gms | German Medical Science

Introduction: Gastric plication is a promising new primary bariatric procedure caracterized by its low cost and the possibility of low complication rates but still need confirmation from long term results and comparative studies. Besides posing as a primary bariatric procedure, plication can act as a very interesting, low risk and low cost revisional bariatric procedure for failed gastric bypass due to pouch dilation, for failed sleeve gastrectomy due to pouch reservoir dilation and for failed band due to slippage and pouch enlargement.

Material and methods: 42 patients with failed primary bariatric procedure were revised using laparoscopic greater curvature gastric plication, being 21 after gastric bypass, 8 after sleeve gastrectomy, and 12 after gastric banding. Plication technique resulted in shortening a dilated pouch and anastomosis for RYGB patients, in imbricating greater curvature over a 32Fr Bougie for failed sleeves, and removal of the band and plication for band failures. All patients had less than 50%EWL and at least 2y from primary procedure.

Results: Procedures lasts from 38 to 115min (mean 56min) for revisional RYGB, 35 to 89min (mean 48min) for revisional sleeve, and a mean of 65 min for band patients. There were no intraoperative complications. All plicated sleeve patients complained of mild nausea and some vomiting up to one week, which didn’t happened to any revised RYGB patients. All patients but 5 achieved at least 50%EWL. One postoperative complication occurred to a band patient that had the fibrotic capsule resected and developed an intra-abdominal abscess (drained by CT-Scan) with no further leak.

Conclusion: Laparoscopic gastric plication has good short term result as a revisional procedure for failed RYGB, sleeve gastrectomy and gastric banding. It shoud be considered in cases with inadequate weight loss after 2 years from the primary procedure.