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Laparoscopic Vertical Clip Gastroplasty with BariClip Experience, Complications, Literature Review, and Proposal of Modification of the Original Technique

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Elkin Benítez Navarrete
Elkin Benítez Navarrete
Elkin Benítez Navarrete
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Manuel García Garza
Manuel García Garza
Manuel García Garza
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Daniel Islas Treviño
Daniel Islas Treviño
Daniel Islas Treviño
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Gerardo Enrique Aguirre Garza
Gerardo Enrique Aguirre Garza
Gerardo Enrique Aguirre Garza
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Abstract and Figures

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.
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Vol:.(1234567890)
Obesity Surgery (2025) 35:322–328
https://doi.org/10.1007/s11695-024-07603-9
REVIEW
Laparoscopic Vertical Clip Gastroplasty withBariClip Experience,
Complications, Literature Review, andProposal ofModification
oftheOriginal Technique
ElkinBenítezNavarrete1,2· ManuelGarcíaGarza3,4· DanielIslasTreviño2,3· GerardoEnriqueAguirreGarza2,5·
PatrickNoel3,4· OreibyAlexanderHernandez1,2· NatanZundel3,4
Received: 27 August 2024 / Revised: 18 October 2024 / Accepted: 22 November 2024 / Published online: 21 December 2024
© The Author(s), under exclusive licence to Springer Science+Business Media, LLC, part of Springer Nature 2024
Abstract
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 complica-
tions 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.
Keywords Laparoscopic vertical clip gastroplasty· BariClip· Erosion· Bariatric clip complications
Introduction
Laparoscopic vertical clip gastroplasty (LVCG) with Bari-
Clip is a recent procedure, that appears to be a safe procedure
[1]; in recent years, some authors reported some cases of dif-
ferent complications and evolution of the technique, looking
for the best way to reduce the incidence of complications.
The initial complications reported were erosion with an inci-
dence of 1.4%, slippage of 6.52%, gastroesophageal reflux of
5% in the first month, and a decrease of 0.72% after the sec-
ond month [2]. This study aims to report the experience of
3years of a single bariatric surgical group, report 3 clinical
cases of complications 1 from this group and 2 from a non-
bariatric group, and do a literature review and a proposal for
a definitive standardization of the technique.
* Elkin Benítez Navarrete
elkinben@gmail.com
Manuel García Garza
dr.manuelgarciagarza@gmail.com
Daniel Islas Treviño
doctordanielislas@gmail.com
Gerardo Enrique Aguirre Garza
draguirrecirujano@gmail.com
Patrick Noel
casanoel@gmail.com
Oreiby Alexander Hernandez
oreanaherdez@gmail.com
Natan Zundel
drnazuma99@yahoo.com
1 IFSO-LAC, Monterrey, Mexico
2 Swiss Hospital, NuevoLeon, Mexico
3 International Federation fortheSurgery ofObesity
andMetabolic Disorders, IFSO, Monterrey, Mexico
4 American Society forMetabolic andBariatric Surgery,
Gainesville, USA
5 American College ofSurgeon, Chicago, USA
Content courtesy of Springer Nature, terms of use apply. Rights reserved.
... However, clip slippage can occur in 4 to 8% of cases with subsequent risk of occlusion and perforation [7]. Other complications include erosion, bleeding, and gastroesophageal reflux [7][8][9]. ...
... Other reported complications include bleeding (1.3%) [7], erosion (1.4%-2.6%%), and gastroesophageal reflux (0,7-5%) [7,8]. A case of a complete intragastric penetration of BariClip necessitating laparoscopic removal has also been reported [14]. ...
... These complications may be associated with technical factors or suboptimal surgical execution. Achieving proficiency in this technique may require a steeper and more demanding learning curve than initially anticipated [8]. A critical step of the procedure is the creation of the retrogastric tunnel which is typically performed under direct vision. ...
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Complete Intra-Gastric Erosion of a Laparoscopic Vertical Gastric Clip
Article
Full-text available
  • Nov 2023
  • OBES SURG
As severe obesity continues to be a serious and worsening medical challenge, there has been a corresponding interest in new therapies. Bariatric surgery remains the most effective and enduring therapy option. Newer techniques which aim to spare gastric anatomy have been introduced. One such procedure, known as the laparoscopic vertical clip gastroplasty (LVCG) or laparoscopic BariClip gastroplasty (LBCG), is intended to mimic the effects of a sleeve gastrectomy without requiring permanent anatomic alteration; however, this method is relatively new and not currently approved for use in the USA. Ten years after clip placement outside of the USA, a 44-year-old female presented to our bariatric clinic with intermittent nausea and abdominal pain. She was lost to follow-up after initial treatment at an outside institution but reported good initial weight loss with the clip; however, she noted slow weight regain over the past few years. The patient underwent an upper gastrointestinal fluoroscopy and upper endoscopy, which concluded complete erosion of the clip into the stomach. She underwent laparoscopic removal of the clip and has had an uneventful recovery with plans for bariatric surgery later. Laparoscopic vertical clip gastroplasty (LVCG) is not a well-known procedure in the USA, and this is the first known reported case of a complete intragastric erosion of the clip necessitating removal. Regular follow-up and surveillance are needed to monitor potential complications, early migration, and possible erosion of these devices into the stomach.
