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Experience with 458 cases of Gastric Plication Surgery Dr Ariel Ortíz Lagardere ,FACS.

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Experience with 458 cases of Gastric Plication Surgery Dr Ariel Ortíz Lagardere ,FACS. Obesity Control Center hospital, México. New procedure?. Similar to sleeve gastrectomy Stomach Sparing Less risk leak No need implant/adjustments/stapling Literature can be found early 1900’s

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Experience with 458 cases of Gastric Plication Surgery

Dr Ariel OrtízLagardere ,FACS.

Obesity Control Center hospital, México

new procedure
New procedure?
  • Similar to sleeve gastrectomy
  • Stomach Sparing
  • Less risk leak
  • No need implant/adjustments/stapling
  • Literature can be found early 1900’s
  • 2001 Dr Talebpour.

Ortiz-Lagardere, MISS 2012

band plication per month
Band/Plication per Month

Ortiz-Lagardere, MISS 2012

Presented IFSO 2011.

patients
Patients
  • 458 total (07/2010 to 12/2011)
  • Primary/Revision : 429/29
  • Gender : 370 Female, 88 male
  • Age: 42.7 years (Range 16-71)

Ortiz-Lagardere, MISS 2012

gastric plication
Gastric Plication

Ortiz-Lagardere, MISS 2012

.

N=458

Surgical time 41 min. ( 26 to 145 min.)

Hospital stay 23 hours ( 6 hrs. to 5 days)

0% mortality

0% conversion

2% Re-operation

8% “Re-plication”

acid reflux
“Acid Reflux”
  • After 6 month follow-up of 278 patients, 68 (24.4%) of patients reported persistent heartburn

37 patients continuous PPI

27 Intermittent use of PPI or other antacids

4 severe (2 resulted in re-operation)

  • Disphagia to solids 2%
ewl longitudinal assessment jul 10 to aug 11 272 patients primary plication
% EWL longitudinal assessment Jul/10 to Aug/11 272 patients (Primary Plication)

53.4%

48.5%

Patients 7 25 23 31 37 35 41 39 34

Ortiz-Lagardere, Presented in IFSO 2011

co morbidities at 6 months
Co-morbidities at 6 months

Patients diagnosed with:

  • Type II Diabetes
  • High blood pressure
  • Sleep apnea
  • Asthma
complications
Complications

Early

  • 9 obstructions (6 surgical).
  • 2 bleeding (short gastric vessels)
  • 1 Intolerance persistent hiccups'
  • 1 wall hematoma
  • 1 sub-diaphragmatic lymphatic collection.

Ortiz-Lagardere, MISS 2012

complications1
Complications

Delayed

  • 9 Bleeding ulcers (2 to 6 months after surgery)
        • 5 Transfusion
        • All: sucralfate and PPI
  • 2 perforated ulcers
        • Distal gastrectomy
  • 1 gastric wall hernia (ischemia, no perforation).
        • Reversal
  • No obstruction.

Ortiz-Lagardere, MISS 2012

revisions from lagb
Revisions from LAGB

29 patients

  • LAGB conversions
  • 27 female, 2 male
  • Age 44 years
  • BMI 38.7 Kg/m²
  • Surgery time 68 min
  • Mortality 0%
  • Morbidity 1 obstruction
  • 15 (52%) Plication revisions
  • 1 conversion to LAGB .
  • %EWL 32%

Ortiz-Lagardere, MISS 2012

re plications
“Re-plications”
  • Total 36 patients (34 female/2 male)

15 conversions from LAGB

  • Chief complaint : loss of restriction
  • Surgery Time 55 min ( 25 to 220 minutes)
  • Complication 0%
  • Hospital stay 22 hours
re plication
“Re-plication”

67 patients 218 patients

re plication1
“Re-plication”

10 patients 16 patients

surgical technique
Surgical Technique

Plication of the stomach

  • Where to start, proximal to distal or distal to proximal?
  • One, two or three suture planes?.
  • What are the ideal suture material(s) for each plane?
  • Size bougie and calibration?
laplace s law
Laplace’s Law

The tension on the wall of a sphere is the product of the

pressure times the radius of the chamber and the tension

is inversely related to the thickness of the wall.

Ortiz-Lagardere, IFSO 2011

the learning curve
The learning curve

Ortiz-Lagardere, IFSO 2011

Aug. 2010- Feb. 2011

150 Plication (18 revision)

  • Surg. Time: 54 minutes
  • Hospital stay: 28 hr.
  • Mortality 0%
  • Complication
    • Early 5%
  • Postoperative nausea and or vomiting 34%
  • 5 Re-operation for obstruction
  • 24 Re-plication

Mar. 2011-Jul 2011

250 Plication (5 revision)

  • Surg. time: 37 minutes
  • Hospital stay: 21 hr.
  • Mortality 0%
  • Complication
    • Early 1%
  • Postoperative nausea and or vomiting 7%
  • 1 reoperation for obstruction
technique requirements
Technique Requirements
  • Symmetrical
  • Start at the Angle of His
  • Containment suture
  • Evenly spaced suture
  • Even pressure calibration
  • Distal plication

Ortiz-Lagardere, IFSO 2011

com plication

complication

Ortiz-Lagardere, IFSO 2011

conclusions
Conclusions
  • Still experimental
  • Requires standardization of technique
  • Requires long term follow-up
  • Study mechanisms

Ortiz-Lagardere, MISS 2012

conclusions1
Conclusions
  • Low complication rate
  • Acceptable short term weight-loss
  • Long learning curve
  • Surgeon dependent
  • Patient acceptance

Ortiz-Lagardere, MISS 2012