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Laparoscopic Adjustable Gastric Band Plication

We previously reported a case wherein augmented weight loss was achieved after LAGB by gastric plication. This effectiveness in weight loss demonstrated by combining both procedures led to the invention of LAGBP [20]. So, in 2009 we introduced this new procedure to overcome the concerns raised by LSG, LAGB and plication and named it as laparoscopic adjustable gastric banded plication (LAGBP) [21]. By maintaining the gastrointestinal continuity and being a relatively reversible procedure, laparoscopic adjustable gastric banded plication (LAGBP) compensates the lacunae of current surgical options [22, 23]. LAGBP can achieve moderate weight loss from the initial greater curvature plication and further weight loss could be augmented and maintained by adjusting the band during long-term follow-up. Moreover, LAGBP has been reported a comparable weight loss effect with sleeve gastrectomy and can achieve 54.9 to 56.3 % and

65.8 to 66.9 % EWL at 12 and 24 post-operative months, respectively [24]. Several authors have reported variations in their technique, bougie size and suture material used to perform isolated plication [19, 25]. Our initial technique of placing the band first and then plicating the stomach resulted in higher incidence of gastric fundus herniation compared to that reported in a systematic review [26]. After our first 65 cases, since March 2012, we have modified our surgical techniques to avert the serious complications like gastric fundal herniation. Firstly, we switched from “banding-first” method to “plication-first” technique to facilitate complete fundus plication. Secondly, every individual’s stomach is different in size; stomach should be plicated based on the gastric plication formula (GPF) to ensure adequate plication. Third, devascularization of all greater curvature vessels impaired venous return of stomach and causing more edema after surgery. By preserving the right gastroepiploic vessels, we improved postoperative vomiting and gastric fundal herniation [27]. Fourth, we replaced the second layer plication from 2-O Ethibond Excel to continuous 2-O Prolene sutures (Ethicon, Somerville, NJ, USA), to tighten the outer layer of greater curvature plication. This technique has become our standard and the same is described later in technique.

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