ArticlePublisher preview available

Laparoscopic Removal of a Displaced Vertical Gastric Clip Causing Gastric Outlet Obstruction

Authors:
Roberto de la Plaza Llamas at Hospital Universitario de Guadalajara
Roberto de la Plaza Llamas
Daniel A. Díaz Candelas at Hospital Universitario de Guadalajara
Daniel A. Díaz Candelas
Jose Manuel Ramia-Angel at Hospital General Universitario de Alicante
Jose Manuel Ramia-Angel
Read publisher preview
Download citation
To read the full-text of this research, you can request a copy directly from the authors.

Abstract

Introduction: Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date. Methods: A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m2 underwent a laparoscopic calibrated tubular gastroplasty at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination: BMI 28.9 kg/m2, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located medially to the esophagogastric junction, the lesser curvature, and the antropyloric region. Results: A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no postoperative complications. Conclusion: This video demonstrates a form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using a laparoscopic approach.
A preview of this full-text is provided by Springer Nature.
Learn more
Content available from Obesity Surgery
This content is subject to copyright. Terms and conditions apply.
MULTIMEDIA ARTICLE
Laparoscopic Removal of a Displaced Vertical Gastric Clip Causing
Gastric Outlet Obstruction
Roberto de la Plaza Llamas
1
&Daniel A. Díaz Candelas
1
&José M. Ramia
1
#Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract
Introduction Recently, some surgical teams have used a laparoscopic vertical clip gastroplasty to treat morbid obesity. This
approach mimics the principle of laparoscopic sleeve gastrectomy, but using a completely reversible mechanism. Displacement
of the device has been reported in 7.7% of cases. The manner of its withdrawal has not been described to date.
Methods A 50-year-old woman with a body mass index (BMI) of 36.3 kg/m
2
underwent a laparoscopic calibrated tubular gastroplasty
at another hospital with an 38-F orogastric tube by a B-CLAMP® gastric clip on January 11, 2019. The patient came to the Emergency
Department 8 months later due to complete oral intolerance, with continuous vomiting of 5 days of evolution. Physical examination:
BMI 28.9 kg/m
2
, dehydration; depressed abdomen, with mainly supraumbilical pain and distension, and significant tympanism on
palpation. No guarding or signs of peritoneal irritation. Simple abdominal x-ray showed gastric distension and gastric clip. The
nasogastric tube drained 2500 cc of gastrobiliary contents. The computed tomography showed the gastric clip displaced and located
medially to the esophagogastric junction, the lesser curvature, and the antropyloric region.
Results A laparoscopic approach was performed using 4 trocars. Signs of gastric suffering in the antral region. The clip was
located to the right of the lesser curvature covered by a layer of fibrosis. The clip was removed by a 12-mm trocar. There were no
postoperative complications.
Conclusion This video demonstratesa form to extract a displaced gastric clip used to create a calibrated tubular gastroplasty using
a laparoscopic approach.
Keywords Laparoscopic vertical clip gastroplasty .Gastric sleeve .Reversible bariatric surgery .Gastric clip .B-CLAMP®
Introduction
Recently, some surgical teams have used a laparoscopic ver-
tical clip gastroplasty to treat morbid obesity. This approach
mimics the principle of laparoscopic sleeve gastrectomy, but
using a completely reversible mechanism. The nonadjustable
clip is placed vertically parallel to the lesser curvature [1,2].
Its proponents claim that the clip restricts oral intake without
changing small bowel anatomy, requires no stapling, causes
no malabsorption, does not require any maintenance or sur-
veillance, and is reversible. Displacement of the device has
been reported in 7.7% of cases [1], but the manner of its
withdrawal has not been described to date.
Methods
A 50-year-old woman with a history of vertebral arthrodesis
and a body mass index (BMI) of 36.3 kg/m
2
(184 cm height
and 123 kg weight) underwent a laparoscopic calibrated tubu-
lar gastroplasty at another hospital with an 38-F orogastric
tube by a B-CLAMP® gastric clip. It was fixed to the anterior
gastric wall with three stitches to the right and another three to
the left of the clip on January 11, 2019. The patient came to the
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11695-020-04606-0) contains supplementary
material, which is available to authorized users.
