Welcome to Utah

Laparoscopic Banding with or without

Gastric Imbrication

The pros and cons of this evolving technique

Covidian TrainerFirst Health FundingBariatrix 360

Internet Headlines

“Banded Gastric Plication: Best of both worlds”

“The Gastric Band plication or “banded plication”procedure was introduced in an effort to find a durable and extremely safe weight loss procedure that can decrease the complication rate of the procedures that are currently being used for surgical weight loss”

Where to get it at

In USAOK, TX, CA, UT, WA, NY, TN, FL, NC, GA, PA

WorldwideMexico, Taiwan, India, UAE, Italy, Australia

Internet Support Groups for this procedure

CK Huang

• Surg Obes Relat Dis. 2011 Mar-Apr;7(2) Augmenting weight loss after laparoscopic adjustable gastric banding by laparoscopic gastric plication.

• Surg Obes Relat Dis.2011 Nov 16. Reversal of gastric plication after laparoscopic adjustable gastric banded plication.

• Surg Obes Relat Dis 2012 Jan;8(1):41-5. Novel bariatric technology: laparoscopic adjustable gastric banded plication: technique and preliminary results.

What is it?

What does it do

• Neither surgery addresses hunger—just satiety

• Band slows down how fast you eat– Doesn’t affect volume of food

• Imbrication decreases the amount you eat– We don’t know how it affects motility– We are learning how it affects satiety– We are learning how it affects weight loss

How do you do it?

• Anterior• Lateral• Tight• Loose• Fundus above• Fundus below

Complications

Short term• Perforation• Gastric prolapse up, down,

middle• Gastric Necrosis• Prolonged nausea vomiting• Port site issues

Long term• Slips?• Port• Gastric dilation• Revisions

Results

• The mean operative time was 87.3 minutes• Average length of stay 1.33 days. • Band adjustment 1.1 times 8 months. • Two complications in 18 patients developed

– gastrogastric intussusception, tube kinking (11%)

My band paper comparisons• Table 4. Mean excess weight loss outcomes in the• matched-pair cohort• LAGB LRYGBP• Months Mean Median Mean Median P-value• 1 16.6 ± 5 21.9 ± 7.5 p<0.001• 3 26.2 ± 8 31 ± 10.5 p0.004• 6 36.8 ± 15 41± 10.8 p 0.141• 9 44 ± 22 55 ± 14 p0.008• 12 48 ± 19 59.5 ± 17.9 p0.003• 18 51 ± 21 70• 24 55 ± 23 ?• 36 51 ± 23 ?

Training?

• Mexico• No industry champion yet• No approved US site• No proctors• Some courses

Conclusion

• It seems to offer better weight loss• It is not inexpensive like a imbrication• It has all the complications of both procedures• It has fewer band fills