Fundectomy with Greater Curvature Plication; New Modification for Patients with Morbid Obesity

Abstract

Background: Obesity is a global epidemic. Laparoscopic greater curvature plication [LGCP] is a restrictive surgical procedure described for the first time on 1981 by Wilkinson. Fundectomy is a selective resection of the acid-producing segment of the stomach, with removal of peptide hormone-producing cells [the oxyntic mucosa] as a consequence of the fundectomy. Aim of the work: Our aim is to assess the feasibility and advantages of the novel modification for morbidly obese patients which include fundectomy with greater curvature plication. Patients and Methods: Ten patients were included in this study, which carried out at Al-Azhar University Hospital [New Damietta]. Results: Body mass index [BMI] ranged from 30 to 48 kg/m2 [the mean was 38.8 kg/m2]. Operative time ranged from 60 to 120 minutes [Mean time: 93.5 minutes]. The mean hospital stay time was 1.35 days. The mean estimated weight loss percentage [EWL%] was 29.1% at three months, 44.6% at six months, 60.4% at one year, and 72.4% at two years. EWL% was less than 50% for one patient which needs reoperation with Laparoscopic Sleeve Gastrectomy. Two patients [20%] developed heartburn due to gastroesophageal reflux disease [GERD]. Nine patients [90%] presented nausea, and vomiting was present in four patients [40%]. Conclusion: Fundectomy and Greater curvature plication is a feasible, safe, effective as a bariatric operation with avoidance of complications of other bariatric operations. As a new modification for bariatric surgery, this operation needs more investigations and longer periods for follow up.

Keywords

• ghrelin hormone
• greater curvature plication
• laparoscopic sleeve gastrectomy
• bariatric surgery
• fundectomy