Gastric plication is a type of bariatric surgery designed to help individuals with obesity achieve significant weight loss. The procedure is considered minimally invasive because it is performed laparoscopically, using several small incisions. It functions by mechanically reducing the stomach’s capacity, which restricts the amount of food a person can consume. This technique is distinct from other common weight loss operations because it does not involve the removal of any stomach tissue or the rerouting of the digestive tract.
Surgical Mechanism: How Gastric Plication Reduces Stomach Volume
The core of the gastric plication procedure involves folding the stomach inward and securing the folds with sutures to create a much smaller gastric cavity. Surgeons use a series of non-absorbable stitches to invaginate the greater curvature of the stomach, effectively creating a restrictive channel. This folding technique reduces the stomach’s functional volume by an estimated 70 to 75 percent, which limits food intake and promotes earlier satiety. Because the stomach is folded and not cut, the natural digestive process remains entirely intact.
The procedure is commonly referred to as Laparoscopic Greater Curvature Plication (LGCP) because it focuses on the stomach’s outer curve. The surgeon creates two or three layers of sutures to ensure the fold is secure and durable. This technique is potentially reversible, as the sutures could theoretically be removed to restore the stomach to its original size. The absence of stapling or cutting also contributes to a lower risk of complications like leaks along a staple line, which is a concern in other bariatric surgeries.
Patient Eligibility and Selection Criteria
Candidates for gastric plication must meet specific medical and behavioral requirements typical of bariatric surgery. Generally, a patient is considered eligible if they have a Body Mass Index (BMI) of 40 or greater. Individuals with a BMI between 35 and 39.9 may also qualify if they have at least one serious obesity-related health condition, such as type 2 diabetes, high blood pressure, or severe sleep apnea. Some practitioners may also consider patients with a lower BMI, specifically in the 30–40 range, especially if they are seeking a less aggressive, reversible procedure.
Before surgery, candidates must demonstrate a history of failed attempts at supervised weight loss through diet and exercise. A comprehensive psychological evaluation is necessary to ensure the patient understands the commitment required for long-term lifestyle changes. The medical team also assesses the patient’s overall health to confirm they are fit enough to undergo the operation and subsequent recovery. Patients must be fully committed to the dietary and follow-up regimen.
Post-Operative Care and Expected Weight Loss
The recovery period following gastric plication is generally short, with most patients requiring a hospital stay of only one to two days. Immediately following the operation, patients begin a carefully structured dietary progression to allow the stomach folds to heal and adjust to the new, smaller capacity. This process starts with a liquid-only diet for the first few weeks, transitioning through stages before the eventual introduction of solid foods.
The dietary progression includes:
- A liquid-only diet for the first few weeks.
- Transition to pureed foods.
- Followed by soft foods.
- The eventual introduction of solid foods.
Patients must adhere to a long-term nutritional plan that emphasizes small, frequent meals and requires lifelong vitamin and mineral supplementation, though the risk of malabsorption is low. Successful weight loss depends heavily on following these dietary guidelines and incorporating regular physical activity. Expected weight loss is substantial, with studies indicating an Excess Weight Loss (%EWL) that can range from 45 to over 55 percent within the first year. Long-term success necessitates ongoing follow-up with the bariatric team to monitor weight loss and manage nutritional status.
Key Differences from Gastric Sleeve Surgery
Gastric plication and Gastric Sleeve Surgery (Sleeve Gastrectomy) both function as restrictive procedures, but they differ fundamentally in their surgical approach and long-term effects. The sleeve gastrectomy involves the permanent removal of approximately 70 to 85 percent of the stomach, using staples to create a narrow, tube-like pouch. In contrast, gastric plication is non-resectional, as the stomach is merely folded and sutured, leaving all tissue intact. This folding means that the plication procedure is potentially reversible, unlike the permanent alteration made by the sleeve gastrectomy.
The removal of the large outer portion of the stomach during a sleeve gastrectomy significantly reduces the production of the hunger hormone Ghrelin. This hormonal effect leads to a substantial decrease in appetite, which is not seen to the same extent with gastric plication, as no hormone-producing tissue is excised.
While the gastric sleeve generally results in higher and more durable long-term weight loss, plication carries a risk of the sutures loosening or the folds stretching over time. This stretching may lead to weight regain. Therefore, plication is often viewed as a less metabolically active and less structurally permanent option compared to the sleeve gastrectomy.