Innovative Technologies and Non-Invasive Procedures in Bariatric Surgery by Jérôme Dargent

Author:Jérôme Dargent
Language: eng
Format: epub, pdf
Publisher: Springer Paris, Paris

Gastric Plication Associated with Banding

A gastric plication can be proposed as an adjuvant of a gastric banding (or vice and versa!). If one can be skeptical about such a combination, attention should be paid to the results of these procedures.

Huang CK promoted this combination procedure and presented it at the Ist NonInva meeting (Lyon, May 2011): The weight loss effect of laparoscopic adjustable gastric banded plication (LAGBP) was similar to sleeve gastrectomy in the early stage because of added plication effect, improving the weight loss and patient compliance. His recent case-matched study showed similar weight-loss effect up to nearly 70 % excess-weight loss and resolution of co-morbidity with sleeve gastrectomy at 2 years. It could be expected that the lower frequency of adjustment will decrease the risk of erosion and infection of the band. It combined three mechanisms, with restrictive, reductive and reversible characteristics. In the long-run, it could act to prevent weight regain after band adjustment, and can be suggested as a salvage procedure for gastric band failure.

Mozzi et al. (2011): Laparoscopic adjustable gastric banding (LAGB) is one of the most widely performed surgical procedures for morbid obesity, allowing up to 55 % of EWL. There is however a wide group of patients with EWL ranging between 25 and 50 %, where an increased effect of LAGB could be useful. Laparoscopic gastric plication (LGCP) is a new restrictive procedure that does not to require gastric resection, is reversible, and can be added to LAGB because it increases the restrictive effect while avoiding contamination of the prosthetic material. A synergistic effect may be obtained because LAGB reduces the esogastric transit, while LGCP reduces the gastric volume. Our aim was to evaluate the effect of LGCP in patients who had experienced poor weight-loss after LAGB and needed revisional surgery. Methods: 5 patients with poor weight-loss after LAGB needed revisional surgery for band slippage (2), tube disconnection in peritoneum (1), band rupture (1), isolated poor weight loss (1). They underwent LGCP in addition to band revision, in order to increase the effectiveness of LAGB. Surgical technique: two 5 mm and two 10 mm trocars were inserted, as in usual LAGB operation. After band revision, a greater curvature omentectomy was performed with the harmonic scalpel from the antrum (3–4 cm from pylorus) to the angle of His. The LGCP was then created with assistance of a 32-Ch bougie, invaginating the greater curvature with a first row of interrupted stitches of 2–0 Polypropylene. A second row of running suture of the same material was done over the whole length of the first one. Results: Postoperative course was uneventful, except slight nausea in the first few days. A gastrografin swallow on the first postoperative day showed a slow gastric transit, the band in place and the ­tubular shape of the plication clearly visible. The patients were discharged on the 3rd postoperative day on a liquid diet, and resumed a solid diet within 4 weeks. The mean preoperative BMI was 37.3  ±  5.19. After 3 months, while the band still was not inflated, all patients lost weight, % EWL was 18.

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