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IN THE NAME OF GOD. Dr. M. Talebpour Advanced Laparoscopic Fellowship Tehran University of Medical Science. LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION ( tVgp ) IN MORBID OBESITY. Disease Incidence Diet & Exercise: <10% Surgery: Restrictive, Mal absorptive New method: TVGP

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Dr m talebpour advanced laparoscopic fellowship tehran university of medical science

Dr. M. Talebpour

Advanced Laparoscopic Fellowship

Tehran University of Medical Science

LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION(tVgp) INMORBID OBESITY


Morbid obesity

Disease

Incidence

Diet & Exercise: <10%

Surgery: Restrictive, Mal absorptive

New method: TVGP

Aim: Report of results after 7 years follow up

MORBID OBESITY


Technique selection

  • RESTRICTIVE: EARLY MORBID OBESITY WITH COOPERATION

    (270 TVGP)

  • MIXED: LATE MORBID OBESITY WITH COOPERATION,

    (20 GB)

    OMEGA ANASTHOMOSIS

    CONTINOUS HAND SWEN

    NYLON 00

  • MALABSORPTIVE: MORBID OBESITY WITHOUT COOPERATION

    (12 ILEOJEJUNAL BYPASS)

TECHNIQUE SELECTION


Method of tvgp

  • Supine position

  • Trocars: 10 mm (one), 5 mm (three)

  • Ergonomy

  • Greater curvature release by ligature

  • Angle of Hiss preserve

  • Plication at greater curvature by continuous suture 00 nylon

  • From cardia to 5 cm of pylorus

METHOD OF TVGP


Result of method

  • False positive sense of thirsty

  • Effective volume of stomach: 50 cc

  • Pain or reflux secondary to more intake

  • Psychological control to continue diet (change of mind)

  • Gradually dilation of remnant volume (4 years)

    from 50 cc to 200 cc

RESULT OF METHOD


Result

  • 270 cases during 7 years

  • 220 cases followed by standard control visits

  • EWL : 28% to 95%, 6 months, wide range

    61% (181 cases) after 6 months

    67% (135 cases) after 1 year

    63% (96 cases) after 2 years

    56% (60 cases) after 3 years

    52% (40 cases) after 4 years

result


Result1

Morbidity = 4 cases

liver hematoma

jaundice (drug hepatitis, 2 cases)

hypocalcaemia

Mortality = zero

Re operation = 4 cases (1.5%)

leak of suture line

acute gastric perforation

stricture at suture line

permanent vomiting secondary to adhesion

RESULT


Regain

  • Regain: less than 20% EWL

  • 10 cases, more than 2 years during 7 years

  • Total cases more than 2 years 105 (9.5%)

  • 3 cases, due to pregnancy and feeding

  • 2 cases heavy drinker

  • 3 cases psychological drugs

  • 2 cases increase of appetite

  • 2 cases replication

  • 4 cases ileojejunal bypass (Dr Fazel) laparoscopic

  • 1 case gastric banding

  • 1 case, feeding of her baby

  • 2 cases waiting

rEGAIN


Who does get the best result

BMI>40 or 35 and comorbidity

Cases over 70% EWL (during 2 years) included

Follow up: every week (first month)

every two weeks (next 5 months)

every month (next 18 month)

10 factors: Age, sex, co morbidity,

marriage, appetite, volume residue,

job, relatives, pain during eating,

group club,

WHO DOES GET THE BEST RESULT?


Detail of data

40 cases / 90 cases

Sex: 38/2 (90/12) 5.2% to 13% M

Age: 24 (18 – 30) to 34(18 – 52)

Co morbidity: 3 to 9 7.5% to 10%

Marriage: 34 S to 41 S 85% to 45%

Appetite: 3 to 10 7.5% to 11%

DETAIL OF DATA


Detail of data1

40 cases / 90 cases

Residue: 35 to 69 87% to 76%

Job: 15 to 38 37% to 42%

Relatives: 36 to 78 90% to 86%

Pain: 38 to 80 95% to 88%

Group club: 25 to 30 62% to 33%

DETAIL OF DATA


Important factors

  • Young, Female, Single, Group club

  • Gaining the best result is not essentially related to the form of operation

  • It is secondary to some other factors that increase the interest of patient to use diet and exercise (incentive)

  • The main goal is change of mind

IMPORTANT FACTORS


Advantage

Laparoscopic

Conservative

Low price

Reversible

Volume residue: 50 cc

EWL: 60% during 6 month

Unrelated to technique morbidity: 1.5%

Reoperation: 1.5%

Regain: 9.5% after 2 years, possibility of all alternatives

Safe alternative of restrictive operations

ADVANTAGE


Invasiveness of methods

  • Diet and exercise <10% EFF

  • Gastric balloon 2-6 months 15% EWL

  • 000

  • TVGP 4-5 years 63%

  • GB 4-5 years 65%

  • GBP 5-7 years 70%

  • IJB Long time 80%

  • DSB Permanent 85%

Invasiveness of methods


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