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Metabolic Effects of Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication: an 18-Month

Metabolic Effects of Sleeve Gastrectomy and Laparoscopic Greater Curvature Plication: an 18-Month

Prospective, Observational, Open-Label Study.
Obes Surg. 2017 Dec
Bužga M1, Švagera Z2, Tomášková H3, Hauptman K1, Holéczy P4.
BACKGROUND:
Laparoscopic greater curvature plication (LGCP) is an innovative restrictive technique designed to reduce gastric volume by
plication at the region of greater curvature. The long-term efficacy, safety, and the metabolic effects of this procedure are the
subject of this study.


METHODS:
One hundred twenty-seven patients were enrolled; 84 underwent laparoscopic sleeve gastrectomy (LSG) and 43, LGCP. LSG
and LGCP were then compared during long-term follow-ups in terms of glycemic control, hormone and lipid secretion, and
changes in body composition. Measured parameters included serum glucose, triglycerides, high- and low-density lipoprotein
cholesterol, testosterone, estradiol, leptin, adiponectin, ghrelin, fatmass, and lean body mass.
RESULTS:
Significant weight-loss and a reduced body composition resulted from either procedure vs. baseline (i.e., pre-surgery), with
levels of fasting glucose and glycated hemoglobin also showing statistically significant reductions (at 3 and 18 months for
either surgery). Intergroup comparisons for glycemic parameters yielded no statistically significant differences. However, a
dramatic reduction in ghrelin was detected following LSG, falling from pre-surgery levels of 140.7 to 69.6 ng/L by 6 months
(P < 0.001). Subsequently, ghrelin levels increased, reaching 107.8 ng/L by month 12. Conversely, after LGCP, a statistically
significant increase in ghrelin was seen, rising from 130.0 ng/L before surgery to 169.0 ng/L by month 12, followed by a slow
decline.
CONCLUSIONS:
Good metabolic outcomes were obtained following LGCP, which might be mediated via altered glucose metabolism and GI
hormones. Nevertheless, this method is less effective than LSG, possibly due to its preservation of the entire stomach,
including secretory regions.