What is gastric plication?
Gastric plication is a type of bariatric, or weight loss surgery. It is a restrictive procedure, meaning it reduces the stomach’s size. This limits the amount of food you can eat at one time and makes you feel full faster. Unlike other bariatric procedures, it does not involve gastric banding, stomach stapling, or bypassing the stomach. Instead, the surgeon creates large folds in the stomach to reduce the size. Other names for this surgery include gastric imbrication and greater curvature plication.
Gastric plication is currently an experimental or investigational procedure. According to the latest statement from the American Society for Metabolic and Bariatric Surgery (ASMBS), the procedure should be part of an approved study protocol. This protocol should be subject to oversight by a third party, such as an ethics committee or an Institutional Review Board (IRB). This ensures patient safety and regular review of outcomes. Due to this experimental status, insurance companies generally do not cover the procedure in the United States.
Why is gastric plication performed?
Your doctor may recommend gastric plication surgery if you meet the following criteria:
You have a BMI (body mass index) of 30 kg/m2 or greater, which means you are obese. This is lower than most bariatric procedures that require you to be morbidly obese with a BMI of 40 kg/m2 or greater or 35 kg/m2 or greater with obesity-related health problems.
You have tried less-invasive strategies, but have not achieved adequate weight loss. This includes diet, exercise, behavioral therapy, and medical weight loss using medications.
You have demonstrated a commitment to losing weight, improving your health, and making lifelong changes to your lifestyle habits. This includes making permanent diet, exercise and behavior changes. It will also involve accepting a lifelong need to limit food portions and change food choices.
In general, bariatric surgery and lifestyle changes can reduce the risk of obesity-related health problems including:
Cancer including breast, colon, kidney, liver, ovarian, pancreatic and thyroid cancers
Osteoarthritis and general pain
Sleep apnea and other breathing problems
Talk with your doctor about all risks and benefits of gastric plication. Find out what you can expect for health outcomes after surgery.
Who performs gastric plication?
Bariatric surgeons and some general surgeons perform bariatric surgeries, including gastric plication. Bariatric surgeons are often general surgeons who specialize in bariatrics. Bariatrics is the field of medicine that deals with the causes, prevention and treatment of obesity. Because of the investigational status of gastric plication surgery, not all providers may offer it as an option.
How is gastric plication performed?
Doctors perform gastric plication in a hospital using a general anesthetic. This involves administering a combination of intravenous (IV) medicines and gases to put you in a deep sleep. You will sleep through the procedure without feeling any pain.
Gastric plication is a laparoscopic, minimally invasive surgery. It involves making 5 to 6 small incisions in the abdomen. Your doctor will insert small surgical instruments through the incisions to perform the operation. Using these instruments, your doctor will create large stomach folds and sew them in place. The stomach folds reduce your stomach’s size by about 70%. The procedure takes 1 to 2 hours.
Is stomach plication reversible?
There is no cutting or stapling of your stomach. This makes the procedure reversible and convertible to another procedure in the future.
What to expect the day of your gastric plication
In general, this is what happens the day of your surgery:
A preoperative nurse will check your preoperative test results, make sure all necessary paperwork is in order, and may perform a brief physical exam.
The surgical team will give you a sedative to help you relax before they take you to the operating room (OR).
Your team will start general anesthesia in the OR. With general anesthesia, you won’t remember anything else until you wake up in the recovery room.
What are the risks and potential complications of gastric plication?
All surgeries carry risks and the possibility of developing complications. These risks and complications are not common, but they can be serious and even life threatening. Complications can occur during the surgery itself or afterwards during your recovery.
General risks of surgery
The general risks of surgery include:
Potential complications of gastric plication
Most gastric plication surgeries are successful, but potential complications include:
Damage to organs or blood vessels
Leaks from the stitches creating the stomach folds, which requires additional surgery to correct
Separation of the stomach fold, requiring additional surgery to correct
Reducing your risk of complications
You can reduce your risk of certain complications by:
Understanding and following your doctor’s activity, dietary and lifestyle restrictions and recommendations before your surgery and during recovery. Ask your doctor or nurse to explain it again if something does not make sense to you.
Informing your doctor if you are nursing or if there is any possibility of pregnancy
Telling all members of your care team if you have allergies
Notifying your doctor immediately of any concerns, such as bleeding, fever, or increase in pain
Taking your medications exactly as directed
How do I prepare for gastric plication?
There will likely be detailed preparation instructions if you are part of a study protocol for gastric plication. Protocols may vary by surgical center and surgeon.
