2. LGCP  Restrictive bariatric procedure similar to vertical sleeve gastrectomy without the need for gastric resection  Reducing risks of complications associated with a permanent implant, such as a gastric band  Minimizing the possibility of leaks from staple lines

3. the procedure  the stomach’s volume is reduced by dissecting the greater omentum and short gastric vessels, as in VSG  and the greater curvature is invaginated using multiple rows of non-absorbable sutures performed over a bougie or endoscope to ensure a patent lumen. 1

4. Restrictive operation

8. ADVANTAGE  Laparoscopic  Conservative  Low price  Reversible  Volume residue: 50 cc  EWL: 60% during 6 month  Unrelated to technique morbidity: 2%  Reoperation: 2%  Regain: (10.9%) reoperation with different methods  Safe alternative between restrictive operations

9. RESULT OF METHOD  False positive sense of thirsty  Effective volume of stomach: 50 cc  Pain or reflux secondary to more intake  Gradually dilation of remnant volume (2 to 4 years) 50 cc to 200 cc  Psychological control to continue diet

10.  Early results demonstrate that  LGCP, a bariatric weight loss procedure, may have a potentially lower risk profile than other bariatric procedures. 1,2,3 Additional studies are needed to assess long-term efficacy.  1 Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure. Obes Surg 2010; 20 (7): 913-918. [DSL 10-1229] 1 Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure. Obes Surg 2010; 20 (7): 913-918. [DSL 10-1229]   2 Brethauer SA, Harris JL, Kroh M et al. Laparoscopic gastric plication for the treatment of severe obesity. Surgery for Obesity and Related Diseases May 2010:6 (3):S16. [DSL-10-0550] Brethauer SA, Harris JL, Kroh M et al. Laparoscopic gastric plication for the treatment of severe obesity. Surgery for Obesity and Related Diseases May 2010:6 (3):S16. [DSL-10-0550]  3 Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc A dv Surg Tech A 2007;17(6):793–8. [DSL 09-1251] 3 Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc A dv Surg Tech A 2007;17(6):793–8. [DSL 09-1251] 

11. Has the same result of weight loss as others

12. Invasiveness of methods METHODEFFECTIVE TIMERESULT Diet & ExercisePermanent<10% EFF Intra gastric balloon2 to 6 months15% EWL, Intolerance in 30% TVGP4 years63% EWL, 2% Complication GB4 years65% EWL, 10-20% Complication, 1% Mortality GBP5-7 years70% EWL, 15% Complication, 1% Mortality IJBLong term80% EWL, 1.5% Mortality, 25% Complication DSBPermanent85% EWL, 2.5% Mortality, 33% Complication

13. 7 YEARS OUTCOME OF TVGP EWL%NOMBER OF CASESDURATION 601976 MONTHS 641511 YEAR 621102 YEARS 59683 YEARS 56404 YEARS 55275 YEARS 52176 YEARS 5087 YEARS

14. Obesity surgery Volume20, Number 7, 913-918, DOI: 10.1007/s11695-010-0132-0 Results  All procedures were completed laparoscopically.  Mean operative time was 50 min and mean hospital stay was 36 h.  Patients returned to their regular activities at an average of 7 days following surgery.  No intra-operative complications occurred.  All patients experienced excess weight loss (EWL) of at least 20% after 1 month. Mean EWL was 62% (45% to 77%) in nine patients after 18 months.  There has been no record of weight regain in any patient to date. Conclusions  LGCP is feasible, safe, and effective for at least 18 months when performed on morbidly obese patients. Longer follow-up and prospective comparative trials are needed.

17. Laparoscopic view

18. Endoscopic view

19. Patent lumen after LGCP

21. Publications  Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure. Obes Surg 2010; 20 (7):913-918. [DSL 10-1229] Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: Initial Results of an Alternative Restrictive Bariatric Procedure. Obes Surg 2010; 20 (7):913-918. [DSL 10-1229]  Brethauer SA, Harris JL, Kroh M et al. Laparoscopic gastric plication for the treatment of severe obesity. Surgery for Obesity and Related Diseases May 2010:6(3):S16. [DSL 10-0550] Brethauer SA, Harris JL, Kroh M et al. Laparoscopic gastric plication for the treatment of severe obesity. Surgery for Obesity and Related Diseases May 2010:6(3):S16. [DSL 10-0550]  Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A 2007;17(6):793–8. [DSL 09-1251] Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A 2007;17(6):793–8. [DSL 09-1251]  Brethauer SA, Harris JL, Chand B, Kroh M, Rogula T, Schauer PR. Initial results of vertical gastric plication for severe obesity. Society of American Gastrointestinal and Endoscopic Surgeons. Phoenix, Arizona. April 22-25, 2009. [DSL 09-1253] Brethauer SA, Harris JL, Chand B, Kroh M, Rogula T, Schauer PR. Initial results of vertical gastric plication for severe obesity. Society of American Gastrointestinal and Endoscopic Surgeons. Phoenix, Arizona. April 22-25, 2009. [DSL 09-1253]  Brethauer S. Gastric Plication as a Bariatric Procedure. Minimally Invasive Surgery Symposium. San Diego, CA. Feb 22-27, 2010. [DSL 10-0256] Brethauer S. Gastric Plication as a Bariatric Procedure. Minimally Invasive Surgery Symposium. San Diego, CA. Feb 22-27, 2010. [DSL 10-0256]  Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: An Alternative Restrictive Bariatric Procedure. Bariatric Times. Bariatric Times. May 2010;7(5):8–10. Ramos A, Galvao Neto M, Galvao M et al. Laparoscopic Greater Curvature Plication: An Alternative Restrictive Bariatric Procedure. Bariatric Times. May 2010;7(5):8–10.