Innovative bariatric solutions.

Laparoscopic total gastric vertical plication: The "physiological" gastric shrinkage.

Laparoscopic total gastric vertical plication (TGVP) is a new restrictive tecnique for the treatment of morbid obesity. This operation may be considered as an advancement of the well-known sleeve gastrectomy and it is carried out with the use of pure non-absorbable surgical sutures. In TGVP the gastric capacity is diminished without gastrectomy or foreign implants. Due to the lack of gastric strictures TGVP does not cause any food intolerance nor impair patient's dietary habits. The resultant weight loss is satisfying (50-55% EWL) while in comparison to the other modern restrictive bariatric techniques (laparoscopic  gastric  banding  and  sleeve  gastrectomy) the advantages of the TGVP 

September 2009 update.

WEIGHT LOSS AFTER LAPAROSCOPIC TOTAL GASTRIC VERTICAL PLICATION. 16 MONTHS STUDY.

Other key words: gastric greater curvature invagination, gastric folding.

The aim of this study is to evaluate the effectiveness of a new bariatric technique (laparoscopic total gastric vertical plication - LΤGVP) in a personal 52 obese patient series. Patients decision/consent for this type of operation was based on the following criteria: minor surgery, reversibility, fast recovery, absence of implants. Mean preoperative weight and body mass index (BMI) were 119.36 +/ 18.22 kg (range 88-157) and 41.50 +/ 4.58 kg/m2 (range 35- 55), respectively. RESULTS: There were no serious complications; the only late side-effect (> 6months) was mild GER which affected 8/49 patients (16.32%). Three patients failed loosing weight due to gastric sewing disruption (one of them had a successfull reoperation 3 months later). This happend in our early experience. These 3 patients were excluded from statistic analysis. Mean follow-up was 9.33 +/ 3.39 months (range 6 -16). The mean postoperative weight loss was 29.36 Kg, mean excess weight loss (EWL) was 62.50%, while mean BMI dropped to 31.18 +/ 4.02 kg/m2. Thirty-nine patients (80%) lost more than 50% of the excess weight, 45% lost 61% or more, while one out four patients lost more than 70% of excess weight (range 71 -120%). CONCLUSION: LΤGVP is a safe and effective restrictive bariatric operation. In comparison to the published results from gastric banding studies, weight loss after LΤGVP comes sooner and is more intense, at the same time interval.

IMPORTANT NOTE
Laparoscopic total gastric vertical plication is introduced and investigated in Greece and Cyprus from the Promedica Ltd. Only our trained Bariatricians have the knowledge 
and the experience to perform safely this procedure. To submit your questions, please click here.

Completed projects

Protocol 09/2005: Laparoscopic "tight" sleeve gastrectomy.
Purpose:This research study is being done to determine whether "tight" sleeve gastrectomy (super sleeve) is a safe and efficient bariatric procedure. 
Study Type: Observational
Study Design: Case Control, Prospective
Official Title: Laparoscopic "tight" sleeve gastrectomy. Mid-term results.
Status: Completed
Enrollment: 96 patients
Study Start Date: 30 September 2005
Study Completion Date: 30 September 2007

Final results published in: Obesity Surgery 2008 Jul;18(7):810-3. Epub 2008 Apr 8) [Medline]

Laparoscopic sleeve gastrectomy (LSG) is a new bariatric technique which has a unique feature: it combines a satisfying gastric restriction with appetite suppression. LSG significantly reduced ghrelin levels due to resection of the gastric fundus, which is the predominant area of human ghrelin production. In other words, LSG has a physiological advantage over other restrictive procedures such as gastric banding or vertical banded gastroplasty, which does not influence the ghrelin-producing cell mass. Furthermore, in LSG no foreign material is implanted avoiding complications such as band migration, erosion and infections. The risk of peptic ulcer or dumping is low, while absorption of nutrients and orally-administered drugs are not altered as may transpire after gastric by-pass.

What is super sleeve?

Laparoscopic sleeve gastrectomy is not so simple as any other gastrectomy. There are some important technical details, unknown to inexperienced surgeons. Gastric tube size influences both the degree of weight loss and weight stability. A large sleeve predisposes to gastric dilatation and weight regain. Inexperienced surgeons tend to create large tubes (B) or to leave back large remnants of the gastric fundus. A standardised technique with a gastric capacity less than 100 mL (A) is mandatory in order to get the patient achieve a durable weight loss. The sleeve should be "super" which means a small gastric sleeve diameter and a higher degree of restriction. In our hands, with the gastric capacity been restricted to 60-80 gr and Ghrelin (the appetite hormone) totally suppressed, the resultant weight loss is predictable and comparable to this achieved with gastric by-pass (60-70% EWL), without any serious complication or side effects (e.g. vitamin mal-absorption). We introduced super sleeve in our bariatric program, as the most effective and safe bariatric solution even for the super-obese patients.

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Future projects

Protocol 04/2009: Natural Orifice Transluminal Endoscopic Bariatric Surgery techniques (NOTES).

The future possibilities of bariatric surgery are rich as many new techniques and devices for weight loss surgery are being developed and employed. In general, the majority of these techniques focus on proven surgical concepts of restriction and malabsorption, but with a less invasive approach.Natural orifice approaches (NOTES) that are considered the new frontier for bariatric surgery,are already used for revisional bariatric procedures e.g. to reduce a stoma size or to repair a fistula. In some cases, endoluminal revision may help minimize some of the difficulty in standard revisional surgery. De novo primary bariatric surgical procedures via a natural orifice are currently under development.