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Classification of Slippage Following Laparoscopic BariClip Gastroplasty
Article
Full-text available
  • Aug 2023
  • OBES SURG
Introduction Laparoscopic BariClip gastroplasty (LBCG) is a new reversible gastric sleeve-like procedure without gastrectomy proposed to minimize the risk of severe complications. Still one of the possible complications described with LBCG is slippage. The purpose of the current manuscript is to analyze different cases of slippage and propose a classification of this complication. Methods A number of 381 patients who underwent LBCG in 8 different centers were analyzed concerning the risk of slippage. All cases with documented slippage were carefully reviewed in terms of patients’ symptomatology (presence of satiety, vomiting), history of weight loss, radiological data, and management of their slippage. A new classification was proposed depending on the anatomy, the symptomatology, and the time of occurrence. Results We have identified a total of 17 cases (4.46%) of slippage following LBCG. In 11 patients, the slippage was symptomatic with repetitive vomiting and nausea, and in the remaining 6 patients, the slippage was identified by radiological studies for insufficient weight loss, weight regain, or routine radiological follow-up. Depending on the interval time, the slippage was classified as either immediate (in first 7 days) in 6 cases, early (in less than 90 days) in 4 cases, and late (after 3 months) in 7 cases. Evaluation of the radiological studies in these cases identified the following: anterosuperior displacement (type A) in 9 cases, posteroinferior displacement (type B) in 6 cases (one case after 3 months), and lateral displacement (type C) in the remaining 2 cases. The management of the slippage consisted of BariClip removal in 7 cases, repositioning in 5 cases, and conservative treatment in the remaining 5 cases. All patients with conservative treatment were recorded at the beginning of the experience. Conclusions Slippage is a possible complication after LBCG. This classification of the different types of slippage can benefit the surgeon in the management and treatment of this complication of LBCG. Graphical Abstract
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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.
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Safety and Efficacy of Laparoscopic Vertical Clip Gastroplasty: Early Results of an Italian Multicenter Study
Article
Full-text available
  • Dec 2022
  • OBES SURG
PurposeSleeve gastrectomy, the most commonly performed bariatric surgery procedure, carries limitations both short term including postoperative complications such as hemorrhage and gastric fistula and long term such as weight regain and gastroesophageal reflux. A new procedure has been proposed to overcome many of these limitations: laparoscopic vertical clip gastroplasty (LVCG) with BariClip.Materials and Methods Fifty patients were offered LVCG and enrolled for a feasibility study in two referral bariatric centers. Indication was given as for sleeve gastrectomy, after a multidisciplinary path evaluating age, gender, BMI, comorbidities, eating behaviors, and gastroesophageal reflux. The primary outcome was major postoperative complications. Secondary outcomes included weight loss, incidence of de-novo GERD, and comorbidity resolution.ResultsPatients had a mean age of 44 years and mean BMI of 37 kg/m2 ± 6.2. All procedures were performed successfully in laparoscopy, with no conversion or intraoperative adverse events. The overall major postoperative complication rate was 6%. Re-operation was required in three patients for slippage. No mortality occurred. Excess weight loss, excess BMI loss, and total weight loss at 6 months were 36%, 57%, and 22%, respectively. There was no instance of de-novo GERD. Resolution of hypertension occurred in 50% of cases, OSAS in 65% of cases, and DMII in 80% of cases.Conclusion The safety of LVCG procedure has been reproduced in a multicentric, multi-surgeon study. Weight loss outcomes appear promising. A randomized trial is needed to fully assess the benefits of LVCG.Graphical Abstract
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Laparoscopic Removal of a Displaced Vertical Gastric Clip Causing Gastric Outlet Obstruction
Article
Full-text available
  • Jul 2020
  • OBES SURG
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.
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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.
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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.
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Content courtesy of Springer Nature, terms of use apply. Rights reserved
  • Jan 2023
  • 3317-3322
  • P Noel
  • S Olmi
  • P Gentileschi
  • R Caiazzo
  • C Marciniak
  • Dgm Pintado
  • G Ungson
  • V Alarcon
  • S Carandina
  • T Manos
  • N Zundel
  • R E Lutfi
  • J Ponce
  • M Nedelcu
Noel P, Olmi S, Gentileschi P, Caiazzo R, Marciniak C, Pintado DGM, Ungson G, Alarcon V, Carandina S, Manos T, Content courtesy of Springer Nature, terms of use apply. Rights reserved. Obesity Surgery Shamoun JM, Zundel N, Lutfi RE, Ponce J, Nedelcu M. Classification of slippage following laparoscopic BariClip gastroplasty. Obes Surg. 2023;33(10):3317-22. https:// doi. org/ 10. 1007/ s11695-023-06780-3.