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Banded Plication

Banded Plication is a combination of two procedures: the gastric band and a new investigational procedure called gastric plication, or plication. During plication, the stomach is folded in on itself and stitched in place. This greatly reduces the stomach’s volume . In addition, a gastric band – most commonly the Lap Band – is placed around the upper part of the stomach. The band compliments the effects of the plication by also significantly reducing the amount of food eaten, as well as feelings of hunger.

bandicationHow it Works
Weight loss with the gastric band is generally slower than with other procedures like the sleeve or gastric bypass. However, since the band is adjustable, patients have ongoing follow-up and “fills” (adjustments). Other than the benefit of a personalized process of finding the optimal tightness of each patient’s band, the adjustable nature of the band means that patients who relapse and begin to gain weight back, can often be helped back on track by further adjusting the band. No other weight loss procedure has this benefit. The banded plication was created with the idea of combining the advantage of the rapid early weight loss seen with plication, and the ability to further sustain weight loss for a longer period of time with the adjustable gastric band.

imbricationThe Procedure
Banded Plication is a procedure that is performed laparoscopically, meaning it’s minimally invasive. Generally the surgery involves five or six small incisions in the abdomen. Using a tiny video camera and instruments through these small incisions, the surgeon performs the procedure with no cutting, stapling, or removal of the stomach or intestines during the Gastric Plication. Additionally, Plication is potentially reversible. This is different from the Sleeve Gastrectomy, in which part of the stomach is removed, making it irreversible.

ibandAfter Surgery
After undergoing a banded Plication, patients usually stay in the hospital for 1-2 days. Patients are usually asked to stay on a liquid diet for several weeks after surgery, and then transitioned to solid foods under the guidance of the surgeon and dietician. Your surgeon and support staff will advise you on what type of post-surgery eating and lifestyle habits you should follow, in order to most benefit for your procedure.

gastric pleatWeight Loss Trends
Although there is significant data about the weight loss that occurs with a gastric band, the banded plication is a new and experimental procedure, so there is very little data available yet. Additionally, even plication performed on its own is a new procedure, and considered investigational because of the current lack of data in terms of safety or efficacy. Short-term clinical studies on the plication have reported that patients lose between 40% to 70% of their excess body weight during the year following the surgery.  Additionally, many co-morbidities improve or resolve after weight loss surgery. However, clinical trials comparing either plication or banded plication to standard bariatric procedures are not available yet.

pleat procedureWho Qualifies
Since Plication is investigational, it is usually performed only in research studies (ASMBS gastric plication statement). Different surgeons and institutions will have different criteria for patients they would accept into these studies, however these requirements would typically be similar to criteria for other bariatric procedures, such as the NIH criteria for bariatric surgery, and the FDA criteria for the Lap-Band.

banded pleatCost
The cost of Banded Plication varies from practice to practice, and is generally expected to be more than the Lap-Band alone, but less than a more complex procedure like the gastric bypass. Because plication is an investigational procedure, and therefore the combined banded plication is investigational, it is not usually covered by insurance.

gastric imbricationPotential Complications
All surgeries have risk of complications. Potential complications of Banded Plication include infection, bleeding, injury to other organs, and a leak from the suture line used to fold the stomach. A good surgeon will inform you about the risks associated with the various weight loss surgery procedures. It’s important to make sure you understand both the benefits and risks of any procedure you consider.

Other weight loss surgery options: