Metabolic Changes After Laparoscopic Total Gastric Vertical Plication


Markus Gass 1 , Ralph Peterli 1 , *

1 Department of Surgery, St. Claraspital, Basel, Switzerland

How to Cite: Gass M, Peterli R. Metabolic Changes After Laparoscopic Total Gastric Vertical Plication, J Minim Invasive Surg Sci. 2013 ; 2(1):118-9. doi: 10.17795/minsurgery-4738.


Journal of Minimally Invasive Surgical Sciences: 2 (1); 118-9
Published Online: February 28, 2013
Article Type: Letter
Received: March 5, 2012
Revised: April 16, 2012
Accepted: April 28, 2012





Obesity Bariatric Surgery Laparoscopy Dyslepidemias Insulin Resistance

Copyright © 2013, Minimally Invasive Surgery Research Center and Mediterranean & Middle Eastern Endoscopic Surgery Association. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License ( which permits copy and redistribute the material just in noncommercial usages, provided the original work is properly cited.

Dear Editor

We read with much interest the publication by Golpaie et al. (1) on metabolic changes in lipid parameters and insulin resistance after laparoscopic total gastric vertical plication (LTGVP). They performed LTGVP in 15 severely obese patients and measured lipid profiles and parameters of glucose homeostasis before and six weeks postoperatively. Patients lost an average of 14.7% of total weight in the first six weeks after the operation. Interestingly, reduction of triglycerides and LDL was statistically significant after six weeks and reduction of homeostatic model assessment (HOMA) index as well. On the other hand, total cholesterol, LDL, fasting glucose, insulin levels and the quantitative insulin-sensitivity check index (QUICKI) did not change significantly.

The authors conclude, that LTGVP is an “effective therapeutic approach for obese patients because it reduces weight, insulin resistance and improves metabolic parameters”. Literature about this new bariatric technique is scarce, especially long-term data is missing. It has to be mentioned that this is the first study to report metabolic changes, especially lipid profiles in patients undergoing this new bariatric surgical procedure. Although the follow-up is only six weeks, the improvement in triglyceride and LDL levels is remarkable. Concerning excessive weight loss (EWL) another study by Ramos et al. describes a mean EWL of 62% (45% to 77%) in nine patients 18 months after gastric plication, which is comparable to other purely restrictive procedures (2). An article by Talebpour et al. analyzes the course of weight loss up to 36 months postoperatively. An EWL of 60% after 24 months (50 cases), and 57% after 36 months (11 cases) is reported (3).

Nowadays, it is at least throughout Europe widely accepted, that purely restrictive methods, i.e. gastric banding procedures, often fail in the long run. Most bariatric surgeons and metabolic physicians are convinced that besides the restrictive and malabsorptive components, concomitant metabolic effects play a pivotal role for the long-time results of weight loss (4). Therefore, as the next step, we would like to encourage the authors to measure meal induced profiles of gastrointestinal peptides like ghrelin, PYY, GLP-1 and cholecystokinin for example as well as adipokines and compare the results with established bariatric procedures like gastric bypass and sleeve gastrectomy (5, 6).



  • 1.

    Golpaie A, Hosseinzadeh-Attar MJ, Hoseini M, Karbaschian Z, Talebpour M. Changes in lipid profile and insulin resistance in morbidly obese patients following laparoscopic total gastric vertical plication. J Minim Invasive Surg Sci. 2012; 1(1) : 24 -9 [DOI]

  • 2.

    Ramos A, Galvao Neto M, Galvao M, Evangelista LF, Campos JM, Ferraz A. Laparoscopic greater curvature plication: initial results of an alternative restrictive bariatric procedure. Obes Surg. 2010; 20(7) : 913 -8 [DOI][PubMed]

  • 3.

    Talebpour M, Amoli BS. Laparoscopic total gastric vertical plication in morbid obesity. J Laparoendosc Adv Surg Tech A. 2007; 17(6) : 793 -8 [DOI][PubMed]

  • 4.

    Gass M, Beglinger C, Peterli R. Metabolic surgery-principles and current concepts. Langenbecks Arch Surg. 2011; 396(7) : 949 -72 [DOI][PubMed]

  • 5.

    Peterli R, Steinert RE, Woelnerhanssen B, Peters T, Christoffel-Courtin C, Gass M , et al. Metabolic and hormonal changes after laparoscopic Roux-en-Y gastric bypass and sleeve gastrectomy: a randomized, prospective trial. Obes Surg. 2012; 22(5) : 740 -8 [DOI][PubMed]

  • 6.

    Woelnerhanssen B, Peterli R, Steinert RE, Peters T, Borbely Y, Beglinger C. Effects of postbariatric surgery weight loss on adipokines and metabolic parameters: comparison of laparoscopic Roux-en-Y gastric bypass and laparoscopic sleeve gastrectomy--a prospective randomized trial. Surg Obes Relat Dis. 2011; 7(5) : 561 -8 [DOI][PubMed]