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IN THE NAME OF GOD

IN THE NAME OF GOD. Dr. M. Talebpour Advanced Laparoscopic Fellowship Tehran University of Medical Science. LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION ( tVgp ) IN MORBID OBESITY. Disease Incidence Diet & Exercise: <10% Surgery: Restrictive, Mal absorptive New method: TVGP

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IN THE NAME OF GOD

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  1. IN THE NAME OF GOD

  2. Dr. M. Talebpour Advanced Laparoscopic Fellowship Tehran University of Medical Science LAPAROSCOPIC TOTAL VERTICAL GASTRIC PLICATION(tVgp) INMORBID OBESITY

  3. Disease Incidence Diet & Exercise: <10% Surgery: Restrictive, Mal absorptive New method: TVGP Aim: Report of results after 7 years follow up MORBID OBESITY

  4. RESTRICTIVE: EARLY MORBID OBESITY WITH COOPERATION (270 TVGP) • MIXED: LATE MORBID OBESITY WITH COOPERATION, (20 GB) OMEGA ANASTHOMOSIS CONTINOUS HAND SWEN NYLON 00 • MALABSORPTIVE: MORBID OBESITY WITHOUT COOPERATION (12 ILEOJEJUNAL BYPASS) TECHNIQUE SELECTION

  5. Supine position • Trocars: 10 mm (one), 5 mm (three) • Ergonomy • Greater curvature release by ligature • Angle of Hiss preserve • Plication at greater curvature by continuous suture 00 nylon • From cardia to 5 cm of pylorus METHOD OF TVGP

  6. False positive sense of thirsty • Effective volume of stomach: 50 cc • Pain or reflux secondary to more intake • Psychological control to continue diet (change of mind) • Gradually dilation of remnant volume (4 years) from 50 cc to 200 cc RESULT OF METHOD

  7. 270 cases during 7 years • 220 cases followed by standard control visits • EWL : 28% to 95%, 6 months, wide range 61% (181 cases) after 6 months 67% (135 cases) after 1 year 63% (96 cases) after 2 years 56% (60 cases) after 3 years 52% (40 cases) after 4 years result

  8. Morbidity = 4 cases liver hematoma jaundice (drug hepatitis, 2 cases) hypocalcaemia Mortality = zero Re operation = 4 cases (1.5%) leak of suture line acute gastric perforation stricture at suture line permanent vomiting secondary to adhesion RESULT

  9. Regain: less than 20% EWL • 10 cases, more than 2 years during 7 years • Total cases more than 2 years 105 (9.5%) • 3 cases, due to pregnancy and feeding • 2 cases heavy drinker • 3 cases psychological drugs • 2 cases increase of appetite • 2 cases replication • 4 cases ileojejunal bypass (Dr Fazel) laparoscopic • 1 case gastric banding • 1 case, feeding of her baby • 2 cases waiting rEGAIN

  10. BMI>40 or 35 and comorbidity Cases over 70% EWL (during 2 years) included Follow up: every week (first month) every two weeks (next 5 months) every month (next 18 month) 10 factors: Age, sex, co morbidity, marriage, appetite, volume residue, job, relatives, pain during eating, group club, WHO DOES GET THE BEST RESULT?

  11. 40 cases / 90 cases Sex: 38/2 (90/12) 5.2% to 13% M Age: 24 (18 – 30) to 34(18 – 52) Co morbidity: 3 to 9 7.5% to 10% Marriage: 34 S to 41 S 85% to 45% Appetite: 3 to 10 7.5% to 11% DETAIL OF DATA

  12. 40 cases / 90 cases Residue: 35 to 69 87% to 76% Job: 15 to 38 37% to 42% Relatives: 36 to 78 90% to 86% Pain: 38 to 80 95% to 88% Group club: 25 to 30 62% to 33% DETAIL OF DATA

  13. Young, Female, Single, Group club • Gaining the best result is not essentially related to the form of operation • It is secondary to some other factors that increase the interest of patient to use diet and exercise (incentive) • The main goal is change of mind IMPORTANT FACTORS

  14. Laparoscopic Conservative Low price Reversible Volume residue: 50 cc EWL: 60% during 6 month Unrelated to technique morbidity: 1.5% Reoperation: 1.5% Regain: 9.5% after 2 years, possibility of all alternatives Safe alternative of restrictive operations ADVANTAGE

  15. Diet and exercise <10% EFF • Gastric balloon 2-6 months 15% EWL • 000 • TVGP 4-5 years 63% • GB 4-5 years 65% • GBP 5-7 years 70% • IJB Long time 80% • DSB Permanent 85% Invasiveness of methods

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