The effect of surgical gastric plication on obesity and diabetes mellitus type 2: a systematic review and meta-analysis

Introduction
All the bariatric procedures have evolved greatly over the past decades and laparoscopic greater curvature plication (LGCP) is one of the quite recently introduced techniques lacking systematic evaluation.

Aim
To compare and summarize the current data in the literature in regard to the effect of gastric plication on obesity and diabetes mellitus type 2.

Material and methods
The systematic review and meta-analysis was performed according to the PRISMA guidelines and registered at PROSPERO under the registration number CRD42018114314. The literature in English and German was searched using the MEDLINE (PubMed) and BJS databases for studies published in the last 10 years. A meta-analysis was performed focusing on the effects of this operation on weight loss, glycemia control and improvement of comorbidities.

Results
Mean preoperative body mass index (BMI) ranged from 34.42 to 46.3 kg/m2. Most of the patients were female. The operation time was in the range from 50 to 192.23 min. Mean follow-up was from one month to 12 years, with most studies having a follow-up of less than 2 years. The postoperative BMI ranged from 28.59 to 38, with reported excess weight loss (EWL%) in the range 20–70%. Glycated hemoglobin (HbA1c) values decreased by up to 5.1% after surgery, ranging from 5.1% to 7.5%.

Conclusions
Despite the quality of most of the included studies being low, the present meta-analysis revealed that, in the short term, gastric plication is an effective measure for weight loss, while the effect on diabetes mellitus type 2 is not statistically significant.