New study results GPS/VSG

[Lmom1980 29]

I feel like this is an honest report on plication. I would not say I regret my plication, because I have lost weight and I

have felt great and been totally healthy since my surgery 6 months ago. I do think if I could do it over again I would do the

sleeve! I am not trying to be negative about plication. I just feel like this is an hosnest report on the surgery, and I just hope

and pray that I am in the % of high BMI people that have success. I had a little more then 100 pounds to lose. I am a little

over half way there. I am not going to let this get me down. I made a choice, and I am going to make the best of what I have.

"LAPAROSCOPIC TOTAL GASTRIC PLICATION. 2- YEAR RESULTS AND COMPARISON TO SLEEVE GASTRECTOMY.

George Skrekas MD, ISS, EAES, General surgeon, Specialist in advanced laparoscopy & bariatric surgery

Other key words: gastric greater curvature invagination, gastric imbrication.

PURPOSE: The presentation of our results with total gastric plication (imbrication) in a 135 patients series and comparison to a randomized series of 80 patients who underwent sleeve gastrectomy in the same period.

METHODS: The study was designed as prospective - double. The GROUP I is consisted from 135 patients (104 women and 31 men) who voluntarily underwent gastric plication in a 2-year period (2008-2010). The GROUP II includes 80 randomly selected patients (50 women and 30 men) who underwent sleeve gastrectomy in the same period. The two groups were comparable as to age (36 vs 35.4 years) but differed as to the initial BMI (BMIGroupI = 39.5 vs BMIGroupII= 46.5Kg/m2).

RESULTS: 12 patients of GROUP I (8.8%) presented post operative complications of which 4 cases were treated surgically ( 1 case of gastric prolapse, 1 case of Portal vein thrombosis with partial jejunum necrosis and 2 cases of late gastric occlusion due to the formation of intragastric seroma). In the last 2 cases we did reversion of the plication 3 months after the primary operation. The mean follow-up was 20.4 months (13-32). In the group of gastric plication (GROUP I) the mean (%) excess weight loss (EWL) was 65.3%. Weight loss was significantly greater in patients with initial BMI < 45 (69.9% vs 55.5%, p = 0.006). 29 patients of GROUP I (21.4%) had poor weight loss (EWL <50%), while in 8 of them (5.9%) the surgery was deemed as failure (EWL <30%). Patients with an initial BMI> 45 were twice as likely to fail loosing adequate weight than those who had BMI <45 (36% vs 18.1%). The patients who underwent sleeve gastrectomy (GROUP II) achieved significantly greater weight loss (EWL = 81.7% vs 65.3%, p <0.001) while they had 9 times less probability of insufficient weight loss (2.5 vs 21.4%). The overall weight loss was considered satisfactory in 78.6% of the patients who underwent gastric plication and in 97.5% of those who underwent sleeve.

CONCLUSION: The total gastric plication surgery presents some good features: adequate gastric restriction without implants or gastrectomy, simplicity, reversibility and acceptable risk of complications. In the short-term, the total gastric plication is able to provide an acceptable weight loss in about 80% of patients, but is considerably less effective when compared to sleeve gastrectomy. According to our experience, the total gastric plication might be offered as an option for the treatment of "less heavy" bariatric cases with BMI <45 because beyond this limit, the probability of insufficient weight loss or failure is high (36%)."

Side note. I googled this doctors name and plication. I read as much of it that was in English. He implied that only did the running stitch in the early stages of plication. I found that interesting. My Doctor and Dr. Cottam do an interupted suture now too. Dr. Ortiz tells his patients that the running stitch is the new and better way, when in fact most plication surgeons have adapted to the interupted stitch. NEWS FLASH ORTIZ...your method is out-dated and the only reason you still do it is to save time and $.

." Three patients failed loosing weight due to gastric sewing disruption (one of them had a successfull reoperation 3 months later). This happend in our early experience. At the time we used a single running suture (prolene) for the plication. These 3 patients were excluded from statistic analysis"

[TijuanaPlication 87]

Dr Watkins also said on verticalsleevetalk here http://www.verticals...291-gps-update/ that interrupted stitches are better (it's at the start of his 2nd paragraph), so I don't know why anyone would be saying anything different.

If anyone out there knows what Dr Lopez Corvala does, I'd love to know. I really wouldn't expect to get a straight answer on a simple yes/no question like that from Angeles Health as I'm a post op, and as I've said the follow up from them is zero.