Laparoscopic gastric plication for treatment of severe obesity

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.