Laparoscopic Total Gastric Vertical Plication and Lipid Profile

Abstract

We read with great interest the article “Changes in Lipid Profile and Insulin Resistance in Obese Patients Following Laparoscopic morbidly Total Gastric Vertical Plication” of Atefeh Golpaie et al. (1). The authors developed a prospective study that included 15 morbidly obese patients who underwent Laparoscopic Gastric Total Vertical plication (LTGVP) with the technique described by Talebpour and Amoli in 2007 (2), and evaluated the evolution of lipid profile; total cholesterol (TC), triglycerides (TG), LDL-C and HDL-C, fasting glucose, insulin, and insulin resistance (HOMA insulin sensitivity and the quantitative check index (QUIKI), before and six weeks after surgery. They found a significant decrease in body weight and BMI, blood level of TG, LDL-C and HOMA at six weeks, but changes in TC, HDL-C, fasting glucose, insulin Levels and QUICKI were not significant. The LTGVP is a new technique with scarce data, which just few patients with short-term follow-up have been investigated. However, initial results reported in terms of decrease in excess weight (EBW) are promising. In the study published by Talebpour et al., EBW loss was 61% at 12 months in patients with a preoperative average body mass index (BMI) of 47 Kg/m2 (2). Brethauer et al. reported an EBW loss of 53.4% in six patients with a mean BMI of 43.3 Kg/m2 at 12 months follow-up (3). Ramos-Cardoso et al. published a series of 15 patients with a mean preoperative BMI of 41 Kg/m2 with EBW loss of 60% at 12 months (4). These short-term results are comparable to those obtained after Sleeve Gastrectomy (SG) (5). The main advantages of this new technique are the low cost, since no mechanical sutures are used, and the possible low incidence of complications. However, after increasing reports, by employing this technique, some complications especially gastric outlet obstruction, vomiting, and gastric perforation, leaks, esophagitis and re-operation will probably be observed. Until now, no late complications have been reported, but follow-up is still limited. Regarding resolution of co-morbidities, it has been widely shown that the significant drop in weight experienced by patients undergoing any bariatric surgery have an impact on the increased insulin sensitivity (6). With regard to dyslipidemia, there are no other reports to assess the evolution of this disease in LTGVP. The postoperative evolution after LTGVP is probably similar to the results