LETTER
Hippokratia 2012, 16, 4: 392
Kourkoulos M1, Giorgakis E1,2, Nikiteas N1, Tsigris C1
1Department of Experimental Surgery & Surgical Research, Faculty of Medicine, University of Athens, Athens, Greece 2Division of Surgery & Interventional Science, University College London, UK
Keywords: Gastric Plication, Laparoscopic Greater Curvature Plication, LGCP
Correspoding author: Giorgakis E, Division of Surgery & Interventional Science, University College London, UK, e-mail: emmanouil.giorgakis.12@ucl.ac.uk
Dear Editor,
Laparoscopic Greater Curvature Plication (LGCP) was initially proposed by Wilkinson1 in 1981 and introduced in 2006 by Dr Mohammad Talebpour in Iran2. There are currently few publications from authors performing the LGCP. This fact has led the American Society for Metabolic and Bariatric Surgery (ASMBS) to issue a policy statement3 containing the following recommendations:
1. Gastric plication should be considered investigational at present.
2. Reporting of short- and long-term safety and efficacy outcomes in the medical literature is strongly encouraged.
3. Any marketing or advertisement for this procedure should include a statement to the effect that this is an investigational procedure.
In the groups of patients studied, LGCP appears to be an effective operation for the treatment of morbid obesity. All patients had a BMI < 50 kg/m2. Current studies show an Excess Weight Loss at the range of 50% on 6 months and 60% on 12 months4,5.
The complications rate reached 15.1%, the re-operation rate was 3% and mortality was zero4,5. Minor complications4,5 were at a rate of 10.7%, with nausea, vomiting and sialorrhoea being the most common in 5.7% and dysphagia or obstruction managed conservatively in 2.6%. Major complications presented at a rate of 4.4%4, 5. Major complications that required re-operation were at a rate of 3%, the most common causes being gastric obstruction due to fold prolapse or edema, adhesions or accumulation of fluid within the gastric fold (1.5%), leak (0.7%) and fistula (0.1%).
Initial data suggest that LGCP is effective for short and medium term weight loss while complication and re-operation rates are low and gastrointestinal reflux symptoms are unaffected6. Its low cost, absence of prosthetic material and potential reversibility make it an attractive option for patients with a BMI < 456. Finally, since the ASMBS policy statement considers LGCP investigational, its clinical application will entail Hospital Institutional Review Board (IRB) approval, special patient consent as well as approval of the local bariatric authorities.
More data are required in order to reach safe conclusions.
References
1. Wilkinson LH, Peloso OA. Gastric (reservoir) reduction for morbid obesity. Arch Surg. 1981; 116: 602–605.
2. Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A. 2007; 17: 793-798.
3. Clinical Issues Committee. ASMBS policy statement on gastric plication. Surg Obes Relat Dis. 2011; 7: 262.
4. Skrekas G, Antiochos K, Stafyla VK. Laparoscopic gastric greater curvature plication: results and complications in a series of 135 patients. Obes Surg. 2011; 21: 1657-1663.
5. Andraos Y, Ziade D, Achcouty R, Awad M. Early complications of 120 laparoscopic greater curvature plication procedures. Bariatric Times. 2011; 8: 10–15.
5. Kourkoulos M, Giorgakis E, Kokkinos C, Mavromatis T, Griniatsos J, Nikiteas N, et al. Laparoscopic gastric plication for the treatment of morbid obesity: a review. Minim Invasive Surg. 2012; 2012: 696348.