*Roberto de la Plaza Llamas
dlplr@yahoo.es
Daniel A. Díaz Candelas
dadc42@gmail.com
José M. Ramia
jose_ramia@hotmail.com
1
Department of General and Digestive Surgery, Hospital Universitario
de Guadalajara, Calle Donante de sangre s/n.,
19002 Guadalajara, Spain
https://doi.org/10.1007/s11695-020-04606-0
Obesity Surgery (2020) 30:2856–2857
Published online: 20 April 2020
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... Some patients who receive LGC may occasionally experience significant dysphagia during solid food ingestion, which is related to the narrow gastric outlet because of the implanted gastric clip (GC) [3,4]. Such a complication has ever been reported with other clip gastroplasties, and removal of the GC would be the definite treatment to relieve patients of this intractable problem [3][4][5][6][7]. Thus, we herein present the case of a patient with a protracted course of symptomatic gastric outlet stenosis after GC removal that resolved spontaneously during follow-up. ...
... LGC is a restrictive bariatric surgery performed via the GC without interrupting the integrity of the gastrointestinal tract. A metallic GC made of stainless steel, different from the GCs for vertical gastro-clip gastroplasties, was horizontally placed on the gastric cardia [5][6][7]. Regarding its relative novelty, only a few scientific reports have mentioned its short-or long-term complications, such as gastrointestinal bleeding, weight recidivism, intractable belching, or reactive left pleural effusion [1][2][3][4]. Transverse partition with restriction that causes gastric outlet stenosis by the implanted GCs might defer the patients from solid food ingestion [1,2,4]. ...
View
... The plan is to tackle these cases in two phases, with the first involving clip extraction from the gastric wall and the second involving a definitive derivative procedure. Authors have emphasized the significance of removing the BariClip in cases of complications such as intolerance, erosion, slippage, unsuccessful repositioning, and gastric obstructions [1][2][3][4][5][6][7]. In our experience, we have also removed clips for similar reasons. ...
Laparoscopic Vertical Clip Gastroplasty with BariClip Experience, Complications, Literature Review, and Proposal of Modification of the Original Technique
Article
Full-text available
  • Dec 2024
  • OBES SURG
Laparoscopic vertical clip gastroplasty (LVCG) with BariClip is a recent procedure that appears to be safe Gentileschi et al. (Obes Surg 33(1):303-12, 2023). The initial complications reported include erosion, slippage, and gastroesophageal reflux. This study aimed to report on the experience of a single surgical group, analyzing three clinical cases, conducting a literature review, and proposing a standardization of the technique. A retrospective study was conducted with data from June 2021 to October 2024. We collected the data from the procedures related to the bariatric clip made by only one surgical group; we collected 69 cases with 1 complication of this surgical group. Additionally, we described 2 clinical cases of complications related to bariatric clips from other surgical institutions and reviewed the literature related to the BariClip experience. The results are related to the evaluation of the technique and compare the different modifications implemented over the last 3 years of follow-up. Furthermore, we aim to share our experience in attending to one of the most concerning complications associated with this procedure. The LVCG is a safe procedure with a low incidence of complications and positive results in %EWL. We propose several modifications to the original technique to further reduce complications, and we share the experience of both treating and resolving some of the complications we encountered.
View
... The last multicentric study published recently found a rate of 6% of slippages [12]. Limited publications exist at this time with only one case report [11] in a patient who underwent BariClip removal after 8 months because of displacement of the device causing obstructive symptoms. Our current study showed a decrease of slippage rate from 4.3 to 2.8% with an evolving technique of the BariClip device. ...
