Gentileschi Paolo, Campanelli Michela, Sensi Bruno, Benavoli Domenico, Arcudi Claudio, Siragusa Leandro, Bianciardi Emanuela, Uccelli Matteo, Di Capua Francesco, Olmi Stefano
Department of Bariatric and Metabolic Surgery, San Carlo of Nancy Hospital, Rome, Italy.
Department of Surgery, University of Rome "Tor Vergata", Viale Oxford 81, 00133, Rome, Italy.
Obes Surg. 2023 Jan;33(1):303-312. doi: 10.1007/s11695-022-06364-7. Epub 2022 Dec 2.
Sleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip.
Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution.
Patients had a mean age of 44 years and mean BMI of 37 kg/m ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases.
The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG.
袖状胃切除术是最常施行的减重手术，但存在短期局限性，包括术后出血和胃瘘等并发症，以及长期的体重反弹和胃食管反流等问题。已提出一种新手术来克服其中许多局限性：使用BariClip的腹腔镜垂直夹胃成形术（LVCG）。
在两个减重手术转诊中心，50例患者接受了LVCG并纳入一项可行性研究。在多学科评估年龄、性别、体重指数、合并症、饮食行为和胃食管反流情况后，其适应症与袖状胃切除术相同。主要结局指标为术后严重并发症。次要结局指标包括体重减轻、新发胃食管反流病的发生率以及合并症的缓解情况。
患者平均年龄44岁，平均体重指数为37kg/m²±6.2。所有手术均在腹腔镜下成功完成，无中转开腹或术中不良事件发生。术后总体严重并发症发生率为6%。3例患者因夹子滑脱需再次手术。无死亡病例。6个月时的超重减轻、超重体重指数减轻和总体重减轻分别为36%、57%和22%。无新发胃食管反流病病例。50%的高血压病例、65%的阻塞性睡眠呼吸暂停综合征病例和80%的2型糖尿病病例得到缓解。
LVCG手术的安全性已在一项多中心、多术者研究中得到验证。体重减轻效果看起来很有前景。需要进行一项随机试验以全面评估LVCG的益处。
