Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure

Vertical sleeve gastrectomy (VSG) is a surgical technique that involves resection of a significant portion of the stomach. This surgery is sometimes associated with gastric leaks, which can be difficult to treat. The present study reports findings from laparoscopic greater curvature plication (LGCP), which is an alternative bariatric procedure similar to VSG but without the need for gastric resection. A prospective study was carried out, following LGCP in 42 morbidly obese patients (30 female/12 male) with a mean age of 33.5 years (23 to 48) and mean BMI of 41 kg/mA(2) (35 to 46). Through a five-port approach, the stomach was reduced by dissecting the greater omentum and short gastric vessels, as in VSG, and the greater curvature was then invaginated using multiple rows of non-absorbable suture performed over a 32-Fr bougie to ensure a patent lumen. All procedures were completed laparoscopically. Mean operative time was 50 min (40 to 100 min) and mean hospital stay was 36 h (24 to 96). Patients returned to their regular activities at an average of 7 days (4 to 13) following surgery. No intra-operative complications occurred. All patients experienced excess weight loss (EWL) of at least 20% after 1 month. Mean EWL was 62% (45% to 77%) in nine patients after 18 months. There has been no record of weight regain in any patient to date. LGCP is feasible, safe, and effective for at least 18 months when performed on morbidly obese patients. Longer follow-up and prospective comparative trials are needed.