Plicatura gástrica laparoscópica: seguimiento a largo plazo / Laparoscopic gastric plication: long-term follow-up

Resumen Introducción: La experiencia internacional no ha logrado reproducir los resultados de los primeros trabajos de plicatura gástrica laparoscópica (PGL). Objetivo: Analizar los resultados a largo plazo de pacientes sometidos a PGL. Materiales y Método: Estudio prospectivo y descriptivo, se incluyeron pacientes obesos adultos que cumplieron criterios universales para cirugía bariátrica. Se registraron datos epidemiológicos, comorbilidades, tiempo operatorio, estadía hospitalaria, porcentaje de pérdida de exceso de IMC (% PEIMC), complicaciones posoperatorias y resolución de comorbilidades. El seguimiento se efectuó con controles periódicos anuales hasta el año 2020. Resultados: Se inició la selección de pacientes durante el año 2010. Se realizaron 26 intervenciones desde enero de 2011 hasta mayo de 2012. Todas las pacientes fueron de género femenino. El IMC preoperatorio promedio fue 38,8 kg/m2 (DS 3,8). El % PEIMC promedio al año, 3 años y 9 años de posoperado, fue 62,2% (DS 27,1), 40,2% (DS 24,5) y 28% (DS 31,9), respectivamente. Las complicaciones, basadas en la clasificación de Clavien-Dindo (CD), durante los primeros 30 días de posoperatorio fueron 21 pacientes con tipo I, 1 con tipo II, y 2 pacientes con complicaciones tipo IVa. A los 9 años de posoperado, 9 pacientes presentaban efectos adversos tipo I. No hubo mortalidad. Hasta los 3 años hubo corrección de comorbilidades. Se objetivaron 3 pacientes diabéticas al final del estudio, 2 de ellas previamente sanas. Conclusiones: El % PEIMC a largo plazo fue insuficiente. El porcentaje de complicaciones es mayor que en otras técnicas. No recomendamos la realización de la PGL.

Background: The international experience has failed to reproduce the first studies of laparoscopic gastric plication (LGP). Aim: The objective is to analyze the outcomes after 10 years of follow-up of patients subjected to LGP. Materials and Method: Prospective and descriptive study, in which obese adult patients who met universal criteria for bariatric surgery were included. Epidemiological data, comorbidities, operating time, hospital stay, percentage of excess BMI loss (% EBMIL) and resolution of comorbidities were collected. The follow-up was realized by annual periodic controls until 2020. Results: Patient selection began in 2010. A total of 26 interventions were performed from January 2011 to May 2012. All patients were female. The average preoperative Body Mass Index (BMI) was 38.8 kg/m2 (SD 3.8). The average % EBMIL at 1st, 3rd and 9 th postoperative years was 62.2% (SD 27.1), 40.2% (SD 24.5) and 28% (SD 31.9), respectively.Complications, based in Clavien Dindo classification, during the first 30 postoperative days was: 21 patients with type I, 1 type II, and 2 patients with complications type IVa. At 9 th postoperative year, 9 patients presented adverse effect type I. There was no mortality. Until the 3rd year there was correction of comorbidities. Three diabetic patients were observed at the end of the study, 2 previously healthy. Conclusions: The long term % EBMIL was insufficient. The percentage of complications is higher than in other techniques. We do not recommend the LGP.

Application value of laparoscopic gastric plication combined with duodeno-jejunal omega switch in modified adjustable gastric banding / 中华消化外科杂志

Objective@#To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding.@*Methods@#The retrospective and descriptive study was conducted. The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected. LGP and DJOS were performed in two-stages after completion of preoperative examinations. Observation indicators: (1) surgical and postoperative situations; (2) follow-up. Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI), insulin therapy, and long-term complications until December 2018. Count data were represented as absolute numbers.@*Results@#(1) Surgical and postoperative situations: the patient underwent LGP in the first stage and DJOS in the second stage successfully. For the LGP, the operation time, time of intestinal reconstruction, volume of intraoperative blood loss, time to first flatus, time to drainage tube removal, time to resume to normal diet, and duration of postoperative hospital stay were 96 minutes, 58 minutes, 210 mL, 32 hours, 48 hours, 42 days, and 3 days, respectively. For the DJOS, the above indicators were 148 minutes, 117 minutes, 260 mL, 47 hours, 72 hours, 21 days, and 7 days, respectively. There was no complication occurred in either LGP or DJOS. (2) Follow-up: the patient was followed up for 24 months after LGP. The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP, and decreased to 37.2 kg/m2 at 18 months after DJOS. Insulin therapy was discontinued. There was no long-term complication such as malnutrition, dumping syndrome, or biliary reflux.@*Conclusion@#LGP combined with DJOS can enrich treatment methods of obese patient with BMI >50 kg/m2, which offers a safer surgical procedure option for patients after gastric binding.

