Metabolic Effects of Sleeve Gastrectomy and Laparoscopic
Greater Curvature Plication: an 18-Month Prospective,
Observational, Open-Label Study
Published online: 3 July 2017
Springer Science+Business Media, LLC 2017
Background Laparoscopic greater curvature plication (LGCP)
is an innovative restrictive technique designed to reduce gastric
volume by plication at the region of greater curvature. The
long-term efficacy, safety, and the metabolic effects of this pro-
cedure are the subject of this study.
Methods One hundred twenty-seven patients were enrolled;
84 underwent laparoscopic sleeve gastrectomy (LSG) and 43,
LGCP. LSG and LGCP were then compared during long-term
follow-ups in terms of glycemic control, hormone and lipid
secretion, and changes in body composition. Measured pa-
rameters included serum glucose, triglycerides, high- and
low-density lipoprotein cholesterol, testosterone, estradiol,
leptin, adiponectin, ghrelin, fatmass, and lean body mass.
Results Significant weight-loss and a reduced body composi-
tion resulted from either procedure vs. baseline (i.e., pre-sur-
gery), with levels of fasting glucose and glycated hemoglobin
also showing statistically significant reductions (at 3 and
18 months for either surgery). Intergroup comparisons for
glycemic parameters yielded no statistically significant differ-
ences. However, a dramatic reduction in ghrelin was detected
following LSG, falling from pre-surgery levels of 140.7 to
69.6 ng/L by 6 months (P < 0.001). Subsequently, ghrelin
levels increased, reaching 107.8 ng/L by month 12.
Conversely, after LGCP, a statistically significant increase in
ghrelin was seen, rising from 130.0 ng/L before surgery to
169.0 ng/L by month 12, followed by a slow decline.
Conclusions Good metabolic outcomes were obtained fol-
lowing LGCP, which might be mediated via altered glucose
metabolism and GI hormones. Nevertheless, this method is
less effective than LSG, possibly due to its preservation of
the entire stomach, including secretory regions.
Keywords Sleeve gastrectomy
Obesity represents one of our greatest contemporary health
problems given its association with multiple comorbidities.
A direct relationship exists between being overweight and
cardiovascular disease, type 2 diabetes, obstructive sleep ap-
nea (OSA), and metabolic syndrome [1, 2]. Bariatric surgery
has proven to be the most effective way of treatment for mor-
bidly obese patients. Laparoscopic sleeve gastrectomy (LSG)
* Zdeněk Švagera
Department of Physiology and Pathophysiology, Faculty of
Medicine, University of Ostrava, Syllabova 19,
703 00 Ostrava, Czech Republic
Institute of Laboratory Diagnostics, University Hospital Ostrava, 17.
listopadu 1970/5, Ostrava, Czech Republic
Department of Epidemiology and Public Health, Faculty of
Medicine, University of Ostrava, Syllabova 19, 703
00 Ostrava, Czech Republic
Department of Surgical Studies, Faculty of Medicine, University of
Ostrava, Syllabova 19, 703 00 Ostrava, Czech Republic
OBES SURG (2017) 27:3258–3266