0 �� 5.0) for hemorrhage, splenic injury in 0 to 10% (mean 0.3, sd 1.3), liver injury in 0 to 7% (mean 0.2 �� 0.9), stricture in 0�C5% (mean 0.6 �� 1.1), and other complications in 0 to 38% (mean 2.4 �� 8.4). selleck bio Mortality rate was assessed at 0.1% with a standard deviation of 0.3. In the 2011 Skrekas et al. Publication [9], 135 patients were studied (evidence Level III). Mean operative time was 58min (45�C80min), mean hospital stay was 1.9 days (1�C6 days), and mean followup was 22.59 months (8�C31 months). Preoperatively, the group of patients had a mean Total Body Weight (TBW) of 113.3 �� 22.5 and a mean BMI of 39.5 �� 17.3. On followup, the percentage of excess weight loss (%EWL) was 51.7% at 6 months, 67.1% at 12 months, and 65.2% at 24 months. Postoperative mean TBW was 83.5 �� 17.

3 and mean BMI was 29.6 �� 4.9. Inadequate weight loss (defined as less than 50% of the %EWL) was observed in 21.48%, with failure (%EWL of less than 30%) in 5.9% of the cases of inadequate weight loss. After subgroup analysis, the authors found that the results in weight loss were better in the group with a BMI of less than 45. Modification of their technique with formation of a double plication had no effect on weight loss. Total complication rate was 8.8% (12/135). Four patients presented nausea and vomiting which persisted for a few days. These patients were part of the single plication group. The authors comment that nausea, vomiting, and sialorrhea generally improved after modificating their technique to a double plication. Two patients presented with upper GI bleeding a few weeks after discharge.

They were treated with endoscopic hemostasis. Two patients returning with general abdominal discomfort were found to have microleaks which were treated conservatively. Four patients had to be reoperated. One patient presented with portomesenteric thrombosis an the 24th postoperative day. The authors comment that portomesenteric thrombosis is a rare but serious complication of all laparoscopic operations, probably attributed to venous stasis due to pneumoperitoneum and anti-Trendelenburgs position [17]. The patient had jejunal necrosis and underwent jejunectomy. 1 patient was reoperated for gastric obstruction due to prolapse of the gastric fold, while two had accumulation of serous fluid within the cavity of the plication.

These final cases led to the modification of their technique with creation of a double plication, thus creating Dacomitinib smaller multiple gastric folds with less probability of both prolapse and accumulation of fluid. Mortality was zero. This is a very interesting study, the largest in literature so far, with relatively good medium term followup. The results on %EWL are similar to those achieved with LSG. Major complication rate is quite low (2.9%) and resulted in no mortality. The authors have presented a new modification to the standard technique of LGCP which could bear many benefits.