Dr. M. Talebpour Advanced Laparoscopic Fellowship Tehran Medical University

 Disease  Diet & Exercise: <10%  Surgery: Restrictive (Total vertical gastric plication)  Variation of results: EWL was 28% to 95% after 6 month  Range of response in other restrictive techniques: 30% to 100%  Aim: To find out effective factors in EWL

 200 cases during 4.5 years (02 to 07)  163 cases followed by standard control visits  EWL : 28% to 95% (6 months), wide range  59% (137 cases) after 6 months  63% (105 cases) after 1 year  60% (64 cases) after 2 years  57% (41 cases) after 3 years  55% (26 cases) after 4 years

 BMI>40 or 35 and comorbidity  Cases over 70% EWL (until 2 years) included  Follow up: Every week (first month) Every two weeks (next 5 months) Every month (next 18 months)  10 factors: Age Sex Marriage Appetite Job Relatives Group club Pain during eating Comorbidity Volume residue

40 cases 90 cases Comparison  Sex: 38/2 90/12 5.2% to 13% M  Age: 24 (18 – 30) 34(18 – 52)  Co morbidity: % to 10%  Marriage: 34 S 41 S 85% to 45%  Appetite: % to 11%

40 cases 90 cases Comparison  Residue: % to 76%  Job: % to 42%  Relatives: % to 86%  Pain: % to 88%  Group club: % to 33%

Young Female Single Group club

Surgery is indicated in morbid obesity Gaining the best result is not essentially related to the form of operation It is secondary to some other factors that increase the interest of patient to use diet and exercise (incentive)

PATIENT WITH THE MOST MOTIVATION ROLE OF DIFFERENT RESTRICTIVE METHODS??