Application value of laparoscopic gastric plication combined with duodeno-jejunal omega switch in modified adjustable gastric banding / 中华消化外科杂志

Objective To explore the application value of laparoscopic gastric plication (LGP) combined with duodeno-jejunal omega switch (DJOS) in modified adjustable gastric banding.Methods The retrospective and descriptive study was conducted.The clinical data of a female 46-year-old patient who had failure to undergo the adjustable gastric banding in the Hospital of Ludwig Maximilian University from December 2016 to December 2018 were collected.LGP and DJOS were performed in two-stages after completion of preoperative examinations.Observation indicators:(1) surgical and postoperative situations;(2) follow-up.Follow-up using outpatient examiantion and telephone interview was performed to collect the information of body mass index (BMI),insulin therapy,and long-term complications until December 2018.Count data were represented as absolute numbers.Results (1) Surgical and postoperative situations:the patient underwent LGP in the first stage and DJOS in the second stage successfully.For the LGP,the operation time,time of intestinal reconstruction,volume of intraoperative blood loss,time to first flatus,time to drainage tube removal,time to resume to normal diet,and duration of postoperative hospital stay were 96 minutes,58 minutes,210 mL,32 hours,48 hours,42 days,and 3 days,respectively.For the DJOS,the above indicators were 148 minutes,117 minutes,260 mL,47 hours,72 hours,21 days,and 7 days,respectively.There was no complication occurred in either LGP or DJOS.(2) Follow-up:the patient was followed up for 24 months after LGP.The BMI of this patient decreased to 45.3 kg/m2 at 6 months after LGP,and decreased to 37.2 kg/m2 at 18 months after DJOS.Insulin therapy was discontinued.There was no long-term complication such as malnutrition,dumping syndrome,or biliary reflux.Conclusion LGP combined with DJOS can enrich treatment methods of obese patient with BMI ＞50 kg/m2,which offers a safer surgical procedure option for patients after gastric binding.

Effect of short-term energy metabolism by which sleeve gastrotomy (SG) and gastric plication (GP) alter on obesity type 2 diabetes Zucker fatty rats / 中华内分泌外科杂志

Objective To investigate the effect of sleeve gastrotomy (SG) and gastric plication (GP) on the short-term metabolism in type 2 diabetes mellitus (T2DM) Zucker fatty rats.Methods Thirty healthy male rats were randomly allocated into three groups:Sham,SG and GP groups,and devices like metabolic cage were applied to detect the metabolic changes in the third week after operation.Results The body weight of the SG and GP group decreased,but no statistical significance was found when compared with that of the Sham group.Less food consumption were found in SG (P＜0.05) and GP (P＜0.05) groups compared with that of the Sham group.In the daytime,the energy expenditure of SG group was higher than that of the sham group(P＜0.01),while in the night,the energy expenditure of both the SG (P＜0.001) and GP (P＜0.001) groups were higher than that of the Sham group.In the night,the activity level of SG (P＜0.05) and GP (P＜0.05) groups were lower than that of the Sham group,and activity level in the night was lower than that in the daytime for SG group(P＜0.05).In the daytime,the respiratory exchange rate (RER) of the SG (P＜0.001) and GP (P＜0.001) group were lower than that of the Sham group,and the night RER of GP group was higher than that in the daytime (P＜0.05).No statistical significance was found in terms of the average speed among the three groups.The average speed of the Sham (P＜0.05) and SG (P＜0.05) group in the night were faster that in the daytime.The fasting plasma glucose (FPG) of SG and GP group were improved compared with that of the Sham group.Conclusion SG and GP procedures can improve the metabolism of diabetic rats in the short term.

Comparação dos níveis plasmáticos de grelina nos períodos pré e pós-operatório em pacientes submetidos à plicatura gástrica associada à fundoplicatura / Comparison of ghrelin plasma levels between pre and postoperative period in patients submitted to gastric plication associated with fundoplication

RACIONAL: A doença do refluxo gastroesofágico e sua recidiva podem estar relacionadas ao ganho de peso tardio após a cirurgia bariátrica, aumentando a incidência de metaplasia colunar e neoplasia. A plicatura gástrica associada à fundoplicatura pode ser empregada com o objetivo de se tratar a doença do refluxo e o sobrepeso. OBJETIVOS: Avaliar o hormônio grelina no pré e pós-operatório, bem como a perda de peso e o controle da doença do refluxo em pacientes submetidos à gastroplicatura com fundoplicatura. MÉTODOS: Foi realizada gastroplicatura com fundoplicatura videolaparoscópica em oito pacientes. Os exames endoscópicos foram realizados no pré e no pós-operatório, bem como a coleta de sangue para a dosagem do hormônio grelina. RESULTADOS: Houve melhora dos sintomas do refluxo e das alterações na mucosa em todos os pacientes. A perda de peso foi significativa. Não houve significância na redução dos níveis plasmáticos de grelina. CONCLUSÕES: Com a plicatura gástrica e fundoplicatura: 1) não houve redução significativa no hormônio grelina, apesar do relato de diminuição da fome e aumento da saciedade pelos pacientes; 2) o procedimento foi eficaz no tratamento da doença do refluxo; 3) obteve-se perda de peso significativa.

