Many bariatric surgeons are excited about the procedure Gastric Plication (LGP) as a bariatric procedure. It promises to be a simple method (remember, “Less Is More!”) that gives weight loss results as good as sleeve gastrectomy without even the risks of that procedure (staple line leaks (read part one and part two here) or bleeding).
What is done is that the greater curvature of the stomach is freed from the tissues attached to it (known as the gastrocolic omentum) using a vessel sealing device like the Harmonic Scalpel or the Ligasure. This is the first step of the sleeve gastrectomy procedure, as well.
However, unlike the sleeve, here we do not use the stapler to remove 80% of the stomach. We merely imbricate/plicate the stomach using running stitches from above downwards, layer by layer, till most of the stomach is pushed inwards, creating a narrowing of the passage, and a tunnel along the lesser curvature, just like the sleeve.
Lap Gastric Plication
In the same vein, if someone wants to reverse the procedure, the stitches may be removed by laparoscopy (making this a potentially reversible procedure like the Lap Band), though this would neither be a good thing nor a great experience!
Some patients have significant reflux symptoms after LGP, as after the sleeve, as we have discussed before.
It is possible that the stitches may give way later and hamper the weight loss, but preliminary results, as presented in the recent International Conference of Obesity in Stockholm, show good results akin to the sleeve.
More info later!
August 10, 2010 at 7:12 AM
hello thank u for presenting this idea i foune it easy economic and reasonable but if there any data available bout the result till now please
thank u
Dr. Mohammed Al Taie
general and lap.surgeon
Hilla general teaching hospital
babylon, Iraq
August 19, 2010 at 8:26 PM
Dr. al Taie:
Thanks for your comment. We will pile on more evidence as times goes.
September 16, 2010 at 8:57 PM
I am shekhar kumar Mondal from barasat (N)24 PGNS. My weight is around 111 kg,age 27+.Actually we had already a conversation at BELLEVUECLINIC & u’hav told me to go for gastric plication (LGP) but some doubt need to be clear for my good.I need to know the longibility of stitches. How long it can hold though m not willing to cut it in future.Can i live with it for whole life because i dont want to hamper the weight loss. Please detail me about this.Waiting for your reply.
September 21, 2010 at 7:22 PM
Shekhar: I have already replied to you. Hope you got my email.
January 13, 2011 at 2:19 AM
What is the price of the surgery. Are their currently any clinical trails for this procedures.
January 13, 2011 at 7:27 PM
Ponce has started a trial in the US (ClinicalTrials.gov identifier: NCT01207609). Thanks for your interest.
R
January 16, 2011 at 2:12 AM
hello, but what about the hormonal aspect (grhelin) and its alleged role.
January 16, 2011 at 2:58 AM
i assume that you used an absorbable stitch in the first run and non-absorbable for the second so why you did not unify the stitch?
and in your experience may it take more than two invaginations of the greater curvature to fit it around 36F tube?
finally, why 36 not larger or smaller tube?
i appreciate your time and thanks for the excellent video presented here
January 23, 2011 at 7:34 PM
Thanks for your comment. Inner absorbable suture prevents problems with the permanent ones: you don’t want the prolene eroding into the gastric lumen and cause symptoms. Uniting the two suture lines is not going to help in anything, is it? We use three layers of stitches, the minimum needed for a snug tube.
The 36 Fr is a good size that works well. It gives good restriction, prevents stricture formation and allows the patient to eat. You could use a bigger or slightly narrower one if you wish. These are not writ in stone.
January 23, 2011 at 7:35 PM
Ghrelin is now known to be a factor in the entire story of weight loss and gain. There is enough evidence to support this.
February 3, 2011 at 12:54 AM
thanx a lot. i am from Egypt and the net was suspended from 25th Jan.i am attempting to do this procedure in a young patient BMI 44 who could not afford price of sleeve.would you advise me about the preferable size of the needle and stitches. when i asked about the ghrelin i meant in this very procedure not in general.i am very glad to keep in touch with you praying that the net will not cut again. by the way from which country are you?
February 6, 2011 at 3:08 PM
Dr. Ahmed,
We are based out of Kolkata, Eastern India. We use 2-0 Vicryl in the first layer, and 2-0 prolene subsequently.
