IN THE NAME OF GOD

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IN THE NAME OF GOD
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TOTAL GASTRICVERTICAL PLICATION IN MORBID
OBESITY

• DR. M. TALEBPOUR
• LAPAROSCOPIC FELLOWSHIP
• TEHRAN MEDICAL UNIVERSITY

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MORBID OBESITY

• DISEASE
• MEANING (BMIW(KG)/H.H(M))
• CHANGE OF PSYCHOLIGICAL DIET HABIT
• THE BEST OBTION OF TREATMENT
• DIET
• EXERCISE
• SUP.O 3-5, MOR.O 10, OB 30, OVE.W50
• SURGERY

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SURGERY MORBID OBESITY

• METHODS
• VOLUME RESTRICTION
• MALABSORPTION
• INDICATIONS
• BMIgt35, COMORBIDITY OR COOPERATION
• BMIgt40, RESTRICTIVE
• BMIgt50, RESTRICTIVEMALABSORPTION

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PATIENT SELECTION

• YOUNG
• FEMALE
• INTEREST (SINGLE)
• CHANGE OF MOOD (OBESITY DURING
• INFANTILE)

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AIM

• WEIGHT LOSS
• CONSERVATIVE
• PRICE
• LAPAROSCOPIC
• MORBIDITY
• MORTALITY

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WEIGHT LOSS

• TECHNIQUE
• DIET EXERCISE
• PSYCHOLOGICAL HABIT

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REGAIN

• POUCH DILATION
• SOCIALITY
• SWEET EATER

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TOTAL GASTRIC PLICATION

• 100 CC VOLUME, 50 CC EFFECTIVE
• ONE OR TWO VERTICAL CONTINOUS LAYER
• OO NYLON
• EXTRAMUCOSAL (ACID)
• 3 WEEKS LIQUID
• PHYSIOLOGIC CHANGE
• 4-5 SPOONS, RAPID THIRSTY
• AFTER 6M 6 S, 12M 8S, 24M 10S,
• VOLUME, FAT AND HYDROCARBONE DIET

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TROCAR SITES
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5 CM FAR AWAY PYLORUS
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FORM OF PLICATION
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END OF PLICATION
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TRANSVERSE SECTION
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CONTRAST IMAGING
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RESULTS

• EWL / 6 MONS 54
• EWL / 1 YEARS 60
• EWL / 2 YEARS 57
• GV / 6 MON 6 SPOONS
• GV / 1 YEARS 8 SPOONS
• GV / 2 YEARS 10 SPOONS
• POST OPERATIVE POINTS
• VOMITING (ANGLE OF HIS)
• WEAKNESS
• QUALITY OF LIFE

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RESULTS

• COMPLICATIONS 2
• STRICTURE
• LEAK/ SUTURE LINE
• GASTRIC PERFORATION
• TIME WITH LIGASURE 90 MIN
• WITH BIPOLAR 120 MIN
• MORTALITY ZERO
• BLOOD INFUSION ZERO

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CONCLUSION

• INDEPENDENT AND EASY FOLLOW UP
• FOREIGN BODY REACTION
• COST
• LESS COMPLICATION
• REGRESSIVE, PROGRESSIVE (2 STAGE OP)
• DONT NEED REOPERATION
• REGAIN, GASTRIC VOLUME DILATION

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CERTIFICATION

• NINEWELLS, DUNDEE, UK, PROF CUSCHIERI,
• IRCAD, STRASBOURG, FRANCE, PROF LEROY, MARESCAUX
• EAES, The Postgraduate Course Bariatric
  Surgery,FIRST European Endoscopic Surgery Week,
  15 June, 2003 Glasgow, Scotland, PROF MURINO
• EAES, The Postgraduate Course Bariatric
  Surgery,12TH European Association For Endoscopic
  Surgery, 9-12 June, 2004 Barcelona, Spain, Prof
  MELOTI
• ASBS, ASBS congress, San Diego, 14-17 june, 2003,
  PROF M. GAGNER

