Gastric Plication
Gastric plication, also known as gastric imbrication, is a form of bariatric, or weight loss, surgery, designed primarily to assist morbidly obese patients who have been unsuccessful with diet and exercise alone. It involves a surgical folding of stomach tissue to decrease the stomach's capacity. A relatively new method of bariatric surgery, gastric plication is sometimes performed in combination with gastric banding.
Candidates for Gastric Plication
Bariatric surgery is not always an appropriate choice for every obese patient. Certain criteria must be met before such surgery is performed to ensure that the patient will reap its full benefits. To determine eligibility, patients are be screened for:
- Age
- Weight and body mass index (BMI)
- Medical condition and history
- Motivation
- Psychological stability
In general, patients must be between the ages of 18 and 65 and have a BMI of 40 or higher or a serious obesity-related medical problem in order to qualify for gastric plication. While in most cases this procedure will promote improvement in overall health, there are certain medical conditions that preclude its use, such as some forms of lung, heart or kidney disease. There are also certain mental health issues, such as eating disorders, which must be addressed before gastric plication is performed.
Benefits of Gastric Plication
Gastric plication is extremely effective at helping obese individuals lose weight. Not only does the weight loss improve self-confidence and daily quality of life, it greatly improves overall health.
Health Improvements
Successful gastric plication may result in remission or disappearance of obesity-related conditions such as type 2 diabetes, hypertension, severe sleep apnea, cardiovascular disease, gastroesophageal reflux, or asthma. Typically, gastric plication significantly lowers mortality risk.
No Malnutrition
Gastric plication is minimally invasive, requiring no cutting or stapling of the stomach. Unlike some bariatric procedures, it requires no gastrointestinal re-routing. Since the procedure does not affect other digestive organs, it does not result in malabsorption or malnutrition.
No Surgical Implantation
Since gastric plication, if performed without gastric banding, involves no implanted device, there are fewer complications likely and no future adjustments are necessary. Gastric plication also has the advantage of being a reversible procedure.
Most patients who undergo gastric plication lose somewhere between 40 and 70 percent of their excess weight.
The Procedure of of Gastric Plication
Plication is defined as the act or process of folding. During gastric plication, the surgeon sews folds into the walls of the stomach to decrease its capacity by as much as 70 percent. As a result, the stomach is unable to contain as much food as it did prior to the procedure so the patient will no longer be able ingest as many calories and will lose weight. This operation has the advantage of allowing the surgeon to control precisely how much the size of the stomach is revised. It is also a reversible procedure.
Gastric Plication typically is performed laparoscopically in an outpatient setting. On occasion, it may be conducted through traditional open surgery, in which case the patient is admitted to the hospital.
Risks of Gastric Plication
Complications from gastric plication are rare, but may include seepage from the stomach sutures. In addition, the risks common to any surgical procedure are also present. These may include:
- Adverse reactions to anesthesia or medications
- Post-surgical infection
- Damage to adjacent organs
- Breathing problems
- Hernia at the incision site
Blood clots and excessive bleeding are also possible risks of gastric plication surgery.
Recovery from Gastric Plication
Recovery from gastric plication is usually uneventful. The patient should expect some soreness at the incisional site(s) for a few days and can gradually resume eating a normal diet, beginning with liquids and then progressing to soft foods. Often there is some temporary digestive distress for a few days until the body adjusts to the modification the stomach has undergone. It is important for the patient to follow instructions relative to diet, portion size and exercise regimen if the surgery is to be successful long term.