February 9, 2011 at 1:26 AM
thankx
February 27, 2011 at 10:38 AM
nice video & nice procedure . some querry, first what is short &long term result . second for ghrelin fundus is still inside . third what are the complications
March 1, 2011 at 3:15 PM
hi, my wight is 262 & hight 5’1 .i would like to know is the gastricplication wright for me and how long does the stichies last ? thank u alot for your information it helps alot thank u!!!
March 1, 2011 at 8:51 PM
Angie:
We could consider it, but there are established procedures you might want to consider. If you are serious in taking this forward, please click on the ‘Contact Us’ page and email or call.
March 1, 2011 at 8:54 PM
Short term results are good. Weight loss is the same as other procedures. Long term–we don’t know.
We can’t comment on other areas not yet established by studies.
April 1, 2011 at 11:55 PM
i want to know two things:
1. is this procedure reversible or not?
2. is it suitable for sweet eaters?
April 3, 2011 at 9:15 PM
thx for ur very nice video
I would like to have a comment about :
1–the use of continous suture in first plan
2–starting 2cm from GE junction to minimise GE. REFLUX
3–average time of the procedure?
4–is there a high incidence of post-op nausea?
many thx again and hope to meet someday in lebanon
Elie
April 3, 2011 at 9:55 PM
Ahmed: It is potentially reversible, but how does that matter? We would want a permanent solution ether than a reversible one. I believe sweet eaters will manage to sabotage the results and, as such, this should be a focus for the assessment before even considering bariatric surgery.
Elie: If you want a continuous suture line at first, you could, I suppose. We find the interrupted first layer easier. Starting below the GE junction may lead to slippage of the fundus and poor results. Reflux is a given with this procedure, but one important complication is prolapsed gastric mucosa. Average OR time is around 80 minutes. No, there is no major nausea problem. Thanks.
April 29, 2011 at 7:29 PM
Im from south africa .. 53 BMI 39…. i had a JIB bypass in jan 2006 by a doctor in south africa and lost a lot of weight but after 18 months i was so ill . I was anemic and my iron level was just so low…My only surviual was to have it reversed in Nov 2008. I have put on most of my weight back but at least my health is back …. I want to know if u think that the gastric plication would be ok for me since i have had surgery.. And for me knowing its reversable makes me comfortable…. What does it cost .. This south african doctor has be banded from doing this produce . Thanking u inadvance….
April 30, 2011 at 11:47 PM
Virginia: I am surprised you got a JIB in 2006: this surgery is historic! I am sorry to hear of your travails. You should go for a sleeve gastrectomy now, I think. However, I haven’t seen you, and can only say that this could be considered, as could the plication. Please read more about these in the site and get back with more questions if you want help.
May 2, 2011 at 6:36 PM
dear sir , i am a general surgeon and i am doing a research on the gastric sleeve plication ,so would u please help me in this subject by sending to me any researches or websites that would include any scientific full data in it ,thanks a lot
May 2, 2011 at 7:26 PM
@ahmed: Where are you based? Please email me.
May 9, 2011 at 11:47 PM
dear sir , i am an egyptian surgeon working as an assistant lecturer in MUST university in egypt , cairo ….. waiting for ur reply soon about the researches ,thanx
May 10, 2011 at 7:39 PM
I think it is a good procedure where cost is the deciding factor. Long term results will have to be seen. Regarding the reversibility who would like to grow big again.
Will need more and more data to reach to the conclusion. Should be a promising thing.
May 12, 2011 at 4:15 AM
Thanks for your comment and for visiting!
May 23, 2011 at 9:21 AM
I am planning on having the Gastric imbrication with the aid of EndoFLIP® here in Utah and I am still trying to get a good answer to can it be reversed. My Dr said after 3 weeks it could not be reversed but I see other posts saying it can be. God there is so much crap on the internet that I am getting confused. What is your opinion on it being reversed? I am 57 with a BMI of 43 and have to choose the band, bypass or imbrication. You can reply back to my e mail. Thanks
May 26, 2011 at 1:22 PM
Hello, I am 28 years old, married with 1 kid, about 120 Kg. I’m plannig to do the gastric plication technique but I have 1 concern: for how long should I wait be4 getting pregnant again & if I gain a little bit of weight during pregnancy will the surgery remain efficient for weight loss after pregnancy? I know that I have to change my lifestyle after surgery but I still have that question mark in my mind. thank you
May 27, 2011 at 8:01 AM
Caroline: Please read this article I had written: http://www.bmi-india.com/bariatric-surgery-patients-and-pregnancy-acog-recommendations/. Enjoy.
