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Gastric Plication

Gastric Plication is a new, investigational or experimental procedure, also referred to as gastric imbrication or laparoscopic greater curvature plication. The word ‘plication’ means fold, which is basically what is done during this surgery: the greater (larger) curve of the stomach is folded in on itself and secured with stitches. The stomach’s volume is greatly reduced, and patients report reduced hunger, resulting in reduced food intake and weight loss. ASMBS has issued a statement on this procedure, which highlights that the procedure must be considered investigational because of the current lack of data available on safety and efficacy. More information is available here.

bandicationHow it Works
Gastric Plication greatly reduces the stomach’s volume, so that smaller amounts of food provide the feeling of being full. It also seems to reduce feelings of hunger. The greater (larger) curve of the stomach will not be able to expand after the procedure, so the amount of food that can be consumed is significantly less than before. Some surgeons are combining Plication and Lap-Band surgery – sometimes referred to as Banded Plication – which is another investigational or experimental procedure. This combination of the adjustable band and plication aims to take advantage of the rapid early weight loss seen with plication, and the ability to sustain weight loss for a longer period of time with the adjustable band.

imbricationThe Procedure
Gastric Plication is a procedure that is performed laparoscopically, which means it’s minimally invasive. Plication usually involves five or six small incisions in the abdomen. The surgeon places a tiny video camera and instruments through these small incisions. There is 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 Gastric Plication, patients usually stay in the hospital for 1-2 days. Patients are usually asked to stay on a liquid diet for 2 to 3 weeks after plication surgery, and then transitioned to solid foods under the guidance of the surgeon and dietician.

gastric pleatWeight Loss Trends
Because the Gastric Plication is a newer procedure, there is not much data available about its long term weight loss.  Short-term clinical studies have reported that patients lose between 40% to 70% of their excess body weight during the year following gastric plication surgery.  Additionally, many co-morbidities improve or resolve after weight loss surgery. However, clinical trials comparing plication or banded plication to standard bariatric procedures are not yet available.

pleat procedureWho Qualifies
Since Plication is new and investigational, it is usually performed only in research studies. Criteria for entering various studies would depend on the individual center, but 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 Gastric Plication and Banded Plication varies from practice to practice, and is usually similar to the cost of a Lap-Band. Because Plication is an investigational procedure, it is not currently covered by insurance.

gastric imbricationPotential Complications
All surgeries have risk of complications. Potential complications of Gastric Plication include bleeding, infection, injury to other organs, and a leak from the suture line used to fold the stomach.

Other weight loss surgery options: