Laparoscopic Greater Curvature Plication

Laparoscopic Greater Curvature Plication

Gastric Plication is the newest Bariatric procedure done. Dr. Mohammad Talebpour from Iran recently presented his 10 year experience in gastric plication. He founded this procedure to mimic Sleeve gastrectomy but without cutting and removing the stomach. It involves folding the stomach by invaginating the greater curvature by several rows of sutures, to make the new stomach look like the sleeve tube. 

In the bariatric world however, this is a new and promising procedure. Cleveland Clinic experience is entering year four with this procedure. Other surgeons have adopted this procedure, especially in the Middle East. At GBMC we perform this procedure under the Institutional Review Board (IRB) protocol to study this procedure further similar to all prestigious centers. The criteria for patient inclusion is having morbid obesity as in other bariatric procedures. It is a purely restrictive procedure with little metabolic effects as compared to Gastric Bypass and Sleeve Gastrectomy. It does limit the volume of food similar to what Sleeve offers, but has little effect on hunger feeling. It is presumed best done, for patients with lower obesity BMI, without severe heartburn and no Diabetes or sweet eating problem. 

The average weight loss after 1 year is 58% in the first year. Only Dr. Talebpour has the 10 year experience in this field and his experience suggest 55% wt loss at 10 years. The world is still learning its long-term results. Standardization of the technique has evolved almost. Potential complications that can happen and mentioned in different series:
  1. Early nausea and vomiting in almost all patients. 
  2. Leak: although case reports are mentioned, it is still a risk that cannot be excluded completely. 
  3. Inadequate weight loss: it is hard to select patients currently. As we know more about the procedure, patient selection will be easier and weight patterns can be predicted.
  4. Unraveling of the plication: in some series up to 10%, this necessitates re-plication through laparoscopy.
  5. Reflux: comparable to sleeve gastrectomy in some series. Long term issues with reflux have yet to be reported. 
  6. Gastric motility issues: Delayed emptying has been reported in patients who underwent this procedure as early as 2 years after. It is hard to know if such problems was present prior but manifested itself more after the surgery. The need to convert this procedure then to gastric bypass is probably needed. 

The need for additional procedures like Endoscopy to check the plication especially in the first year we think is essential if there are any changes: Reflux, increasing volume of food, or inadequate weight loss are noted. 

It is a new but promising procedure, that may prove to be better than gastric banding long term. However, a lot of questions have to be answered. We know now that we can reverse the procedure, but will the stomach be functional enough if we reverse it? As with other procedures, lifestyle modification is essential for the success of this procedure.