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The incidence of obesity has been increasing steadily,
with approximately 10% of the world’s population meeting
the criteria (1). The limited success of lifestyle and
pharmaceutical interventions has resulted in an increased
interest in bariatric surgery, as it is the only proven
modality for achieving sustainable weight loss, and
impacting survival in the clinically severe obese (BMI ≥
40 or ≥ 35 with severe co-morbid disease) (2). In general,
bariatric surgical intervention involves either a restrictive
or mal-absorptive mechanism, to achieve weight loss.
The two most renowned and successful procedures are;
the Roux-en-Y gastric bypass and the biliopancreatic diversion
with duodenal switch, and these use both routes.
However, both of these procedures have potentially life
threatening post-operative complications, mainly entailing
leakage at anastomoses sites, thus making them less
than ideal interventions.
Gastric banding, sleeve gastrectomy and now recently
gastric plication, are other bariatric surgeries that are
essentially restrictive procedures, which are becoming
more popular (3). Of the restrictive procedures, Laparoscopic
Sleeve Gastrectomy (LSG) and Laparoscopic Total
Gastric Vertical Plication (LTGVP) are relatively similar.
Both involve decreasing the greater curvature of the
stomach, and creating a gastric reservoir resembling a
vertical tube (3). In general, LSG accomplishes this goal
with staple lines and removal of a gastric section, while
LTGVP achieves it with suture lines, without the need for
a gastric section. The advantages of both procedures consist
of; not introducing a foreign object into the body, preserving
the stomach’s pylorus, and avoiding dumping
syndrome (2). However, there are some advantages enjoyed
only by plication. Since LTGVP does not involve the
removal of gastric material, it has the ability to be reversible,
which could make it a more ideal surgical procedure
for some patients (4). Another reported benefit of LTGVP
is that it decreases the risk of fistula formation at the gastroesophageal
junction. It is important to recognize that
these stated surgical advantages of LTGVP rely on the operator’s
competency at minimally invasive techniques, in
this case to perform manual laparoscopic suturing (4).
This article highlights the promise that LTGVP has
shown in achieving significant weight loss and reduction
of comorbid conditions. Golpaie et al. have produced a
well-organized study design that involved a multidisciplinary
team. The drawbacks of this study were that; only

     

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