Phil Schauer, MD

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Laparoscopic Gastric Plication

• Phil Schauer, MD
• Bariatric and Metabolic Institute

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Education and Research Support, Consulting

• NIH/NIDDK
• Ethicon Endosurgery
• Stryker Corporation
• Invacare Corporation
• Covidien
• Gore Corporation
• Bard/Davol Corporation
• Baxter Corporation
• Cardinal Health
• Surgical Excellence
• Barosense
• ReMedyMD
• SurgiQuest
• Quadrant

www.ccf.org
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Laparoscopic Gastric Plication

• No stomach stapling or removal
• low leak risk, low bleeding risk
• No bypass
• minimal nutritional risk
• no bowel re-routing
• No foreign body (i.e. band)
• no prolapse or erosion risk
• Potentially reversible or modifiable to another
  procedure if needed
• Minimally invasive short stay
• Lower cost

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LGCP Normal Endoscopic Appearance

• Invagination of the greater curvature results in
  decreased intraluminal gastric volume
• Normal, intact plication results in lobular
  contour abnormalities and intraluminal filling
  defects on imaging

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LSG vs. LGCP
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Variations in TechniqueLaparoscopic Greater
Curvature Plication

• Suture Type
• Suture Pattern
• Suture Spacing
• Depth of Fold
• Calibration
• Use of Endoscopy

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Video - Technique
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Clinical Studies - Outcomes
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OUTCOME OF LAPAROSCOPIC TOTAL VERTICAL GASTRIC
PLICATION IN MORBID OBESITY Talebpour M, Amoli
B. J Laparo Adv Surg Tech 2007 17793-798
N150, Mean BMI 47
61
60
57
57
72p
51p
55
94p
23p
10p
10

• N 100
• Age 15-64 y
• BMI 31.64 - 45.09 kg/m2 Mean37.47Kg/m2
• Results at 1 year
• Mean weight loss 26.4 /- 8.7 kg (13-51 kg)
• Mean EWL 69.6 /- 7.44 (6.2 95.6)
• No reported complication or mortality

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Laparoscopic Greater Curve PlicationRamos et al.
Obes Surg 2010 Jul20(7)913-8

• 42 patients
• Mean BMI 41 kg/m2
• Mean operative time 50 minutes
• Mean length of stay 36 hours
• No major complications
• Mean 62 EWL at 18 months

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Brethauer SA et al. SOARD 2011 715-22
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Laparoscopic Gastric Plication for the Treatment
of Severe ObesityMETHODS

• IRB approval obtained for this investigational
  procedure
• 15 patients (three male)
• Mean preop BMI 43.5 (36.9 49.0)
• 9 patients underwent anterior surface plication
• 6 patients underwent greater curvature plication
  (gcp)

Brethauer SA et al. SOARD 2011 715-22
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Anterior Plication
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Greater Curvature Plication
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Anterior Plication
6 months
12 months
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6 months
Greater Curvature Plication
12 months
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Weight Loss
Procedure Three Months Three Months Three Months Twelve Months Twelve Months Twelve Months
Procedure N ? BMI EWL N ? BMI EWL
Anterior 9 -4.8 /- 1.4 23.0 /- 6.4 7 - 4.3 /- 4.5 19.8 /- 19.3
Greater Curvature 6 -7.8 /- 1.5 38.9 /- 8.2 6 -10.9 /- 5.5 53.9 /- 22.3
2 patients lost to follow-up Data from 2 patients collected after scheduled 12 month visit 2 patients lost to follow-up Data from 2 patients collected after scheduled 12 month visit 2 patients lost to follow-up Data from 2 patients collected after scheduled 12 month visit 2 patients lost to follow-up Data from 2 patients collected after scheduled 12 month visit 2 patients lost to follow-up Data from 2 patients collected after scheduled 12 month visit 2 patients lost to follow-up Data from 2 patients collected after scheduled 12 month visit 2 patients lost to follow-up Data from 2 patients collected after scheduled 12 month visit
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Comparison to Other Studies
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Complications

• No bleeding or infectious complications
• First GCP patient required reoperation and
  plication reduction on POD2 due to gastric
  obstruction
• Mild to moderate nausea in all patients (2
  severe).
• Resolved within two weeks.
• One GCP patient required laparoscopic
  cholecystectomy 11 months after procedure

Brethauer SA et al. SOARD 2011 715-22
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Laparoscopic Gastric Greater Curvature Plication
Results and Complications in a Series of 135
PatientsSkrekas et al. Obes Surg. 2011
Nov21(11)1657-63.

• April 2008 December 2009
• One or two-layer plication over 36 Fr Bougie
• Mean OR time 40-50 minutes
• Mean LOS 1.9 days (1-6)
• Mean F/U 22 mos (8-31)

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Skrekas et al. Obes Surg. 2011
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Multicenter Trial Underway

• 3 centers
• 45 patients
• 3 year follow-up
• All sutured Greater Curve Plication
• Standardized technique
• Enrollment complete

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Plication with Gastric Banding
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Laparoscopic Gastric PlicationSummary

• Anterior Plication safe, but not effective
• Greater Curve Plication
• Technically feasible, reproducible
• Good short-term weight loss
• Low major complication rate
• Remains investigational (ASMBS Position
  Statement)

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MISS 2013 Las VegasFEBRUARY 21-23, 2013
Year Venue
2001 Snowbird, UT
2002 Beaver Run, Breckenridge, CO
2003 Squaw Creek, Lake Tahoe, Calif
2004 Whistler, British Columbia
2005 Squaw Creek, Lake Tahoe, Calif
2006 Vail Cascade, CO
2007 Snowbird, UT
2008 Steamboat, CO
2009 Harrahs, Lake Tahoe, NE
2010 Marriott Marina, San Diego, Calif
2011 Grand America Hotel, Salt Lake City
2012 Grand America Hotel, Salt Lake City
2013
www.miss-cme.org
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Thank You