LGCP appears to be an effective operation for the treatment of morbid obesity. All studies show a %EWL at the range of 50% on 6 months and 60% on 12 months. Studies with longer follow-up periods indicate a durable result for up to 36 months. Complication rate appears to molecular weight calculator be low. In the 521 patients presented by the prospective studies, the rate of reported complications reaches 15.1% and reoperation rate was 3%. There was only 1 conversion (0.2%) due to a mesenteric injury from a faulty trocar, a rare but serious complication of laparoscopic surgery, and mortality was zero. Minor complications were at a rate of 10.7%, with nausea, vomiting, and sialorrhea being the most common in 5.7%, intraoperative bleeding which was managed without the need for conversion or transfusions in 1,7%, and dysphagia or obstruction which was successfully managed conservatively in 2.
6%. Major complications presented at a rate of 4.4%. The ones managed conservatively included upper GI bleed managed with gastroscopy and endoscopic haemostasis in 0.6% and microleaks managed conservatively in 0.4%. Major complications that required reoperation were at a rate of 3%, the most common causes being gastric obstruction (due to fold prolapse, fold edema, adhesions, or accumulation of fluid within the gastric fold) in 1,5%, leaks due to suture line disruption and herniation in 0.7%, and gastric fistula in 0.1%. No worsening of GERD symptoms or new GERD onset was reported; in fact there is reason to believe that LGCP could be the best operation in case of coexistence of GERD in an obese patient.
There are many lessons to be learnt from all the publications. The data currently available may not be representative as many patients could have an LGCP in foreign countries and not return for followup. Their weight loss and complications may never be studied. One recurrent theme in all studies is gastric wall edema, which may cause transient dysphagia, complete dysphagia, or even gastric compartment syndrome and perforation. One should be very careful when performing a tight plication as the ensuing edema could lead to serious complications . In fact, most complications presenting with vomiting could be successfully treated with anti-inflammatories and PPI’s in an attempt to reduce the edema. In more persistent cases, gastroscopy should be attempted as repositioning of the fold could relieve the obstruction.
If that fails, reoperation is the only option. The Skrekas modification of the LGCP with formation of multiple smaller folds may prove a valuable alternative . Suture line disruption with herniation and leaks are serious complications. Experimental data show that careful positioning of the sutures at a minimum distance of Carfilzomib 2.5cm, without penetration of the mucosa, produce a strong durable plication.