Twelve year experience of laparoscopic gastric plication in morbid obesity: development of the technique and patient outcomes.
Twelve year experience of laparoscopic gastric plication in morbid obesity: development of the technique and patient outcomes.
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DOI：
10.1186/1750-1164-6-7
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发表时间：
2012-08-22
期刊：
影响因子：
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通讯作者：
Vahidi H
中科院分区：
文献类型：
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作者：
Talebpour M;Motamedi SM;Talebpour A;Vahidi H
腹腔镜胃折叠术（LGP）是一种新的限制性减肥手术，作者之前曾介绍过。本研究的目的是解释修改，并提出12年的经验，关于早期和长期的结果，并发症和成本。在过去的12年里，我们使用LGP治疗病态肥胖。前折术10例，包括胃网膜右动脉的双行折叠术42例，排除胃网膜右动脉的双行折叠术104例，双行折叠术644例。在膈肌水平使用2/0 prolen从胃底折叠胃大弯，保留His角至幽门近端。二排法胃的解剖容积为50cc，功能容积为25cc。有序的术后访视还包括评估体重减轻、并发症、饮食改变和运动控制。在800例患者中进行了LGP（平均年龄：27.5岁，范围：12至65岁，9例在18岁以下）。男女比例为81%比19%，平均BMI为42.1（35 - 59）。术后24个月和5年的平均额外体重减轻（EWL）分别为70%（40%至100%）和55%（28%至100%）。134例（16.7%）未完成长期随访。随访1个月~12年，平均5年。术后4年和12年分别有5.5%和31%的患者主诉体重增加。平均手术时间72（49-152）min，平均住院时间72 h（24 h~45 d）。手术费用比胃束带或袖带手术节省2000元，比胃旁路手术节省2500元。800例患者中有8例（1%）因并发症需要再次手术，如：微穿孔、梗阻和希氏角粘连后呕吐。其他并发症包括肝炎肺炎、自限性腹腔内出血和低钙血症。EWL在该技术中的百分比与其他限制性方法相当。该技术是安全的，并发症发生率为1.6%（1%再次手术），12年内复发率为31%。手术费用低于其他方法。
Laparoscopic Gastric Plication (LGP) is a new restrictive bariatric surgery, previously introduced by the author. The aim of this study is to explain the modifications and to present the 12-year experience, regarding early and long term results, complications and cost. We used LGP for morbid obesity during the past 12 years. Anterior plication (10 cases), one-row bilateral plication while right gastroepiploic artery included (42 cases), and excluded from the plication (104 cases) and two-row plication (644 cases). The gastric greater curvature was plicated using 2/0 prolen from fundus at the level of diaphragm preserving the His angle to just proximal to the pylorus. The anatomic and functional volume of stomach was 50cc and 25cc respectively in two-row method. Ordered postop visits also included evaluation of weight loss, complications, change of diet and control of exercise. LGP was performed in 800 cases (mean age: 27.5, range: 12 to 65 years, nine under 18). Female to male ratio was 81% to 19% and average BMI was 42.1 (35-59). The mean excess weight loss (EWL) was 70% (40% to 100%) after 24 months and 55% (28% to 100%) after 5 years following surgery. 134 cases (16.7%) did not completed long term follow-up. The average time of follow up was 5 years (1 month to 12 years). 5.5% and 31% of cases complained from weight regain respectively during 4 and 12 years after LGP. The mean time of operation was 72 (49–152) minutes and average hospitalization time was 72 hours (24 hours to 45 days). The cost of operation was 2000 $ less than gastric banding or sleeve and 2500 $ less than gastric bypass. Eight patients out of 800 cases (1%) required reoperation due to complications like: micro perforation, obstruction and vomiting following adhesion of His angle. Other complications included hepatitis pneumonia, self-limiting intra-abdominal bleeding and hypocalcaemia. The percentage of EWL in this technique is comparable to other restrictive methods. The technique is safe with 1.6% complication (1% reoperated), and 31% regain during 12 years. The cost of operation is less than the other methods.