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Dr. M. Talebpour Advanced Laparoscopic Fellowship, Tehran Medical University Sina Hospital LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION(tVgp) INMORBID OBESITY
Supine position Trocars: 10 mm (one), 5 mm (three) Ergonomy Greater curvature release by ligature Angle of Hiss preserve Plicationat greater curvature by continuous suture 00 nylon From cardia to 5 cm of pylorus METHOD OF TGVP
Disease Incidence Diet & Exercise: <10% Surgery: Restrictive, Malabsorptive New method: TVGP Aim: Report of results after 4.5 year follow up MORBID OBESITY
False positive sense of thirsty Effective volume of stomach: 50 cc Pain or reflux secondary to more intake Gradually dilation of remnant volume (2 to 4 years) Psychological control to continue diet RESULT OF METHOD
200 cases during 4.5 years 163 cases followed by standard control visits EWL : 28% to 95%, 6 months, wide range 59% (137 cases) after 6 months 63% (105 cases) after 1 year 60% (64 cases) after 2 years 57% (41 cases) after 3 years 55% (26 cases) after 4 years result
Morbidity = 4 cases liver hematoma jaundice (drug hepatitis, 2 cases) hypocalcaemia Mortality = zero Re operation = 4 cases leak of suture line acute gastric perforation stricture at suture line permanent vomiting secondary to adhesion RESULT
Laparoscopic Conservative Low price Reversible Volume residue: 50 cc EWL: 60% during 6 month Unrelated to technique morbidity: 2% Reoperation: 2% Regain: effective time of operation Safe alternative of restrictive operations ADVANTAGE