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EAES CONGRESS, VENICE 1-4 JUNE 2005
Sina Hospital Laparoscopic surgery Dr, Phd M.
Talebpour Date 31/03/2005 Abstr. no. 39
Concerns 13th International Congress of the
EAES, Venice 1-4 June 2005 Abstract TOTAL
GASTRIC PLICATION IN MORBID OBESITY Dear Mr.
Talebpour, On behalf of the Programme Committee
we would like to inform you that your abstract
include for "POSTER" presentation during the 13th
EAES International Congress. Please note that you
must register to attend the 13th EAES Conference
and pay the appropriate fee.
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10th World Congress of Endoscopic Surgery, 14th
EAES Congress,13 - 16 September 2006, Berlin,
Germany  
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• January 27, 2006
• Dear MOHAMMAD TALEBPOUR On behalf of the ASBS
  Program Committee we are very pleased to inform
  you that your paper has been accepted for Poster
  presentation at the 23rd Annual Meeting of the
  ASBS, June 26 - July 1, 2006 at Moscone West
  Convention Center in San Francisco,
  California.   Posters will be on display
  Wednesday, June 28 through Friday, June 30. 
  Specific time during the Plenary Session has been
  designated for Poster Rounds.  Posters will be
  judged for presentation quality.  First authors
  of the top two Posters will receive a financial
  award. We are looking forward to an interesting
  and informative session.  If you have any
  questions regarding the program, please do not
  hesitate to contact me. Sincerely, Pat
  WatsonConvention Manager

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J Laparoendosc Adv Surg Tech A. USA 2007
Dec17(6)793-8. Laparoscopic total gastric
vertical plication in morbid obesity.Talebpour
M, Amoli BS.Laparoscopic Surgical Ward, Sina
Hospital, Tehran Medical University, Tehran, Iran

• BACKGROUND The aim of this study was to
  introduce a new technique, total gastric vertical
  plication (TGVP), as a restrictive operation. It
  has the same result of weight loss as others with
  minimal risk of complication and very low cost,
  especially in developing countries.
• METHODS This technique was used by one surgeon
  in private hospitals during 3 years in Tehran,
  Iran. Patients were placed in the supine position
  with a 30-degree reverse Trendelenburg position.
  Trocars were inserted based on an ergonomic
  assessment (three 5 mm and one 10 mm). After the
  release of the greater curvature, continuous
  sutures were used with 00 nylon from the fondus
  to 3 cm of the pylorus. A vertical plication was
  performed in one or two layers. Distance between
  the stitch and lesser curvature was 2 cm in the
  anterior and posterior and between each stitch,
  all of them getting extra mucosal (far away from
  acid effect) owing to mild tension on the sutures
  that cut mucosa and put on a submucosa layer.
• RESULTS TGVP was performed in 100 cases (mean
  age, 32 standard error of the mean 2.1)
  mostly female (F/M 76/24) and with average body
  mass index of 47 (36-58). The mean weight loss in
  our patients was 21.4 of excessive weight loss
  (EWL) 1 month after the operation, 54 after 6
  months (72 cases), 61 after 12 months (56
  cases), 60 after 24 months (50 cases), and 57
  after 36 months (11 cases). The average time of
  follow-up was 18 months. The mean time of
  operation was 98 (70-152) minutes and all of the
  patients were discharged from the hospital after
  an average of 1.3 days (range, 1-4). The main
  postoperative complications were permanent
  vomiting, intracapsular liver hematoma,
  hypocalcemia at early postoperative period,
  hepatitis, leakage at the suture line, and acute
  gastric perforation. The volume of the stomach in
  this condition was 100 cc, but just one half of
  it was effective. If more than 50 cc was used, a
  painful condition would occur.
• CONCLUSIONS The percentage of EWL in this
  technique is comparable to other restrictive
  methods, but EWL appears more rapidly. Early
  postoperative complications of this method are
  minimal, without any important late
  complications. This technique needs more
  expertise and is more time consuming. A long-term
  follow-up is advised.
• PMID 18158812 PubMed - in process

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