Evolving Technique of Laparoscopic Vertical Gastric Clip Placement
Article
Full-text available
  • Feb 2023
  • OBES SURG
Introduction: Laparoscopic BariClip gastroplasty (LBCG) will address a similar tubular restriction than the one achieved with the laparoscopic sleeve gastrectomy (LSG) at the level of the gastric fundus, while maintaining the advantage of simplicity and anatomic preservation. The purpose of the current study was to analyze the risk of slippage and to present the evolving technique by adding gastro-gastric plication of the gastric wall covering the BariClip at those areas where the gastric wall "slips" between the limbs of the clip. Methods: All patients undergoing LBCG with the evolving technique of gastric plication around the device associated with antral gastroplasty from January 2021 to May 2022 were included in the study group (group A). A control group (group B) was designed with patients who underwent previous LBCG technique between May 2017 and June 2019. This is a case-controlled group with patients matched by gender and BMI. We have analyzed the postoperative complications and more notably the slippage. Results: One hundred seventy-six patients (44 male and 132 female) with a mean age of 33 years (± 11) underwent evolving technique of LBCG. A control group of 67 patients who underwent previous technique of LBCG was included. All procedures were completed by laparoscopy with no intraoperative complication. For the study group, we have recorded a number of 5 slippages (2.8%). The diagnosis occurred during the first 6 months after the operation. The management consisted of repositioning-3 cases-and BariClip removal-2 cases. For the control group, we have recorded a number of 3 slippages (4.3%). All three patients underwent BariClip removal, with no repositioning. Conclusions: We reported a new technique of placement of the BariClip with additional gastric plication anterior, posterior, and volume reduction in the antrum to potentially reduce the rate of slippage and improve weight loss outcomes.
View
... No GC-related erosions to the stomach or diaphragm that have been presented in current literature were noted [8,9,15]. However, the concern of clip displacement or gastric outlet obstruction in such clip gastroplasties during follow-up still exists [17,18]. Furthermore, significant adhesion around the GC was inevitable, which was found in the current case series, and may impede following revisional surgeries [15]. ...
Laparoscopic Revision for Gastric Clipping: a Single Center Experience and Taiwan Database Review
Article
Full-text available
  • Aug 2021
  • OBES SURG
Purpose Laparoscopic gastric clipping (LGC) is a relatively novel restrictive bariatric surgery wherein a horizontal metallic clip is applied to the gastric fundus. Its intraoperative complications or the difficulties associated with the applied gastric clip (GC) during revisional procedures have seldom been mentioned. Herein, the experience of revisional procedures after initial gastric clipping is reported. Materials and Methods A retrospective cohort review of LGC based on the Taiwan Bariatric Registry of Taiwan Society Metabolic and Bariatric Surgery was performed. Six patients with severe obesity presented for revisional surgery after initial LGC by other surgeons. Patients’ characteristics, indications, and details of revisional surgery were recorded. Results Between 2012 and 2019, 39 patients who underwent pure LGC and six patients with previous LGC history were referred for revisional surgery. Their mean age and the mean body mass index were 34.7 ± 9.5 years and 38.4 ± 10.5 kg/m2, respectively. Three, two, and one patient underwent revisional surgery for insufficient weight loss, weight recidivism, and intractable belching, respectively. The mean interval between initial LGC and revisional surgery was 40.5 ± 22.4 months. Laparoscopic removal of the GC with concomitant revisional surgeries were collected, including a revision to sleeve gastrectomy (n = 5) and revision to Roux-en-Y gastric bypass (n = 1). Moreover, the mean operative time was 286.8 ± 78.2 min. All patients had uneventful recovery postoperatively but experienced significant adhesion around the GC and the left liver. Conclusion Laparoscopic revisional surgery with concomitant GC removal for patients with severe obesity after gastric clipping could be feasibly conducted by experienced bariatric surgeons.
