Bariatric and Metabolic Institute, Cleveland Clinic, Cleveland, Ohio 44195, USA.
Surg Obes Relat Dis. 2011 Jan-Feb;7(1):15-22. doi: 10.1016/j.soard.2010.09.023. Epub 2010 Nov 9.
Current gastric restrictive procedures include either a prosthetic device or gastric resection. We present the results of a feasibility study using laparoscopic gastric plication for weight loss achieved without stapling or banding.
After institutional review board approval, 2 methods were used to achieve laparoscopic gastric volume reduction. In the first group (anterior plication [AP]), the anterior gastric wall was folded inward from the fundus to the antrum using 2 rows of running sutures. The greater and lesser curvatures were approximated to create an intraluminal fold of the stomach. In the second group (greater curvature plication [GCP]), the short gastric vessels were divided, and the greater curvature was folded inward, with 2 suture lines to reduce the gastric capacity by a large intraluminal gastric fold.
The average preoperative body mass index was 43.3 kg/m(2) (range 36.9-49.0), and 3 patients were men. Of the 15 patients, 9 underwent AP. For the 9 patients who underwent AP, the 6- and 12-month endoscopic evaluations demonstrated comparable-size plications over time, except for in 1 patient, who had a partially disrupted fold. Of the 6 patients who underwent GCP, the 6- and 12-month follow-up endoscopic examinations demonstrated a durable intraluminal fold, except for in 1 patient, with a partial disruption at the distal fold owing to a broken suture. For patients completing 1 year of follow-up, the percentage of excess weight loss was 23.3% ± 24.8% in the AP group (n = 5) and 53.4% ± 22.7% in the GCP group (n = 6). No bleeding or infectious complications developed. The first patient in the GCP group required reoperation and plication reduction owing to gastric obstruction.
Our initial experience has suggested that a reduction in gastric capacity can be achieved by way of plication of the anterior stomach and greater curvature. The early weight loss results have been encouraging, with better weight loss in patients who underwent GCP. The use of laparoscopic GCP warrants additional investigation as a primary bariatric procedure.
目前的胃限制性手术包括假体装置或胃切除术。我们报告了一种使用腹腔镜胃折叠术实现减肥效果的可行性研究结果，该手术无需使用订书钉或带。
在机构审查委员会批准后，使用 2 种方法来实现腹腔镜胃容量减少。在第一组（前折叠术 [AP]）中，从前胃底到胃窦，从前壁将胃折叠成 2 排连续缝线。将胃的大、小弯向内侧靠拢，形成胃内折叠。在第二组（大弯折叠术 [GCP]）中，切断胃短血管，将大弯向内折叠，用 2 条缝线形成一个大的胃内折叠，以减少胃容量。
平均术前体重指数为 43.3kg/m2（范围 36.9-49.0），3 例为男性。15 例患者中，9 例行 AP。对于 9 例接受 AP 的患者，6 个月和 12 个月的内镜评估显示随着时间的推移，折叠的大小相似，除 1 例患者的折叠部分破裂外。在 6 例接受 GCP 的患者中，6 个月和 12 个月的内镜随访检查显示出持久的腔内折叠，除 1 例患者由于缝线断裂导致远端折叠部分破裂外。对于完成 1 年随访的患者，AP 组（n=5）的超重体重减轻百分比为 23.3%±24.8%，GCP 组（n=6）为 53.4%±22.7%。无出血或感染并发症发生。GCP 组的第 1 例患者因胃梗阻需要再次手术和折叠减少。
我们的初步经验表明，通过前胃和大弯折叠可以减少胃容量。早期减肥效果令人鼓舞，GCP 组患者的减肥效果更好。腹腔镜 GCP 的应用值得进一步研究作为主要的减肥手术。
