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First Comparative Study Between Sleeve Gastrectomy, Laparoscopic Greater Curvature Plication and Endoscopic Plicated Gastroplasty

Amador Garcia Ruiz, Eduard Espinet Coll, Gontrand Lopez-Nava, Javier Nebreda Duran, Manoel Galvao Neto, Jordi Pujol Gebelli

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©️ 2016 Published by Elsevier Inc.

Restrictive procedures are an excellent option for patients with lower BMI. New procedures in this area, both surgical and endoscopic, have widened the bariatric armamentarium with less invasive choices. This study compares sleeve gastrectomy, laparoscopic and endoscopic gastric plication. We retrospectively reviewed operated patients for Sleeve Gastrectomy (SG), Laparoscopic Greater Curvature Plication (LGCP) and Endosopic Gastric Plication (EGP) from 4 different Centers. SG was constructed over a 36F bougie wit 4 to 6 staplers. LGCP was performed also over a 36F bougie with 2 layers of continuous non-absorbable sutures from Hiss to Antrum. EGP was constructed with an average of 6 sutures with 6 stiches each (including anterior wall, greater curvature and posterior wall). We compared patients with BMI up to 45kg/m2. Multicenter, retrospective comparative study of efficacy at 6 and 12 months follow-up, and safety (morbidity and mortality) of each technique in patients with BMI 30-39.9 kg/m2 and BMI 40 to 45kg/m2. 173 patients (69 EGP, 38 LGCP and 66 SG) with a mean BMI of 39.48, 39.95 and 40.23kg/m2 respetively. The BMI≤40 group included 89 patients (48 EPG, 17 LGCP and 24 SG) with respective initial average BMI of 36.4, 38.3 and 37.5 kg/m2;. At 12 months: TBWL: 19.8, 25.3 and 24.4 kg; %EWL 60.6, 64.4 and 76.1%; TBMIL: 7.2, 9.4 and 9.0 kg/m2;, without statistically significant differences. Hospitalization: EPG: 1 day. TPG and VG: 3 days. Major complications: EPG: 0%. TPG: 6% (1 reoperation). SG: 4% (1 reoperation).The BMI 40 to 45 group included 84 patients (21 EGP, 21 LGCP and 42 SG) with a mean BMI of 41.88, 42.25 and 42.47kg/m2. At 12 months: EWL: 45.86, 64.39 and 67.30%; TBWL: 21.28; 30.01 and 31.40kg and TBMIL 8.89, 12.80 and 13.38kg/m2. All parameters showed statistically significance favoring the surgical group. Hospital stay was also 1 day for EGP and 3 days for surgical group. Morbidity was 0 for the endoscopic group and 4 patients of SG and 3 for the LGCP group. 2 patients after SG had to be reoperated and 2 in the LGCP group. Mortality was 0 in the whole series. All these restrictive procedures achieve good weight loss in these group of patients. Endoscopic gastric plication showed the same results after 1 year than the surgical groups, but when initial BMI grows up to 45, the surgical group is better. Morbidity and hospital stay are better in the endoscopic procedures


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