This is a recently suggested procedure that is gaining a large interest. However we do not have controlled result for the procedure. A few surgeons state that they have good results, while others have abandoned the procedure after the first few cases for complications

They said that unlike sleeve gastrectomy, plication has few complications particularly leak and bleeding. Moreover it is economic

There is no need for staplers and therefore is economic, but that's it! We do non know anything about complications because there are far too few cases done in the world to have even a minimal long term insight into the issue. If you want to know my opinion, but it is only my opinion, we will see that there are going to be plenty of medium/long term complications due to the bulk of the stomach left there and sutured, when we will have to intervene on those situations it will be a nightmare because of adhesions among the layers of the stomach wall. Moreover several surgeons have abandoned the techique right after having started it for intense vomit (while other do not refer the same finding). On long term weight loss we will have to see: the ghrelin producing cells are left behind and this will probably have a meaning on weight loss in the future.

Your opinion about plication seems very logic... But let us wait for the long term results...

i read with interest a recent article in obesity surgery journal. Laparoscopic Gastric Greater Curvature Plication: Results

and Complications in a Series of 135 Patients by Georgios Skrekas & Konstantinos Antiochos & Vaia K. Stafyla

i think this answers some questions regarding plication

I've performed 24 laparoscopic gastric plications. I've started August 2010. Only 2 cases needed reoperation. One of them, had lost 70 % of his excess body weight. But at the 6th month, he had a food intoxication, and after vigorous vomiting, proximal sutures ruptured and liguid intolerance started. We've deplicated. The other case is deplicated at early postoperative period, because of the continious vomiting. The other cases are OK, and EWL is succesful as LSG.

My patient count reached to 29 patients. But, unfortunately I converted one patient to sleeve gastrectomy from plication 6 days ago. I will publish operation video at the International Bariatric Club on Facebook, as soon as I finished to edit.

I think plication has two main disadvantages. 1. Unlike sleeve gastrectomy, it is difficult to calibrate the tube. The calibration differs from surgeon to anther. 2. It is a temporary procedure. Weight regain will occur in almost all cases within few years.

But i saw two videos discribing revision of plication. One of them 9 months after plication and the dissection of adhesions seamed very easy as stated by the surgeon. The other one 8 months after plication and the surgeon was not forced to divide adhesions as the gastric tube was large.

Murat, can you tell us anything about adhesions you had to face to de-plicate your patients?

I've deplicated 3 patients bynow.. First of them, at the 6. th month of operation. The other one at 2.nd month, and the third one at 15th day. All of the procedures are quite difficult but all operations was uneventful, and any serozal damage or perforation occured. One of the patients converted to sleeve gastrectomy easily, the others left deplicated. All of this decisions made by agreement with patients preoperatively.

Ok, that is 10% deplication, when did you perform your first plication? In other words: how long id the follow up of those cases?

I am sorry, I did not realize that you already said to have started in august 2010, it is about 10 % deplication at 1 year. Of course we have to consider the learning curve that everybody of us would have to face, but I am not sure I would start on an operation with 10% need of reversal in the first year. I am looking forward to see the long term results, but, of course, it will take time

You're right, reversal rates seems so high. But two patients have too special conditions. On of them (6.th month reversal) have a food intoxication. Due to vigorous vomiting, fundal wrap herniated. Second case drunk 5 liters of fruit juice at the 3.rd day of operation. We saw partial sutur line rupture in both cases. So, real reversal rate is 1/29.

it is a new procedure, we have to wait for the long term results, though , Dr. Talebpore the founder of the plication, had shown reasnable results at 5 years F/U, I think the main advantage of the this operation, is the preservation of the gastric cell mass, so the micro defecencies which we do see it in other procedure would be much less, other than avoiding the staplers and its complications.

there are too many centers started the plicationa world wide,and it is early to get to final conclusion.

Personally, I started gastric plication on December 2010, so far, i have done around 35 cases, 9 of them , I combined gastric plication with fundoplication, to treat GERD with obesity.

Results are encouraging, with very good weight loss in most of the patients.

the patients where , I combined fundo and gastric plications, their reflux symptoms are cured or improved.

I think we have to pay attension to plicate the fundus and not to invert it inward to avoid herniation of the inverted fundus into the GEjunction which can cause persistant vomiting for long time,I already had one of those cases, likely enough it relived byitself with very good weight loss.

I had one case of perforation of the stomach at the suture line, ischemic necrosis , most likely from tight plication, had to take patient back to operating room and to close the perforation, it was two holes,and release the plication a bit.

as mentioned earlier

the technique has to be standarized, size of the tube, how tight, how to ensure it is not so tight, to plicate the pylours or not, one layer or more than one layer plication, suture type, postop. care and much more.

The issue of going back for deplication or redo, i think it should not be a big problem, i have gone back to remove the gall bladder and there is a space for doing either sleeve or ?? bypass.

I think,it will have a role, specially , if patients are selected properly.

If somebody drinks 5 liter of juice on POD 3 he certainly has got a problem!! Do you operate without a previous psychological clearance? Of course that patient is a big time sweet eater (in the best case scenario!) and probably he should not receive that operation in the first place. The real reversal is still 3/29, however. Real life situations have to be included in the count, otherwise we should say that gastric pouch dilatation in gastric banding it is not a complication of the band because is often due to alimentary excess of the patient, don't you think?