الفهرس 
ANATOMY AND PHYSIOLOGY OF THE STOMACHOnly 14 pages are availabe for public view
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Abstract
As the number of morbid obese patients is increasing, bariatric surgery is considered the only effective treatment for long-term sustainable weight loss.
Different restrictive operations have 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 and disadvantages. However, most of the patients accept the risk because of their miserable and limited life secondary to morbid obesity.
The risk of weight 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, comorbidities, 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 decreased in 90s and is considered obsolete worldwide nowadays, because poor long-term outcome, with high incidence of complications (staple line disruption , weight regain and stomal stenosis which lead to poor quality of life and persistent vomiting with nutritional deficiency and 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 has good results in Australia, USA, may be because they still did 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 (a 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, LGP started to be practiced by many surgeons from different countries with short & mid term results that are promising when the right patient is selected with good postoperative follow-up. In 2012 Talebpour published a 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.
Nevertheless, 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, prokintics. Also acute gastric obstruction, transesophageal herniation leading to total dysphagia, rupture of the suture line and herniation of the gastric wall through the sutures and leakage have been reported.
Scarce data are available in the literature about metabolic effects of LGP, long-term outcomes, incidence of reflux, so LGP is considered investigational at present.
Our study was conducted at Ain Shams university hospitals and included 25 patients. Laparoscopic greater curvature plication (LGCP) was done for all patients. The patients had regular postoperative follow up at the out patients clinic in Eldemerdash hospital at 1, 3, 6, 12 months postoperatively. Our results revealed that: all cases were done laparoscopically with no need for conversion. Intraoperative complications was recorded only in one case (intraoperative bleeding that was controlled). The mean operative time was 111.8 min. and the mean postoperative hospital stay was 3 days. The most common postoperative complications were nausea and vomiting in 92% of patients which was controlled by medical treatment (antiemetics, PPIs and prokinetics), other reported complication in our study was port site infection in two patients. The mean EWL% after 12 months was 52.74 ± 11.65%. The study had showed good resolution of associated comorbidities. 17 patients had good postoperative diet control and behavior changes.
To conclude, short term results of LGP are promising, comparable to other restrictive operations.