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Greater curvature plication

LGGCP improves comorbidities but majority regain weight

Futures studies should assess the possibility of association between weight regain observed in such patients and an increase in the size of the gastric pouch

Laparoscopic gastric greater curvature plication (LGGCP) has ‘acceptable’ short-term weight loss and improved patients’ comorbidities however, some patients regained weight, according to researchers from Qatar and published in the Journal of Obesity.

The researchers from the Hamad General Hospital, Cornell Medicine-Qatar, Qatar Metabolic Institute, Qatar University, Doha, Qatar, and the University of Skövde, Skövde, Sweden, wanted to assess the procedure’s efficacy, effects on associated comorbidities, safety and the rate of complications, and patient satisfaction with LGGCP’s outcomes among morbidly obese patients over a two-year period.

In their study, ‘Outcomes of Laparoscopic Gastric Greater Curvature Plication in Morbidly Obese Patients’, retrospectively analysed data collected from medical records of 26 patients who had undergone LGGCP at Hamad General Hospital, Qatar, during 2011-2012. Most patients (92%) were Qatari nationals (8% were non-Qataris); females comprised 69% of the sample (n=18), compared to 31% males (n=8); and patients’ mean age was 35 (±7.9) years.

Technique

All patients underwent a standardised procedure with dissected greater omentum and short gastric vessels. The greater curvature was then folded from the angle of His up to the antrum using silk nonabsorbable sutures. Tubing of the stomach was undertaken over bougie tube size 38 F with initial two layers of continuous sutures and a second layer of interrupted sutures (Figure 1).

Figure 1: Gastric plication procedure. Suturing starts at the angle of His

All patients had postoperative gastrografin meal imaging (to rule out any leaks) and there was no evidence of any significant stenosis or leak though irregular stomach wall due to postoperative changes and oedema.

Four patients had previous adjustable gastric banding and underwent laparoscopic removal of gastric band in addition to LGGCP. Another two patients had symptomatic GERD (gastroesophageal reflux disease), and their intraoperative findings showed hiatal hernia therefore these patients underwent laparoscopic hiatal hernia repair in addition to LGGCP. The primary objective was to assess the efficacy of LGGCP and the weight loss after LGGCP.

Oral fluid intake started six hours postoperatively and progressed as tolerated. All patients were seen by a bariatric dietitian and instructed to follow liquid diet for three weeks, after which they were then advanced to mashed and solid diet gradually.

Outcomes

One patient (3.8%) was readmitted for nausea, vomiting, and dehydration and was treated for three days and discharged. The mean pre-operative BMI was 40.7, which decreased at two years to 34.9. In order to assess the efficacy of LGGCP, they measured the weight variables EWL% and BMI at one, three, six, 12 and 24 months postoperatively. Follow-up of EWL% at two years showed a loss of 37.5+22.3%. At two years, one patient had regained weight and exceeded her initial preoperative weight. Hence the inclusion of this patient in the calculation of the sample’s mean EWL% decreased the mean EWL% at two years from 39% (25 patients) to 37.5% (26 patients). Figure 2 depicts the EWL% of the whole sample at one, three, six, 12 and 24 months.

p style="width: 532px;" class="inlinecaption">Figure 2: EWL% of 26 patients at 1, 3, 6, 12, and 24 months post-LGGCP. *Patients who gained weight = 16 and patients who did not gain weight = 9 patients

In terms of the associated comorbidities, preoperatively 18 patients (69%) had associated comorbidities (e.g., hypertension, hyperlipidaemia, back and joint pain, hypothyroidism, end stage renal disease, and obstructive sleep apnoea), whereas eight patients (30.8%) had no comorbidities. Among those with comorbidities, measured at two years postoperatively, five patients (19.2%) improved, two patients (7.6%) had complete resolution of the comorbidities, and 11 patients (42.3%) showed no effect of the LGGCP on their comorbidities. Seven patients had hyperlipidaemia with mean cholesterol 6.18mmol/L that decreased to 5.33mmol/L at two years.

Overall patient satisfaction, feedback from 20 patients (76.9%) indicated low satisfaction with the extent of their weight loss. Probably due to some of the dissatisfaction with their body weight after LGGCP, ten patients had a laparoscopic sleeve gastrectomy (LSG) at a later stage. The remaining six patients (23.1%) expressed high satisfaction in terms of their weight loss after LGGCP.

“There seems to be a different genetic profile associated with obesity among the Qatari population compared to Western populations, which could be of primary importance as the aetiology of a given disease might be population-specific,” the authors write.

The authors concluded that LGGCP is a safe procedure with almost no postoperative complications and the procedure results in ‘acceptable’ short term weight loss, but was not associated with much improvement in patients’ lipid profile. They cautioned that patients’ satisfaction seems poor and although there was an observed durability of the gastric fold, some patients regained weight. Therefore, they said that further studies should assess the possibility of association between weight regain observed in such patients and an increase in the size of the gastric pouch.

To access this paper, please click here

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