BACKGROUND: The recurrence of the gastroesophageal reflux disease may be related to later postoperative weight gain, therefore increasing the chances of developing columnar metaplasia and cancer. The gastric plication associated with fundoplication can be employed in order to be treating the two issues. AIM: To evaluate the serum ghrelin hormone in preand postoperatively as well as weight loss and control of reflux disease in patients undergoing gastroplication associated with fundoplication. METHODS: Was performed laparoscopic gastric plication with fundoplication in eight patients; endoscopic examinations were performed pre and postoperatively as well as blood collection for ghrelin hormonal dosage. RESULTS: There was control of reflux symptoms and mucosal lesions. Weight loss was significant. Since the change of the hormone ghrelin was not of great significance. CONCLUSIONS: Gastric plication associated with fundoplication was effective in treating reflux disease with surgical indication and for weight loss in obese patients. Appetite control occurs, but not due to ghrelin, because no significant decrease of its plasmatic levels was observed.

Técnicas restrictivas en cirugía bariátrica: evolución y tendencias actuales / Restrictive bariatric surgery techniques: evolution and current trends

La cirugía bariátrica ha demostrado ser más efectiva que el tratamiento médico para el control del peso y las comorbilidades asociadas. Se han descrito múltiples técnicas, las cuales pueden ser divididas en tres grupos: cirugías restrictivas, en las que el objetivo principal es disminuir el volumen de la ingesta calórica; cirugías malabsortivas, en las que se limita la absorción a nivel intestinal; y una combinación de ambas. Dentro de las técnicas restrictivas, la gastroplastía fue uno de los primeros procedimientos descritos. Inicialmente horizontal y luego la gastroplastía vertical anillada, mostraban buenos resultados a corto plazo, pero con una importante tasa de fracaso a largo plazo, por lo que estas técnicas fueron abandonadas paulatinamente. La banda gástrica ajustable tiene la ventaja de ser mínimamente invasiva y reversible, la baja de peso es adecuada pero menos efectiva que en el bypass gástrico. Las complicaciones postoperatorias son pocas inicialmente, sin embargo aumentan con los años de seguimiento. La gastrectomía vertical tubular es un procedimiento efectivo para bajar de peso, que puede ser realizado en forma segura como procedimiento primario único o como primera etapa de otro procedimiento. Esto se refleja en una excelente baja de peso y control de las comorbilidades, lo cual la hace comparable a otros procedimientos bariátricos aceptados. Finalmente en los últimos años han aparecido reportes promisorios de una nueva técnica, la plicatura gástrica.

Bariatric surgery has proved to be more effective than medical therapy in the treatment for obesity. Multiple techniques have been described and can be divided into three main groups: Restrictive surgery, where the main objective is to decrease the volume of caloric intake; malabsortive surgery, where a portion of the absortive circuit is bypassed and thus limiting the caloric absortion; and a combination of both. Among the restrictive techniques, gastroplasty was one of the first procedures described. First horizontal gastroplasty and then vertical banded gastroplasty showed good short-term results but with poor long-term outcomes. These techniques have been gradually abandoned. Adjustable gastric banding is a minimally invasive technique and has the advantage of being reversible. Weight loss is adequate, but less effective than gastric bypass. Postoperative complications are low at short-term, but increase per year at long-term follow-up. Sleeve gastrectomy is an effective weight loss procedure that can be performed safely as a first stage or primary procedure. This results in excellent weight loss and co-morbidity reduction that exceeds, or is comparable to, that of other accepted bariatric procedures. Gastric plicature is a relatively new procedure and has reported good short-term outcomes in weight loss with few short-term complications. However, long-term outcomes are yet to be demonstrated.

Plicatura gástrica laparoscópica, un nuevo procedimiento bariátrico: a propósito de un caso clínico / Laparoscopic gastric plication, a new bariatric procedure: report of one case

Bariatric surgery is an effective treatment for morbid obesity. Various techniques have been developed with different outcomes and complications. A new technique with promising results recently described in the literature: the gastric plication, which would not have the complications of using mechanical suture and would imply a reduction of costs. We report the first case in Chile under this technique.

La cirugía bariátrica es un tratamiento efectivo para la obesidad mórbida. Diversas técnicas se han desarrollado con diferentes resultados y complicaciones. Una nueva técnica con resultados prometedores se ha descrito recientemente en la literatura: la plicatura gástrica, la cual no tendría las complicaciones del uso de sutura mecánica e implicaría una reducción de los costos. Presentamos el caso clínico del primer paciente en Chile sometido a esta técnica.