Gastric Plication for Morbid Obesity
Gastric plication is a new bariatric procedure. Laparoscopic greater curvature plication(LGCP) has gained popularity within the last 2 years because it is a restrictive procedure that reduces gastric volume without the need for stomach resection.
LGCP was first described by Wilkinson in 1981. LGCP successfully reduces gastric volume by plication of the greater curvature without the use of foreign materials or gastrectomy. It has been thought that a lack of stomach resection will result in better outcomes regarding postoperative risks such as leakage.
Restrictive bariatric procedures to reduce food intake are traditionally accepted techniques used for weight loss as ajustable gastric banding(AGB) and laparoscopic sleeve gastrectomy (LSG). Laparoscopic greater curvature plication is considered a restrictive procedure where the greater curvature of the stomach is elimenated by invaginating it against a calibration tube without gastric resection. Currently, there is no standardized technique for gastric plication. Authors described their experience differently.
Main complications after LGCP are nausea and vomiting. It usually resolved within 1 to 2 week but it can last for 20-25 days.
One of the most important reason that gastric plication was found appealing is the fact that the technique does not involve any gastric resection nor does it leave a staple line behind, and by so reducing the risks of staple line-related complications.
In gastric plication, there is neither foreign body placement nor need for adjustment compared to the gastric banding and therefore alleviates the problems of foreign body and the psychological discomfort a patient might have knowing that a foreign body is placed in his body. Currently, gastric plication has been described as a stend-alone procedure.
All authors reported a significant percentage of EWL with gastric plication that was comparable to sleeve gastrectomy.Talebpour and Amoli had the longest follow-up of 3 years with 50 patient having a mean of 60% EWL at the second year and 11 patient häving 57% at 3 years.*
Laparoscopic gastric plication is still in its infancy. Prospective randomized studies with long-term follow-up comparing gastric plication to other well-established bariatric procedures are needes to proove the reliability and metabolic effectiveness of such new procedure. This evidence-based comparison will properly place the gastric plication in the armamentarium of weight loss surgery.
LGCP is considered feasible and safe in the short term when applied to morbidly obese patients, but may be unsustainable. It is also an inferior restrictive procedure in resolution of type 2 diabetes.
(c) Dr. Rein Adamson
* The examples given in the text are general and may vary in individual patients. For the most accurate information, please contact with doctor.