I do gastric plication for morbidly obese patients. I had excellent results. But I do not know why this operation is not gaining widespread acceptance. Is it may be due to the huge industrial companies that market for staplers?
Dear Ahmed,
Gastric plication is not widely accepted due to two important factors. First it is not being done routinely in most of the surgical centres and second lack of fully dedicated centres of mimimally invasive surgery for morbid obesity.
Laparoscopic gastric plication (LGP) was conceived as a more tissue-sparing alternative to sleeve gastrectomy (LSG). However, there are some theoretical drawbacks, which has now also been seen in clinical reports: LGP is less effective than a modern LSG regarding bariatric and metabolic outcomes, without being safer.
Dr. Ahmed, Laparoscopic gastric plication is surely cheaper than sleeve gastrectomy, so it is useful in developing countries. The main drawback of gastric plication, according to literature, is gastric congestion, edema, postoperative vomiting. However, new studies (Fried M, Dolezalova K, Buchwald JN, McGlennon, et al. Laparoscopic greater curvature plication for treatment of morbid obesity in a series of 244 patients. Obes Surg 2012;22:1298-307) are encouraging.
LGP is an interesting operation,surely it is cheaper than LSG but not suited for a developing country.It does produce severe vomiting,Ghrelin producing area is intact,revision after LGP is very difficult and Leaks have occurred from the sutured area. It is a good operation in the hands of Dr Martin Fried.
Instead of gastric plication, I am now thinking if we can resect the stomach without staplers and hand suture to form the 'sleeve'....................
Dear Dr Muthukumar,It is a good alternative particularly for you as you are good in Lap suturing and knotting.3 0 V lock suture is very helpful,but you need to leave at least 1 to 2 cms of fundus to prevent leaks from the suture bite.
Dear Sir, thanks for your input. Maybe closure in 2 layers can minimize leak ?
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