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Laparoscopic Gastric Plication in Pediatric Patients with Morbid Obesity


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Laparoscopic Gastric Plication in Pediatric Patients with Morbid Obesity 

Jonathan DeAntonio, MD; Hannah Cockrell; Hae Sung Kang, MD; Melanie Bean, PhD; Nancy Thompson MS, RN, CPNP; Claudio Oiticica, MD; Edmond Wickham III, MD, MPH; and David Lanning, MD, PhD 



•Evaluate Laparoscopic Gastric Plication (LGP) in adolescents with morbid obesity.

    - Retrospective review of anthropometric data, clinical labs, symptom, and psychological assessments for 4 patients with morbid

    obesity and minor comorbidities who underwent an LGP from 2014-2016



•17% of US children have Body Mass Index (BMI)  ≥ 95 percentile1
•Lifestyle and diet modifications alone are not shown to provide long term   significant weight loss
•Sleeve gastrectomy has been demonstrated to be effective in the pediatric   population

    -Limited long term data

    -Low, but persistent risk of anastomotic leak with significant   consequences

    -Limited support from pediatric providers

•Plication mainly in adults (US/World)

    -Iran- largest prospective adolescent study2

    -Potential Advantages: Restrictive/metabolic, decreased risk of   leak/malnutrition, potentially reversible, no foreign bodies,   progressive (plication can be converted to sleeve)



Laparoscopic Procedure- Fat pad removed, Short gastrics taken up to   angle of His. Interrupted ethibonds (x4) along the greater curvature (Imbricating). 2-0 prolene run from Angle of His caudally. EGD to   evaluate, 2-0 running prolene to imbricate. Figure 1 & 2.

•Anthropometric data, clinical labs, & symptom assessments: preop., 2 weeks, 3, 6, 12, 18, 24, and 36 months.
•Licensed clinical psychologist conducted psychological assessments: preop., 3, 6, 12, 18, 24, and 36 months.
•Retrospective chart review of prospectively collected data
2 patients with 24/36 mo Follow up (2 withdrew at 90 days)
•Lost 20.7 & 24.3cm of abdominal girth (at umbilicus)
•One had improvements in lipid profile (mg/dl)

  -LDL: 122 -> 85, TG: 114-> 55, & HDL: 46 -> 50

•Other had HDL increase from 67à76 mg/dl
•No major complications or readmissions
•Revised Child Anxiety and Depression Scale (RCADS)3

  -No clinically significant disorders preop. (T-scores all < 70)

  -Social phobia (dec. 10 & 14 pts), Generalized anxiety (dec. 5 & 11)  

  -Separation anxiety disorder (dec. 0 & 5 pts), OCD (dec. 0 & 10)

•Impact of Wt. on Quality of Life (IWQOL-Kids)4

  -Improvements in Body self esteem (1.66), Physical comfort (1.22), and Social life (1.13)

    (1 = No Change and >1 = Improvement)



•Limitations: small sample (n=4) with 50% attrition after 90 days
•Patients with long term follow up continue to acknowledge early satiety and   improved hunger control
•Demonstrated LGP can be performed in adolescents with minimal   morbidity and modest efficacy
•Possible option for adolescent patients with morbid obesity, particularly in   those whose care providers are reluctant to agree to a laparoscopic   gastric sleeve resection for their child
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