Gastric plication: all you need to know

Laparoscopic gastric plication or laparoscopic greater curvature plication or gastric imbrication is a relatively new minimally invasive weight loss surgery first introduced by an Iranian bariatric surgeon, Dr. Mohammad Talebpour. He devised this bariatric surgery technique as a safer and less expensive alternative to other methods.

Gastric plication surgery is a restrictive weight loss surgery, meaning the amount of food the patient can take after surgery will be reduced, leading to decreased calorie intake. It works just like the gastric sleeve but doesn’t require removal of a portion of the stomach.

How is gastric plication performed?

Gastric imbrication is done laparoscopically. The surgeon makes small holes in the abdomen to insert surgical instruments, including a tiny camera to see the inside of the body on a monitor while doing the operation. The procedure takes 1-2 hours under general anesthesia and the patient normally is required to be hospitalized for 1-2 nights.

In a gastric plication procedure, one or two folds are made in the stomach and then they are stitched up. The size of the stomach will reduce by 70%-90%, making it hold much less food.

Who are good candidates for gastric plication?

Gastric plication is a surgical weight loss option for those obese people who have tried to lose weight non-surgically without success. Gastric plication is usually recommended for people with a BMI over 35.

Good candidates for gastric plication are those who are determined to make changes to their lifestyles after surgery. A healthy lifestyle that includes low-calorie diet and regular exercising is crucial in the success of any weight loss surgery, including gastric plication.

Gastric plication is not recommended for women who are planning to be pregnant in the future. Make sure to inform your surgeon about your health status and previous diseases and surgeries. A bariatric surgery specialist is the only person who can determine if you are a good candidate for gastric plication surgery.

What are the results of a gastric plication surgery?

In a paper titled “Twelve year experience of laparoscopic gastric plication in morbid obesity: development of the technique and patient outcomes,” Dr. Talebpour, the inventor of gastric plication, published the results of his study on the outcome of the gastric plication procedures performed by him and his colleagues.

He examined 800 cases who had an average follow-up of five years after surgery, finding that the mean excess weight loss was 70% (40% to 100%) at the peak level (2 years after surgery) and 55% (28% to 100%) 5 years after the procedure.

The following figure shows the average excess weight loss (EWL) in the studied gastric plication patients 1 month to 10 years after surgery. As you can see, the weight loss began right after the surgery and peaks 2 years after the procedure, after which some weight gain began to happen gradually. This degree of weight loss is comparable to the gastric sleeve technique.

The percentage of excess weight loss during a period of 10 years after gastric plication surgery (taken from Dr. Talebpour’s paper).

What are the advantages and of gastric plication over other methods?

Gastric plication has a number of advantages over other gastric sleeve procedures. They are as follows:

• Gastric plication is somehow reversible and the stomach can be reversed to its original shape in case complications occur or you change your mind after surgery. A gastric plication also can be turned into a gastric sleeve or gastric bypass if needed.
• Unlike gastric sleeve, no part of the stomach is removed in gastric plication.
• Unlike gastric bypass and Duodenal switch, the digestive system isn’t rearranged in gastric plication and the absorption process isn’t affected.
• Unlike lap-band and gastric balloon, no foreign object is inserted into the body.
• Gastric plication is cheaper than gastric bypass and sleeve gastrectomy.
• A second surgery can be performed on the stomach in case it stretches and enlarges over time.

What are the common side effects and risks of gastric plication?

Gastric plication was invented to overcome some of the drawbacks of other bariatric surgeries. However, it is still a surgery and carries potential risks and complications. The risks include:

• Slight bleeding
• Injury to other organs
• Infection
• Nausea
• Vomiting
• Complications related to general anesthesia
• In the case of overeating, stomach expansion is possible up to 15%

The rate of the occurrence of complications in gastric plication is very low. According to Dr. Talebpour’s study (mentioned earlier), this rate was 1.6% among his patients, with 1% having to undergo a revision surgery (8 out of 800).

What to do before a gastric plication?

Our consultants at AriaMedTour give you clear instructions before your surgery. Be sure to ask them any question about preparation for your gastric plication. Here are a few pre-op tips you should follow before a gastric plication surgery:

• Do not eat anything 12 hours before surgery
• Do not drink anything 6 hours before surgery
• Consult a nutrition specialist
• Talk to your surgeon before the surgery and make sure you are well-informed about the surgery, including results, potential the complications and recovery
• Discuss your current medications with your doctor
• Make arrangements for your transportation after surgery
• Stop drinking alcohol six weeks before surgery
• Quit smoking at a few weeks before the appointment
• Make sure that you are psychologically and mentally prepared for the surgery.

Gastric plication recovery and post-operative care

In the first month after your gastric plication, you need special aftercare and diet to adhere to. Within the first two weeks, only liquids are permitted, such as water, black tea, milk, fruit juices, sherbets, etc. within the second two weeks after the surgery, you are permitted to take soft foods, like soup, fruits, yogurt, and pureed foods. After one month, you can return to a normal diet. It is important to follow a diet rich in protein, calcium, and vital minerals.

Here are a few post-op tips for gastric plication recovery.

• Eat slowly and chew carefully to have easy digestion
• Use a small spoon
• Take proteins daily. You may use milk, red meat, and/or eggs
• To avoid vomiting, do not drink while eating. There is not enough room for both liquids and solid foods at the same time
• Avoid alcohol, sodas, and confections
• Avoid carbonated drinks and high-calorie snacks

Also, take a look at this guide to a healthy diet for one month after weight loss surgery.

 Gastric plication vs. gastric sleeve

A gastric plication works in the same way as the sleeve gastrectomy does, with the only difference being that it doesn’t involve cutting away a portion of the stomach.

The amount of weight loss in gastric sleeve and plication is similar. Gastric sleeve is not a reversible surgery, but a gastric plication can be reversed if the patient happens to be unsatisfied later on. Some side effects such as nausea and vomiting are more common after gastric plication, while leakage is more common in the gastric sleeve. The length of hospital stay in both procedures is the same.

How much does a laparoscopic gastric plication cost?

Gastric plication surgery prices vary depending on different factors, including the country and city where you undergo the surgery, the hospital, and the experience of the surgeon. The cost of a gastric plication in the United States, for example, range between $10,000 and $20,000.

Gastric plication cost in Iran

On average, a gastric plication surgery costs between $2,500 and $4,000 in Iran. The low price of gastric plication in Iran compared to other countries is due to the low value of Iranian Rial against foreign currencies, as well as the availability of numerous bariatric surgeons in Iran.

AriaMedTour offers gastric plication surgery packages with the best bariatric surgeons in Iran, performed in high-class hospitals. The packages come with all the services you need, such as accommodations, transfer, interpreter, and so on. To get a free quotation for a gastric plication surgery in Iran, feel free to send us a message, give us a call, or fill out the online form on this page. Our support staff will help you with the details.