Comparison of bariatric restrictive operations: laparoscopic sleeve gastrectomy and laparoscopic gastric greater curvature plication.

Morbid obesity continues to increase in prevalence, becoming a major socioeconomic and medical problem. The success in treating morbid obesity with surgery has been well documented. The categories of surgical treatment include restrictive, malabsorptive, and combination operations. Two of the restrictive operations at the forefront of today's treatments are laparoscopic sleeve gastrectomy (LSG) and laparoscopic gastric greater curvature plication (LGCP). A literature review has been completed to compare the current technique and results for LSG and LGCP. LSG is a restrictive technique in which reduced gastric volume is achieved by partial greater curvature resection. The benefits of LSG include ease of operation, sustainable weight loss, and low complication rate. The disadvantages include risk for severe complications such as gastric leak and bleeding. LGCP is a novel restrictive technique which reduces gastric volume by plication of the greater curvature; it is still in the investigational stages for use in the United States. A gastric tube is formed with the plication, but no portion of the stomach is excised. The benefits of LGCP include low cost, low risk of complication, such as gastric perforation and bleeding, as well as adequate short term weight loss. The disadvantages include higher risk of nausea and vomiting post-op, a non-zero risk of perforation and bleeding, and likely an unsustainable weight loss. In comparison, LGCP is considered feasible and safe in the short term and especially suited for institutions requiring lower-cost procedures. However, LGCP weight loss may be unsustainable compared to LSG. While LSG complication rates are slightly higher, LGCP is an inferior restrictive procedure for weight loss. Further studies are needed to evaluate the long term outcomes for procedural comparison.