Laparoscopic total gastric vertical plication in morbid obesity

Background: The aim of this study was to introduce a new technique, total gastric vertical plication (TGVP), as a restrictive operation. It has the same result of weight loss as others with minimal risk of complication and very low cost, especially in developing countries. Methods: This technique was used by one surgeon in private hospitals during 3 years in Tehran, Iran. Patients were placed in the supine position with a 30-degree reverse Trendelenburg position. Trocars were inserted based on an ergonomic assessment (three 5 mm and one 10 mm). After the release of the greater curvature, continuous sutures were used with 00 nylon from the fondus to 3 cm of the pylorus. A vertical plication was performed in one or two layers. Distance between the stitch and lesser curvature was 2 cm in the anterior and posterior and between each stitch, all of them getting extra mucosal (far away from acid effect) owing to mild tension on the sutures that cut mucosa and put on a submucosa layer. Results: TGVP was performed in 100 cases (mean age, 32; standard error of the mean = 2.1); mostly female (F/M = 76/24) and with average body mass index of 47 (36-58). The mean weight loss in our patients was 21.4% of excessive weight loss (EWL) 1 month after the operation, 54% after 6 months (72 cases), 61% after 12 months (56 cases), 60% after 24 months (50 cases), and 57% after 36 months (11 cases). The average time of follow-up was 18 months. The mean time of operation was 98 (70-152) minutes and all of the patients were discharged from the hospital after an average of 1.3 days (range, 1-4). The main postoperative complications were permanent vomiting, intracapsular liver hematoma, hypocalcemia at early postoperative period, hepatitis, leakage at the suture line, and acute gastric perforation. The volume of the stomach in this condition was 100 cc, but just one half of it was effective. If more than 50 cc was used, a painful condition would occur. Conclusions: The percentage of EWL in this technique is comparable to other restrictive methods, but EWL appears more rapidly. Early postoperative complications of this method are minimal, without any important late complications. This technique needs more expertise and is more time consuming. A long-term follow-up is advised.