Laparoscopic Gastric Plication: Appropriate Option in Times of Crisis?

Objective: The aim of this study is to investigate the practice of laparoscopic gastric plication (LGP) in Syria with particular emphasis on efficacy and complications, and to explore the concept of bariatric surgery in times of crisis with its related issues and concerns.

Materials and Methods: A prospective cohort study included all patients who underwent LGP between February 2011 and September 2014. The main outcome was the percentage of excess weight loss (%EWL). Secondary outcomes included operative time, hospital stay, postoperative complications, and improvement of related comorbidities.

Results: Of the 129 patients who underwent LGP in the study period, 96 patients were included in the final analysis. The mean body mass index was 39.5 kg/m2 (32–49 kg/m2). No cases of conversion to laparotomy, leak, intraabdominal infection, or mortality were seen. Vomiting was the most common postoperative complaint, which was encountered in 91.6% of patients. Two patients required operation reversal because of protracted vomiting. Mean %EWL was 60%, 65%, 70%, 67%, 66% and 65% at 6, 12, 18, 24, 30 and 36 months respectively. Obesity-related comorbidities were present in 33 patients (34.4%), and they showed considerable improvement or complete resolution in 57-100% of cases. Weight regain was seen in 7 patients (7.3%) after 36 months, three of whom (3.1%) requested reoperation.

Conclusions: LGP is a feasible and safe operation for the treatment of morbid obesity, and it is comparable to other restrictive bariatric operations with fewer rates of serious complications. It is an appropriate technique in times of crisis due to low cost and ease of follow-up.