Promethazine/Dexamethasone and Metoclopramide /Dexamethasone on Postoperative Nausea and Vomiting after Laparascopic Gastric Placation: A Randomized Clinical Trial. Anesth Pain Med 2017; 7:e57810. [PMID: 29226110 PMCID: PMC5712203 DOI: 10.5812/aapm.57810] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2017] [Revised: 04/18/2017] [Accepted: 05/14/2017] [Indexed: 11/16/2022] Open
Abstract
Background Laparoscopic gastric plication (LGP) is a technique in the restrictive category of bariatric procedures that reduces the gastric volume and increases intragastric pressure. Nausea and vomiting are the most common complications after this procedure. The goal of this research is to compare the combined effect of promethazine/dexamethasone versus Metoclopramide/ dexamethasone on the prevention of nausea and vomiting after LGP. Methods In recovery, the patients were divided into two groups, the Metoclopramide group which was given Metoclopramide 10 mg plus dexamethasone 4 mg/8 hours intravenous for 48 hours, and the promethazine group which was given promethazine 50 mg /12 hours, intramuscular for the first 24 hours and then promethazine 25 mg/12 hours for the next 24 hours plus dexamethasone 4 mg/8 hours intravenous for 48 hours. The frequency of nausea and vomiting, number of reflux episodes, frequency of epigastric fullness, and the duration of walking around q12 hours were recorded in the first 48 hours post-operation. Results Eighty patients were enrolled into the study. Promethazine group were found to significantly reduce the incidence of PONV in the first 24 hours compared with the other group (41% vs. 97.5%), relative risk = 0.042 [95% CI = 0.006, 0.299]. The mean numbers of epigastric fullness and severity of epigastria pain were lower in the promethazine group (P = 0.01) and the total opioid requirement was also reduced in promethazine group (32.1 ± 2.6 VS .68.5 ± 4.6 mg). However, the patients in the promethazine group were more sedated, which caused the duration of walking q12 hours in this group to decrease. Conclusions In morbidly obese patients undergoing laparoscopic gastric plication, promethazine/dexametasone was more effective than Metoclopramide/dexametasone in preventing and reducing the incidence of nausea, epigastric fullness, and reflux. That combination was also more effective than Metoclopramide in reducing the severity of epigastric pain.
Collapse
Affiliation(s)
- Mohammad Talebpour
- MD, Department of Surgery, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran
| | - Naser Ghiasnejad Omrani
- MD, Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran
| | - Farsad Imani
- MD, Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran
| | - Reza Shariat Moharari
- MD, Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran
| | - Pejman Pourfakhr
- MD, Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran
| | - Mohammad Reza Khajavi
- MD, Department of Anesthesiology, Tehran University of Medical Sciences, Sina Hospital, Hassan Abad Square, Tehran, Iran
- Corresponding author: Mohammad Reza Khajavi, Sina Hospital, Tehran University of Medical Sciences, Hassan Abad sq, Zip Code: 1136746911, Tehran, Iran. Tel: +98-9123837096, Fax: +98-2166348550, E-mail:
| |
Collapse
|
17
|
Zerrweck C, Rodríguez JG, Aramburo E, Vizcarra R, Rodríguez JL, Solórzano A, Maydón HG, Sepúlveda EM. Revisional Surgery Following Laparoscopic Gastric Plication. Obes Surg 2017; 27:38-43. [PMID: 27220850 DOI: 10.1007/s11695-016-2242-9] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND The laparoscopic gastric plication (LGP) is a relative new bariatric procedure that has gained popularity over the last few years, but no real consensus exists and the evidence is unclear, especially in its real efficacy, safety, and durability. METHODS Retrospective study analyzing the records patients submitted to LGP between 2009 and 2010. The primary objective was to describe the characteristics and outcomes of patients submitted to revisional surgery. Baseline data and evolution were obtained and analyzed. Surgical analysis included revision cause, perioperative outcome, type of surgery, complications, and weight loss after 18 months. A comparison between gastric bypass and sleeve gastrectomy was performed. RESULTS One hundred LGP were performed. After a mean time of 13.5 months, 42 patients presented an overall excess weight loss (EWL) <50 % and 38 had severe symptoms. Thirty patients accepted revisional surgery with BMI before conversion of 38.6 ± 4.2 kg/m2. There were 17 laparoscopic sleeve gastrectomy (LSG) and 13 laparoscopic gastric bypass (LGBP) with comparable preoperative characteristics. The LSG group had lower pneumoperitoneum time and less hospital stay. At 18 months, the LGBP group had lower BMI (24.1 ± 1.1 vs. 25.8 ± 1.3 kg/m2 for the LSG; p = 0.006) and higher %EWL (75.7 ± 16.1 vs. 61.4 ± 14.5 % for the LSG; p = 0.008). CONCLUSION In our series, LGP presented a high failure rate and an increased number of symptomatic patients. Revisional surgery proved to be safe and effective. Revision to LSG was faster and had less hospital stay. Revision to LGBP showed better %EWL at 18 months.
Collapse
Affiliation(s)
- Carlos Zerrweck
- The Obesity Clinic at "Hospital General Tláhuac", Mexico City, Mexico
| | - José G Rodríguez
- The Obesity Clinic at "Star Médica Hospital", Calle Paseo de la Victoria 4370, Partido Iglesias, 32618, City of Juárez, Chihuahua, Mexico.
| | - Elmo Aramburo
- The Obesity Clinic at "Star Médica Hospital", Calle Paseo de la Victoria 4370, Partido Iglesias, 32618, City of Juárez, Chihuahua, Mexico
| | - Rafael Vizcarra
- The Obesity Clinic at "Star Médica Hospital", Calle Paseo de la Victoria 4370, Partido Iglesias, 32618, City of Juárez, Chihuahua, Mexico
| | - José L Rodríguez
- The Obesity Clinic at "Star Médica Hospital", Calle Paseo de la Victoria 4370, Partido Iglesias, 32618, City of Juárez, Chihuahua, Mexico
| | - Andrea Solórzano
- The Obesity Clinic at "Star Médica Hospital", Calle Paseo de la Victoria 4370, Partido Iglesias, 32618, City of Juárez, Chihuahua, Mexico
| | - Hernán G Maydón
- The Obesity Clinic at "Hospital General Tláhuac", Mexico City, Mexico
| | - Elisa M Sepúlveda
- The Obesity Clinic at "Hospital General Tláhuac", Mexico City, Mexico
| |
Collapse
|
18
|
Abstract
Obesity in children and adolescents is a severe health, psychosocial, and economic problem. Treatment of obesity should be based on the physiology, biochemistry, and genetics of the disease. Treatment is designed to prevent the comorbidities of obesity and allow a healthy, high-quality, and productive life. Treatment is based on healthy living and usually involves tools such as pharmacotherapy, medical device therapy, and bariatric surgery. Bariatric surgery is not acceptable to most patients, parents, primary care providers, and payers. The most successful treatment of obesity follows a chronic disease model, provides a continuum of care, and involves many different disciplines.
Collapse
|