1. Welcome to Utah

3. Laparoscopic Banding with or without Gastric Imbrication The pros and cons of this evolving technique Covidian Trainer First Health Funding Bariatrix 360

4. Internet Headlines “Banded Gastric Plication: Best of both worlds” “The Gastric Band plication or “banded plication”procedure was introduced in an effort to find a durable and extremely safe weight loss procedure that can decrease the complication rate of the procedures that are currently being used for surgical weight loss”

5. Where to get it at In USA OK, TX, CA, UT, WA, NY, TN, FL, NC, GA, PA Worldwide Mexico, Taiwan, India, UAE, Italy, Australia Internet Support Groups for this procedure

6. CK Huang Surg Obes Relat Dis. 2011 Mar-Apr;7(2) Augmenting weight loss after laparoscopic adjustable gastric banding by laparoscopic gastric plication. Surg Obes Relat Dis.2011 Nov 16. Reversal of gastric plication after laparoscopic adjustable gastric banded plication. Surg Obes Relat Dis 2012 Jan;8(1):41-5. Novel bariatric technology: laparoscopic adjustable gastric banded plication: technique and preliminary results.

7. What is it?

8. What does it do Neither surgery addresses hunger—just satiety Band slows down how fast you eat – Doesn’t affect volume of food Imbrication decreases the amount you eat – We don’t know how it affects motility – We are learning how it affects satiety – We are learning how it affects weight loss

9. How do you do it? Anterior Lateral Tight Loose Fundus above Fundus below

10. Complications Short term Perforation Gastric prolapse up, down, middle Gastric Necrosis Prolonged nausea vomiting Port site issues Long term Slips? Port Gastric dilation Revisions

11. Results The mean operative time was 87.3 minutes Average length of stay 1.33 days. Band adjustment 1.1 times 8 months. Two complications in 18 patients developed – gastrogastric intussusception, tube kinking (11%)

12. My band paper comparisons Table 4. Mean excess weight loss outcomes in the matched-pair cohort LAGB LRYGBP Months Mean Median Mean Median P-value 1 16.6 ± 521.9 ± 7.5 p<0.001 3 26.2 ± 8 31 ± 10.5 p0.004 6 36.8 ± 15 41± 10.8 p 0.141 9 44 ± 22 55 ± 14 p0.008 12 48 ± 19 59.5 ± 17.9 p0.003 18 51 ± 21 70 24 55 ± 23 ? 36 51 ± 23 ?

13. Training? Mexico No industry champion yet No approved US site No proctors Some courses

14. Conclusion It seems to offer better weight loss It is not inexpensive like a imbrication It has all the complications of both procedures It has fewer band fills