May 27, 2011 at 8:03 AM
Steve:
Reversibility should be the LAST criterion to choose a bariatric operation, IMO. The plication CAN be reversed, as can the gastric bypass and band, but it is a hell of a job to do that. All in all, if the mentality of the patient is not focused on getting better all the time, and rather on being able to eat more later on, the surgery is not for him/her.
June 27, 2011 at 2:35 PM
Hello there, I’m 34 years old woman with a BMI 32.3
My question is about hunger hermone reduction in gastric plication and for long term result and Is it possible to regain weight or stomach size in the future? Is it possible to lose too much weight (more than desirable?
are there different measurement for stomach size reduction depending on the amount of weight needed to be lost?
and finally how can i choose the right doctor in Syria Damascus?
Thanks
July 9, 2011 at 8:41 AM
Hala: the simplest answer to your questions is “I don’t know”.
But I wouldn’t worry about ghrelin, as there is not enough info yet. You would typically lose around 65% EBW after the plication, so excess wt loss is not an issue.
July 16, 2011 at 4:26 AM
Hala
Greeting
It is my pleasure to be at your help to get over your problems with your mild degree of obesity .
You just have a look at my website http://www.surgi-guide.com ( now under maintenance ) and you will find the proper answer to your queries .
I am performing Laparoscopic Gastric placation in and all other types of Bariatric Surgeries in Damascus .
If you wish you can contact me at my private mobile phone 0944 27 12 15 at your convenience .
Dr M A Kubtan
August 8, 2011 at 3:07 AM
Post wasn’t complete. I will try again.
I had the Nissen fundoplication about 8 years ago to strengthen my spincter muscle for reflux. Procedure has been very successful. I now am considering my options for WLS. Has anyone performed the Gastric Plication leaving the Nissen in place?
Do I have any other options considering my previous procedure.
Thanks
August 14, 2011 at 4:58 AM
Dear Dr
I do gastric plication since last year in Augost when i have organized the first gastric plication workshop in Lebanon with Dr Talebpour the father of this procedure who is from Tehran. this was in Augost 2010 . Also We have organized the first world meeting and census in Barcelona in 3rd of May 2011 with a group of expert international surgeons ( http://www.lgcpsummit.org) . visit also http://www.gastricplication.org . I have done last month another workshop in lebanon , tyre , 23 july 2011 with live transmission of one case with the presence of many international surgeons as well from the Arabic area and Europe. I am directing also a Workshop in MMESA annual meeting in Catania, Sicily in the 16 of November and we will speak a lot about our experience in gastric plication.
Dr Ali Fardoun Consultant Bariatric Surgeon , Emirates International Hospital, Al-Ain. My E mial tyre_lap@hotmail.com
September 6, 2011 at 5:30 AM
Hi I am 53 with a BMI of 36. and approximately 50 lbs overweight. I am considering gartric plication. What is the cost of the surgery and how can I find a reliable MD to do it in Utah?
September 27, 2011 at 2:53 AM
Are there ANY surgeons in the USA performing this procedure?
October 2, 2011 at 9:27 AM
Noelle: I think you could try Cleveland Clinic. Dr. Tomasz Rogula is the man who may be able to help you.
October 25, 2011 at 4:49 PM
i m 47 year old my bm is 35 i want to know about lgp and pl.suggest me name of doctor in kolkatta india
November 7, 2011 at 6:28 PM
Mr Ratan Goel
Since your BMI is 35 you should try diet and exercise in a supervised program. However if it doe not help you could get in touch with us to understand about bariatric surgery. LGP is an option for you. To understand more please call at 98300 08668 begin_of_the_skype_highlighting 98300 08668 end_of_the_skype_highlighting or 98300 31663 begin_of_the_skype_highlighting 98300 31663 end_of_the_skype_highlighting for appointment.
Dr Sarfaraz Baig
BMI