View
Efficacy and Mechanisms of Gastric Volume-Restriction Bariatric Devices
Article
Full-text available
  • Oct 2021
Obesity is a chronic disease that affects over 795 million people worldwide. Bariatric surgery is an effective therapy to combat the epidemic of clinically severe obesity, but it is only performed in a very small proportion of patients because of the limited surgical indications, the irreversibility of the procedure, and the potential postoperative complications. As an alternative to bariatric surgery, numerous medical devices have been developed for the treatment of morbid obesity and obesity-related disorders. Most devices target restriction of the stomach, but the mechanism of action is likely more than just mechanical restriction. The objective of this review is to integrate the underlying mechanisms of gastric restrictive bariatric devices in obesity and comorbidities. We call attention to the need for future studies on potential mechanisms to shed light on how current gastric volume-restriction bariatric devices function and how future devices and treatments can be further improved to combat the epidemic of obesity.
View
Laparoscopic Vertical Clip Gastroplasty – Quality of life
Article
Full-text available
  • Jul 2018
  • SURG OBES RELAT DIS
Background Over the last decade, several techniques have emerged and the bariatric trends have changed. A new bariatric procedure that has been proposed is laparoscopic vertical clip gastroplasty (LVCG), which mimics the principle of laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. The introduction of a new procedure in the bariatric armamentarium necessitated a period of preclinical and clinical studies and a validation of the procedure concerning the quality of life. Setting Private hospital, Dominican Republic. Objectives The purpose of this manuscript was to evaluate patient satisfaction, measured by various questionnaires after LVCG. Methods From November 2012 to February 2017, 138 patients underwent LVCG and demographic data were collected prospectively. A total of 82 were evaluated for quality of life with a minimum follow-up of 6 months after the procedure. The quality of life was also analyzed regarding the complications and resolution of different medical conditions included in the Bariatric Analysis and Reporting Outcome System score. Results Eighty-five patients (73.9%) agreed to participate in the study and a total of 82 patients completed the questionnaires at all points in time. Seventy-one patients were female, with an average age of 34 (19–38). Mean body mass index before operation was 42.4 kg/m² and declined significantly in both the first and second year postoperatively to 33.7 kg/m² (1-year follow-up) in 65 patients and 34.3 kg/m² (2-year follow-up) in 37 patients. The results showed failure for 1.2% of patients and were fair for 6.1% of cases. Quality of life was assessed as good for 26 patients (31.8%), as very good for 39 patients (47.5%), and as excellent for 11 patients (13.4%). Conclusions LVCG represents a new bariatric procedure that mimics the principle of laparoscopic sleeve gastrectomy, but with a completely reversible mechanism. The procedure consists of a nonadjustable clip that is vertically placed parallel to the lesser curvature. After >3 years of clinical use, the weight loss results seem to be encouraging and up to 92.7% of patients have an improved quality of life.
View
A Vertically Placed Clip for Weight Loss: a 39-Month Pilot Study
Article
Full-text available
  • May 2017
  • OBES SURG
Background: Morbid obesity remains one of society's significant medical dilemmas. It is rapidly worsening and expected to affect 35% of the US population by the year 2020. Common current bariatric procedures exist and include, but not limited to, the adjustable gastric band, gastric bypass, and the sleeve gastrectomy. Although beneficial to morbidly obese patients, they also alter the patient's anatomy and involve resections, or require maintenance. The goal of the trial is to show a new minimally invasive vertical gastric clip technique that produces significant weight loss but requires no resection, no change in anatomy, and is reversible. Methods: From November 2012 to February 2016, prospective collected data from 117 patients was included in the gastric clip trial. The clip consists of a silicone-covered titanium backbone with an inferior hinged opening that separates a medial lumen from an excluded lateral gastric pouch. The inferior opening allows the gastric juices to empty from the fundus and the body of the stomach into the distal antrum. Results: Weight loss and comorbidities were evaluated among 117 patients over a 39-month period. 66.7% excess weight loss was seen with minimal adverse events. Average length of surgery was 69 min. Average length of stay was 1.3 days. Fifteen of the originally implanted clips were electively removed based on the original protocol, and the other two were removed for displacement of the device. Conclusion: The vertical, gastric clip trial has shown that excellent weight loss can be achieved without some of the complications seen with historical bariatric procedures. This clip is placed without requiring stapling, resection, malabsorption, change in anatomy, or maintenance. It is also easily reversible.
View