Laparoscopic Greater Curve Plication as an Outpatient Weight Loss Procedure

Laparoscopic Greater Curvature Plication for the Treatment of Obesity: a Systematic Review

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.

How Bad Is "Bad"? A Cost Consideration and Review of Laparoscopic Gastric Plication Versus Laparoscopic Sleeve Gastrectomy

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.

Laparoscopic Gastric Plication versus Laparoscopic Sleeve Gastrectomy: An Up-to-Date Systematic Review and Meta-Analysis

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.