In general, you can prepare for surgery by:
Knowing your health and medical history
Listing what medications you take including prescriptions, over-the-counter drugs, herbal supplements, and vitamins, as well as drug allergies
Not eating or drinking before surgery as directed. Your team may postpone your surgery if you eat or drink too close to the start of surgery because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible (if you smoke) to help with healing after surgery
Taking or stopping medications exactly as directed. Your doctor will give you instructions for taking your specific medications and supplements.
Questions to ask your doctor
It can help to list questions you want to ask during your appointments. Questions you may want to ask the doctor include:
Why are you recommending gastric plication for me? How do the outcomes compare with other types of bariatric surgery?
How many of these procedures have you performed? How often do you see complications?
Will my gastric plication be part of a supervised study protocol?
How much does gastric plication surgery cost?
What is involved in gastric plication? What other treatments will I need?
When can I go home from the hospital?
What restrictions will I have after surgery? What kind of assistance will I need at home?
When can I return to work and other activities?
When should I follow up with you?
How should I contact you after hours if I have a problem?
What can I expect after gastric plication?
Knowing what to expect makes it easier to plan and prepare for a successful recovery.
How long will it take to recover?
Gastric plication typically requires a shorter hospital stay than other types of bariatric surgery. The usual stay lasts 1 to 2 days. Like other restrictive procedures, you will start on a liquid diet in the hospital. Gradually, you will transition to thicker foods, soft foods, and finally solid foods. This process can take up to 12 weeks.
Recovery from gastric plication is generally easier than other bariatric surgeries because there is no stapling, stomach removal, or diversion of your digestive system. How quickly you recover will depend on your age and your overall health. Physical therapy can help you recover. Using physical therapy, you will regain strength and stamina, minimize pain, and return to activities more easily than without it. It is also useful before surgery to prepare your body for the road ahead.
Most people return to work and other activities within 10 days. Full recovery can take several weeks.
Will I feel pain?
Pain and discomfort will be part of your recovery after gastric plication. Managing pain is important for your recovery. It lets you complete physical therapy and other rehabilitation activities necessary for smooth healing. Tell your doctor if your pain gets worse or changes in any way. It could be a sign of a complication.
When should I call my doctor?
Call your doctor’s office during regular business hours if you have questions between appointments. Your doctor will tell you how to contact someone after hours or for urgent concerns. Call your doctor right away or seek immediate medical care if you have:
Breathing problems or shortness of breath
Confusion or changes in level of alertness
Chest pain, pressure or tightness
Drainage of pus, redness or swelling around an incision
Fever. It’s common to have a fever right after surgery. Your doctor will give you instructions about when to call for a fever.
Inability to urinate or move your bowels
How might gastric plication affect my everyday life?
Any kind of bariatric surgery can be life changing. Like other restrictive procedures, one of the biggest changes will be your diet. Your stomach will be significantly smaller after gastric plication. This means you will need to eat smaller, more frequent meals. You will also need to limit portion sizes and change the types of food you eat. Working with a dietitian is helpful. This provider will offer advice and planning to ensure you get enough calories, protein, and other nutrients.
Unlike some other types of bariatric surgery, severe malnutrition is usually not a problem following gastric plication. Your body is still able to absorb nutrients because the surgery does not divert food past the upper small intestine. Your dietitian may recommend supplements if issues arise.
Exercise and behavior therapy will also be part of your life after gastric plication. They are part of treatment protocols because they make weight loss surgery more successful.
Weight loss can change the way you see yourself.
Once weight loss starts, some people have difficulty with their new appearance. Weight loss can also change the way others see you and respond to you. This can trigger issues with body image and strain personal and social relationships. The emotions surrounding these changes have the potential to interfere with diet and exercise habits. Counselors on your bariatric care team can help you work through these challenges and stay on track with your treatment.
For gastric plication, more research is necessary before it can become a standard bariatric treatment. Doctors need to understand how it compares to other bariatric procedures with regard to long-term success. However, the benefits of bariatric surgery in general are well worth the journey. Surgery can improve or even resolve obesity-related conditions, such type 2 diabetes and heart disease. It can also decrease the risk of dying. Bariatric surgery patients tend to have a better quality of life than obese people who do not have surgery.
If you are considering bariatric surgery, talk with your doctor about all the options. Find out which bariatric centers offer gastric plication as part of a supervised clinical trial. Usually, clinical trials cover some or all of the cost of care related to the trial.