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Laparoscopic Gastric Pacing

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Obesity, Bariatric and Metabolic Surgery

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Abstract

Laparoscopic gastric pacing (LGP) was first developed in the early 1990s for gastroparesis, and was also found to be effective in the treatment of obesity. Gastric electrical stimulation (GES) inhibits gastric motility and has effects on the central nervous system and the hormones related to satiety. It has been investigated for the treatment of obesity as it reduces appetite and induces early satiety.

In LGB, the application of electrical current to the stomach alters gastric myoelectrical activity without any changes in the gastrointestinal anatomy. The exact mechanism of LGP remains to be elucidated. However, potential mechanisms to assess the success of LGP might include an increased feeling of satiety as a result of reduced gastric emptying, or changes in neuropeptide levels. LGP is a minimally invasive technique that is potentially safe and effective for treating obesity; nevertheless, the selection of patients for gastric stimulation therapy appears to be an important determinant of the outcome of this treatment.

The first GES method used to treat obesity was a device called implantable gastric stimulation (IGS). It uses short pulses and has almost no effects on gastric motility (Transcend™). It changes central neuronal and hormonal activities. The second GES device (Tantalus ™) that was used clinically in patients with obesity was designed to improve gastric motility.

The third GES device used for treating obesity was called Closed-Loop Gastric Electrical Stimulation System that delivered electrical stimulation upon food intake (abiliti® system).

This chapter reviews the current status, potential mechanisms of action, operating techniques, complications, postoperative management and outcomes, and possible future applications of gastric stimulation in obesity management.

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Authors and Affiliations

  1. Kings College London Hospital, Dubai, United Arab Emirates

    Karl Miller

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  1. Karl Miller
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Correspondence to Karl Miller .

Editor information

Editors and Affiliations

  1. Homerton University Hospital, London, UK

    Sanjay Agrawal

Section Editor information

  1. Department of General and Bariatric Surgery, Whittington Hospital, London, UK

    Chetan Parmar

Electronic Supplementary Material

The lead of the pacemaker is inserted into the muscle tunnel of the stomach, which positions are on the lesser curvature. An adequate length of the tunnel is mandatory, to ensure that both the electrodes are buried within the tunnel wall. The location of the generator should be on the anterior abdominal wall. The device that controls the settings (wand) is covered with a sterile cover and the system impedance is checked (MP4 16338 kb)

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Miller, K. (2021). Laparoscopic Gastric Pacing. In: Agrawal, S. (eds) Obesity, Bariatric and Metabolic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-54064-7_49-1

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  • DOI: https://doi.org/10.1007/978-3-030-54064-7_49-1

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  • Print ISBN: 978-3-030-54064-7

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