Talebpour Mohammad, Motamedi Seyed Mohammad Kalantar, Talebpour Atieh, Vahidi Hamed
Laparoscopic Surgical Ward, Sina Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Ann Surg Innov Res. 2012 Aug 22;6(1):7. doi: 10.1186/1750-1164-6-7.
Laparoscopic Gastric Plication (LGP) is a new restrictive bariatric surgery, previously introduced by the author. The aim of this study is to explain the modifications and to present the 12-year experience, regarding early and long term results, complications and cost.
We used LGP for morbid obesity during the past 12 years. Anterior plication (10 cases), one-row bilateral plication while right gastroepiploic artery included (42 cases), and excluded from the plication (104 cases) and two-row plication (644 cases). The gastric greater curvature was plicated using 2/0 prolen from fundus at the level of diaphragm preserving the His angle to just proximal to the pylorus. The anatomic and functional volume of stomach was 50cc and 25cc respectively in two-row method. Ordered postop visits also included evaluation of weight loss, complications, change of diet and control of exercise.
LGP was performed in 800 cases (mean age: 27.5, range: 12 to 65 years, nine under 18). Female to male ratio was 81% to 19% and average BMI was 42.1 (35-59). The mean excess weight loss (EWL) was 70% (40% to 100%) after 24 months and 55% (28% to 100%) after 5 years following surgery. 134 cases (16.7%) did not completed long term follow-up. The average time of follow up was 5 years (1 month to 12 years). 5.5% and 31% of cases complained from weight regain respectively during 4 and 12 years after LGP. The mean time of operation was 72 (49-152) minutes and average hospitalization time was 72 hours (24 hours to 45 days). The cost of operation was 2000 $ less than gastric banding or sleeve and 2500 $ less than gastric bypass. Eight patients out of 800 cases (1%) required reoperation due to complications like: micro perforation, obstruction and vomiting following adhesion of His angle. Other complications included hepatitis pneumonia, self-limiting intra-abdominal bleeding and hypocalcaemia.
The percentage of EWL in this technique is comparable to other restrictive methods. The technique is safe with 1.6% complication (1% reoperated), and 31% regain during 12 years. The cost of operation is less than the other methods.
腹腔镜胃折叠术（LGP）是一种新型的限制性减肥手术，由作者先前提出。本研究的目的是解释手术的改良之处，并介绍12年的经验，包括早期和长期结果、并发症及费用情况。
在过去12年中，我们采用LGP治疗病态肥胖症。手术方式包括前折叠术（10例）、保留右胃网膜动脉的单排双侧折叠术（42例）、不包括右胃网膜动脉的单排双侧折叠术（104例）以及双排折叠术（644例）。使用2/0普理灵缝线从膈肌水平的胃底开始对胃大弯进行折叠，保留His角直至幽门近端。双排折叠术时胃的解剖学和功能容积分别为50cc和25cc。术后按序随访还包括评估体重减轻情况、并发症、饮食变化及运动控制情况。
共进行了800例LGP手术（平均年龄：27.5岁，范围：12至65岁，9例年龄小于18岁）。男女比例为81%比19%，平均体重指数为42.1（35 - 59）。术后24个月时平均超重体重减轻（EWL）为70%（40%至100%），术后5年时为55%（28%至100%）。134例（16.7%）未完成长期随访。平均随访时间为5年（1个月至12年）。LGP术后4年和12年分别有5.5%和31%的病例出现体重反弹。平均手术时间为72（49 - 152）分钟，平均住院时间为72小时（24小时至45天）。手术费用比胃束带术或袖状胃切除术少2000美元，比胃旁路手术少2500美元。800例中有8例（1%）因微小穿孔、梗阻及His角粘连后呕吐等并发症需要再次手术。其他并发症包括肝炎性肺炎、自限性腹腔内出血和低钙血症。
该技术的EWL百分比与其他限制性方法相当。该技术安全，并发症发生率为1.6%（1%需再次手术），12年内体重反弹率为31%。手术费用低于其他方法。
