الفهرس 
ANATOMY & PHYSIOLOGY OF THE STOMACHOnly 14 pages are availabe for public view
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Abstract
The number of morbid obese patients is increasing; bariatric surgery is considered the only effective treatment for long term sustainable weight loss.
Different restrictive methodshave been developed to achieve sustainable, significant weight loss with minimal invasion and complications, but until now there is no ideal choice, each operation still have reported complication which can occur in different time and way, however most of the patients accept the risk because of their miserable and limited life secondary to morbid obesity.
The risk of regain is the problem of all kinds of bariatric surgeries, to reach the best method one should tailor the choice according to the patient’s life style, co morbidities, eating habits, BMI with the least risk of complication.
Restrictive methods succeed only in motivated patients who can change their life style, keep on healthy high protein low calorie diet, and keep on regular exercise.
Vertical banding gastroplasty(VBG) gained popularity in 80s, and decresed in 90s and considered obsolete worldwide nowadays, because poor long term outcome, with high incidence of complications; staple line distruption with weight regain, stomal stenosis lead to poor quality of life and persistant vomiting with nutritional deficiency, reflux.
Gastric banding appeared in early 90s in Europe and replaced VBG, but now is decreasing after twenty years because of poor long term results and patient compliance with band adjustments, but still hasgood results in Australia, USA, may be because they still not reached the twenty years’ experience of Europe.
Sleeve Gastrectomy is first stage of duodenal switch, and appeared as stand alone procedure in 2001, and gained international consensus in 2007 to be considered one of the choices, since that time it gained widespread worldwide because of simplicity, higher results than gastric banding and comparable to gastric bypass, but still carry risk of leakage and vitamin deficiency, many patients refused the concept of resection.
In 2007 Talebpour surgeon from Iran, presented his result on 100 cases with new technique; laparoscopic Gastric plication (LGP), with EWL 54% after 6 months, 61% after 12 months, 60% after 24 months, and 57% after 36.
Since that time LGPstarted to be practiced by many surgeons from different countries, good short & midterm results are promising when the right patient is selected with good postoperative follow-up, in 2012 Talebpour published large series study on 800 cases with EWL was 60% after 6 months, 67% after 12 months, 70% after 24 months, 66% after 3 years, 62% after 4 years and 55% after 5 years following surgery.
But insufficient weight loss was reported by others with 35% EWL at 1 year, so the concept of choosing the right motivated patient with restrict follow up is very important in all kinds of surgery especially the restrictive type.
Advantages of LGP over other restrictive methods are less cost, less risk of vitamin deficiency, no postoperative adjustments or foreign body reaction, the risk of leakage is decreased but not eliminated completely, there are reported cases in the literature, the possible mechanisms for postoperative gastric perforation include acute distension of the stomach or severe vomiting with a resultant full-thickness tear at the suture line, as well as delayed thermal injury of the stomach that occurs during division of the short gastric vessels, particularly if the attachments to the upper pole of the spleen were very short.
The most common reported complication are nausea, vomiting, sialoreia which managed by PPI, pro kintics. Also acute gastric obstruction, transosophageal herniation led to total dysphagia, rupture of the suture line and herniation of the gastric wall through the sutures and leakage have been reported.
Scarce date in the literature about metabolic effects of LGP, long term outcomes, incidence of reflux, so LGP according to ASMBS is considered investigational at present.
To conclude, short and mid-term of LGP is promising, comparable to other restrictive operations but with less cost.
It is still so early for LGP to gain international consensus, RCTs are required to study its long term outcomes.