Laparoscopic gastric plication with intraoperative endoscopy: a guide for a correct procedure
Epublication WebSurg.com, Apr 2014;14(04). URL: http://websurg.com/doi/vd01en4222
The field of bariatric surgery is continually evolving. Laparoscopic gastric plication (LGP) is an experimental bariatric procedure developed with the intent to offer the same effect as sleeve gastrectomy in gastric restriction without the same degree of risk. The LGP procedure consists in a complete mobilization of the fundus and body, followed by an invagination of all the greater curvature of the stomach, maintained by a full-thickness suture, from the angle of His down to 6cm from the pylorus, in order to create a large intraluminal gastric fold. The aim of the present video was to report our technique in LGP, presenting the role and all the advantages of intraoperative endoscopy. The procedure was completed in a 37-year-old woman, with previous gastric banding. Due to limited weight loss, LGP was performed in a single step procedure after concomitant gastric banding removal. The video shows all surgical steps: gastric banding isolation and removal, mobilization of the greater gastric curvature, gastric plication by double invagination suture lines controlled by intraoperative endoscopic evaluation. The endoscope was left in place during the whole plication procedure like a calibration tube to ensure a patent lumen, and the intragastric vision represents a three-fold guide: a guide for the surgeon in terms of size of the gastric fold, a guide in terms of shape of the gastric lumen, and a guide for a correct suture and position of full-thickness bite. The video is also completed by a postoperative 8-month endoscopic evaluation, to assess the appearance of the fold and plication durability. In our preliminary experience, intraoperative endoscopy is a mandatory combined procedure during LGP to achieve all the required information for a correct surgical procedure. The endoscopic evaluation also represents a fundamental step during follow-up, also considering the experimental phase of this surgical procedure.