Gastric pacing to treat morbid obesity: two years experience in four patients

BACKGROUND: Gastric pacing to treat morbid obesity has been found to be safe and the implant tecnique simple to perform. Appetite is reduced and satiety is increased after the implant. There are two components in the Implantable Gastric Stimulation (IGS): a) an electrical stimulator connected to a b) bipolar lead that is positioned in the muscle wall of the stomach. We describe the optimal procedure to safely place the components. We present our results after preliminary experiences. METHODS: From August 2005 to January 2006 4 patients (F) mean age 44 (33-63) underwent to IGS implant. The mean BMI was 41.8 (37.8-47), mean weight 117.2 Kg (107-133). The IGS was activated 30 days after implant. Fasting and postprandial plasma ghrelin concentrations after a test meal were measured before and 1, 2, 3 and 6 months after implanting operation. RESULTS: All procedures were successfully completed laparoscopically There were no major operative complications. Postoperative course was uneventful in all cases. One patient was lost to follow up after six months. Postoperative lead dislodgement and cutaneous decubitus occurred in another patient, making necessary the removing of the device. For the other two patient only in-one there was a significant weigth loss (49 Kg), in the second weight was unchanged. Plasma ghrelin concentrations were no correlated among patients, and results were not in line with what waited by the producer. CONCLUSION: Morbid obese patients can undergo IGS imlantation by laparoscopy with minimal perioperative complcations. Attention to technical details is essential. In accordance with the producer (Medtronic) our data demonstrate that gastric pacing is a safe procedure for selected patients supported by adequate psychological treatment, but outcome about weight loss should be evaluated among bigger trial, as our experience didn't give satisfactory results, and therefore discouraged us to carry on with the study.