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LSG vs LGP

LSG betters LGP for complication rates and post-op weight loss

No statistically significant difference between the two procedures regarding the major postoperative complications, the length of hospital stay, the operation duration, the reoperation rate or cost

Laparoscopic sleeve gastrectomy (LSG) has lower overall complications rate, fewer minor post-operative complications and better short- and medium-term weight loss compared to laparoscopic gastric plication (LGP), according to a meta-analysis paper by researchers from the University Hospital of Larissa, Mezourlo, Larissa, Greece. However, they reported no statistically significant difference between the two procedures regarding the major postoperative complications, the length of hospital stay, the operation duration, the reoperation rate or cost. The paper, ‘Laparoscopic Gastric Plication versus Laparoscopic Sleeve Gastrectomy: An Up-to-Date Systematic Review and Meta-Analysis’, was published in the Journal of Obesity.

“Summing up the results from all trials comparing LSG and LGP, we demonstrated that, in total, LSG demonstrates a significantly safer postoperative profile, when compared to LGP,” they summerised. “More specifically, when categorised, LGP was associated with statistically significant higher rates of benign minor postoperative complications, such as abdominal pain, nausea, and vomiting. Regarding severe complications (i.e., haemorrhage, fistula, leak, SSI, etc.) that are in fact the main factors that affect postoperative outcome, the rates were comparable between the two techniques.”

The authors conducted a systematic literature search identified 12 studies (4 trials, 3 prospective studies and 5 retrospective studies (7 studies were conducted in a single institution and 5 incorporated multiple surgical centres)), which were included in the qualitative and quantitative synthesis of the paper.

The results revealed that there was a statistically significant (p=0.02) lower rate of complications in favour of LSG group, as well as statistically significant lower rates of abdominal pain (p=0.02) and nausea and vomiting (p=0.0009). However, there were no significant differences in major complications rates of anaemia (p=0.27), haemorrhage (p=0.82), invagination (p=0.29), fistula or leak (p=0.39), SSI (p=0.49) and stenosis (p=0.84). There was a statistically significant higher %EWL in the LSG group at 3 (p<0.04), 6 (p<0.0001) and 12 (p<0.0001) months, postoperatively. With regard to BMI, there was a statistically significant higher BMI in the LGP group at 6 (p=0.02) and 12 (p=0.003) months, but not at 3 (p=0.45) months.

There was no statistically significant difference between the two groups, regarding improvement in hypertension (p=0.96), diabetes (p=0.96) and sleep apnoea (p=0.31).

“Taking into consideration the above-mentioned results and several study limitations, we can safely claim that evidence exists for the superiority of LSG over LGP in terms of overall complications rate and postoperative weight loss,” they concluded. “However further prospective randomsed trials, with a higher methodological quality level, are needed in order to validate these results.”

To access this paper, please click here

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