Laparoscopic gastric greater curvature plication versus laparoscopic sleeve gastrectomy: early outcome in 140 patients.

BACKGROUND: Laparoscopic gastric greater curvature plication (LGGCP) is a novel bariatric procedure. Its outcome as a standalone procedure has been studied in the literature. We herein describe a comparative study between LGGCP versus laparoscopic sleeve gastrectomy (LSG). The objective of this study was to analyze %excess weight loss (%EWL), co-morbidity improvement and complication rate in both groups at 1, 3, 6, 12 months follow-up. METHODS: Retrospective study of 140 patients undergoing LGGCP and LSG between July 2011 and March 2012 at University of Alexandria, Egypt. Data on patient demography, operative time, length of stay, body mass index (BMI) were collected. RESULTS: Baseline characteristics were similar for both groups, except for preoperative BMI that was higher among the LSG group. Follow up rate was 98% (n = LGCCP: 68 - LSG: 69) at 6 months and 81% (n = LGGCP: 54 - LSG: 60) at 1 year. The mean operative time and mean length of stay were longer in the LSG group (P = .03) and (P = .02), respectively. There were 4 (6.5%) readmissions and 2 (3.2%) reoperations in the LGGCP group compared to 3 (3.8%) readmission and 2 (2.6%) reoperations in the LSG group. At 6 months follow-up the mean %EWL for LGGCP and LSG was 40.4±11.9% and 47.1±13.9% (P<.001), while at 1 year it was 52.1±15.1% and 68.1±15.8% (P<.001), respectively. Both techniques showed similar results in co-morbidity improvement at 1 year. CONCLUSION: In the short term, both techniques were comparable as regards to co-morbidity resolution. However, LSG appears to have achieved a higher weight loss.

Laparoscopic cholecystectomy under spinal versus general anesthesia: a prospective, randomized study.

BACKGROUND: For laparoscopic cholecystectomy (LC), the use of spinal anesthesia may offer several advantages over general anesthesia. The aim of this prospective, randomized study was to compare the surgical outcome of LC performed under general anesthesia to that of LC performed under spinal anesthesia. METHODS: Sixty patients were randomly assigned to either the SALC (spinal anesthesia LC group, 30 patients) or GALC group (general anesthesia LC group, 30 patients). Intraoperative events related to spinal anesthesia, postoperative complications, and pain scores were recorded. Patient satisfaction as to the anesthetic technique received was assessed 2 weeks postoperatively by direct patient questionnaire. RESULTS: In both groups, all procedures were completed laparoscopically. In the SALC group, all procedures were completed under spinal anesthesia and there were no anesthetic conversions. There was no statistically significant difference in the mean operative time between both groups. For the first 2 and 4 hours postoperatively, the mean pain score of the SALC group was statistically significantly lower than that of the GALC group. For the first 24 hours postoperatively, the mean number of analgesic ampoules/patient was statistically significantly lower in the SALC group. In the SALC group, 28 patients (93.3%) considered the technique "very well," compared with 30 patients (100%) in the GALC group. The difference in the overall patient satisfaction scores between both studied groups was not statistically significant. CONCLUSIONS: LC performed under spinal anesthesia is feasible, safe, and is associated with significantly less early postoperative pain, compared to that performed under general anesthesia.