New Technique for Obesity Surgery: Internal Gastric Plication Technique Using Intragastric Single-Port (Igs-Igp) in Experimental Model

Abstract

Background: Bariatric surgery is currently the most effective method to ameliorate co-morbidities as consequence of morbidly obese patients with BMI over 35 kg/m2. Endoscopic techniques have been developed to treat patients with mild obesity and ameliorate comorbidities, but endoscopic skills are needed, beside the costs of the devices. Aim:To report a new technique for internal gastric plication using an intragastric single port device in an experimental swine model. Methods: Twenty experiments using fresh pig cadaver stomachs in a laparoscopic trainer were performed. The procedure was performed as follow in ten pigs: 1) volume measure; 2) insufflation of the stomach with CO2; 3) extroversion of the stomach through the simulator and installation of the single port device (Gelpoint Applied Mini) through a gastrotomy close to the pylorus; 4) performance of four intragastric handsewn 4-point sutures with Prolene 2-0, from the gastric fundus to the antrum; 5) after the performance, the residual volume was measured. Sleeve gastrectomy was also performed in further ten pigs and pre- and post-procedure gastric volume were measured. Results: The internal gastric plication technique was performed successfully in the ten swine experiments. The mean procedure time was 27±4 min. It produced a reduction of gastric volume of a mean of 51%, and sleeve gastrectomy, a mean of 90% in this swine model. Conclusion: The internal gastric plication technique using an intragastric single port device required few skills to perform, had low operative time and achieved good reduction (51%) of gastric volume in an in vitro experimental model.

Gastric plication surgery changes gastrointestinal and metabolic parameters in an obesity‐induced high‐fat diet model

“…4 Novel less invasive surgical techniques, such as gastric plication (GP), were developed to avoid potential complications. 5 GP uses sutures invading the great curvature, avoiding stapling or gastric resection that promotes the reduction of gastric volume through mechanical restriction of food intake. 6 In addition, this procedure induces weight loss 6 and ameliorates plasma glucose levels.…”

“…Bariatric surgery is still the most effective and sustainable treatment for obesity 4 . Novel less invasive surgical techniques, such as gastric plication (GP), were developed to avoid potential complications 5 . GP uses sutures invading the great curvature, avoiding stapling or gastric resection that promotes the reduction of gastric volume through mechanical restriction of food intake 6 .…”

New technique of intragastric sleeve: viability and survival in a pig model

“…The importance of developing operatory techniques for obesity treatment that are inexpensive and have unrestricted access to all, MARIANA S. RIBEIRO et al represents a need of our society. In order to make the surgical procedure less invasive, practical and with lower cost, a new laparoscopic technique called intragastric single port sleeve by endoplication was developed (Muller et al 2017).…”

“…A preliminary research using post mortem swine stomachs have already proved that intragastric sleeve by endoplication produces a significant reduction of gastric volume, restricting its area of distension without causing gastric ischemia, besides the impossibility of the occurrence of leaks, gastric necrosis or bleeding, since the technique does not induce gastric ischemia (Muller et al 2017).…”

New intragastric sleeve technique reduces adipose tissue in pig experimental model: tomographic study

“…The transluminal (intragastric) surgery refers to an operation performed inside the peritoneal cavity, which is accessed through a hollow viscosity (stomach) 6 . The intragastric placement of single-port devices has been described by some authors [7][8][9] , with emphasis on the new technique of intragastric sleeve by endoplication, which produces a significant reduction in gastric volume 10 .…”