Laparoscopic Gastric Plication in Adolescents and Young Adults with Severe Obesity: Description of the First Patient Enrolled in a Pilot Study

Abstract

Introduction:

Laparoscopic gastric plication (LGP) is a novel restrictive bariatric operation that has had some success in adult patients with weight loss and improvement in associated comorbidities (as demonstrated by Saber et al.). ¹ We are currently conducting a prospective research study, IRB # HM14809, entitled “A Pilot Study of Laparoscopic Gastric Plication in Adolescents and Young Adults” and have included the details from our first case in this abstract. The video demonstrates the plication technique with a run time of 4:58.

Background:

A 17-year-old girl is followed in our multidisciplinary weight loss program. While she had been adherent to the program, she was only able to lose approximately 7 pounds over 6 months (preoperative BMI was 42.5) and had several comorbidities, including polycystic ovarian syndrome, pseudotumor cerebri, and iron deficiency anemia.

Methods:

Three 5-mm and one 12-mm trocars were placed across the upper portion of her abdomen and a Nathanson liver retractor in the epigastrium. The short gastric blood vessels up to the angle of His as well as the vessels to the antrum were ligated, to approximately 4 cm above the pylorus. Four 2-0 polyester sutures were placed in an interrupted manner along the greater curvature as well as at the incisura and one on the antrum. Each of these sutures included a small portion of the posterior stomach as well as the anterior stomach to imbricate in the greater curvature. Two consecutive rows of 2-0 polypropylene running suture were placed from just inferior to the angle of His to several centimeters above the pylorus to further plicate the greater curvature and antrum. Care was taken to ensure that the diameter of the incisura was not compromised. Final esophagogastroscopy confirmed good apposition of the plicated stomach mucosa along the entire course of the lesser curvature without evidence of obstruction. The port sites were closed in a standard manner.

Results:

The patient tolerated the procedure well with minimal blood loss and no perioperative complications. She was discharged home on the third postoperative day on a liquid diet. At her 2-week follow-up, she was noted to have no nausea or pain, was advanced onto her pureed diet, and had lost 10 pounds.

Conclusion:

This report details the perioperative results of the first patient enrolled in a new pilot study examining LGP in morbidly obese adolescents and young adults. As the LGP is purported to be reversible and some parents are hesitant to consent to gastric bypass or sleeve resection for their child, this operation may be a reasonable alternative for young patients who have not been successful with nonoperative treatment of their morbid obesity.

No competing financial interests exist.

Run time of video: 4 mins 58 secs