Laparoscopic Gastric Plication (LGP) as an Alternative to Laparoscopic Sleeve Gastrectomy (LSG) in Patients with Morbid Obesity: A Preliminary, Short-Term, Case-Control Study.

BACKGROUND: Based on short-term outcome, gastric plication (LGP) could be considered as an alternative to sleeve gastrectomy (LSG) in patients with severe obesity. However, long-term follow-up of weight loss and comorbidity are yet to be available. Theoretical advantages include reduced fistula rate, no implantable device, preservation of the alimentary pathway, and no gastric resection. We report a case-control study comparing short-term outcome in two groups of patients who had either LGP or LSG, respectively. METHODS: From January 2012 to June 2013, 40 patients had LGP, matched with 40 patients who had LSG. RESULTS: No postoperative mortality was observed. Overall morbidity rate reached 22.5 % in the LGP Group and 10 % in the LSG Group (P = 0.04). The most common complication was nausea and vomiting occurring in 20 % of patients with LGP and 5 % of patients with LSG, respectively (P < 0.001). No clinical or radiological leak occurred. Mean operative time was 91.5 ±18.6 min in the LGP group and 81 min ±16.8 min in the LSG group, respectively (P = 0.104). Mean hospital stay was 3.4 ±1.1 days in the LGP Group and 3.2 ±1.2 days the LSG group, respectively (P = 0.614). Average total operating room (OR) cost was 1736 euros for LGP as compared to 2842 euros for LSG, respectively (P < 0.001). At 18-month follow-up, mean excess weight loss (EWL) was 56.5 % +9.8 in LGP patients and 71.3 % +10.4 in patients who had LSG (P = 0.041). CONCLUSIONS: LGP for patients with severe obesity is safe and feasible with low rates of serious complications. As compared to LSG, LGP is associated to higher postoperative rate of nausea, lower operative cost, and lower EWL at 18-month follow-up (P = 0.041).

Roux-en-Y fistulo-jejunostomy as a salvage procedure in patients with post-sleeve gastrectomy fistula: mid-term results.

BACKGROUND: Sleeve gastrectomy (SG) is currently the most commonly performed bariatric procedure in France. It achieves both adequate excess weight loss and significant reduction in comorbidities. However, fistula is still the most common complication after SG, occurring in more than 3 % of cases, even in specialized centers (Gagner and Buchwald in Surg Obes Relat Dis 10:713-723. doi: 10.1016/j.soard.2014.01.016 , 2014). Its management is not standardized, long, and challenging. We have already reported the short-term results of Roux-en-Y fistulo-jejunostomy (RYFJ) as a salvage procedure in patients with post-SG fistula (Chouillard et al. in Surg Endosc 28:1954-1960 doi: 10.1007/s00464-014-3424-y , 2014). In this study, we analyzed the mid-term results of the RYFJ emphasizing its endoscopic, radiologic, and safety outcome. METHODS: Between January 2007 and December 2013, we treated 75 patients with post-SG fistula, mainly referred from other centers. Immediate management principles included computerized tomography (CT) scan-guided drainage of collections or surgical peritoneal lavage, nutritional support, and endoscopic stenting. Ultimately, this approach achieved fistula control in nearly two-thirds of the patients. In the remaining third, RYFJ was proposed, eventually leading to fistula control in all cases. The mid-term results (i.e., more than 1 year after surgery) were assessed using anamnesis, clinical evaluation, biology tests, upper digestive tract endoscopy, and IV-enhanced CT scan with contrast upper series. RESULTS: Thirty patients (22 women and 8 men) had RYFJ for post-SG fistula. Mean age was 40 years (range 22-59). Procedures were performed laparoscopically in all but 3 cases (90 %). Three patients (10 %) were lost to follow-up. Mean follow-up period was 22 months (18-90). Mean body mass index (BMI) was 27.4 kg/m(2) (22-41). Endoscopic and radiologic assessment revealed no persistent fistula and no residual collections. CONCLUSIONS: Despite the lack of long-term follow-up, RYFJ could be a safe and feasible salvage option for the treatment of patients with post-SG fistula, especially those who failed conservative management. Mid-term outcome analysis confirms that fistula control is durable. Weight loss panel is satisfactory.