Plication is a surgical term that describes the act of folding. In a medical context, plication surgery involves a surgeon folding or pleating a section of tissue or a whole organ onto itself. This technique is not meant to remove any tissue, but rather to change the structure’s dimensions.
The goal of this procedure is to tighten, shorten, or decrease the size of a targeted anatomical part. By creating these surgical tucks, a surgeon can reinforce a weakened area or reduce the capacity of a hollow organ. The applications of this technique are varied, addressing different needs throughout the body.
The Surgical Technique Explained
The core of any plication procedure is creating a fold or pleat. A surgeon grasps the targeted tissue, which may be the wall of an organ or a layer of muscle, and folds it over onto itself. This action creates a tuck that reduces slack and alters the organ’s size or tension. To make this change permanent, sutures or surgical staples are used to stitch the folded tissue into its new position.
This surgical principle can be applied through two distinct approaches. The traditional method is open surgery, which involves creating a single, larger incision for direct visual and physical access to the organ being treated. This approach allows for direct handling of the tissues and may be necessary for more complex plications.
A more modern alternative is minimally invasive surgery, performed either laparoscopically or with robotic assistance. In these procedures, a surgeon makes several small incisions and inserts a tiny camera, called a laparoscope, to view the surgical site on a monitor. The surgeon then uses specialized instruments through the other incisions to perform the folding and suturing.
Common Medical Applications
- Gastric Plication: A well-known use in bariatric medicine, a surgeon folds the large, curved part of the stomach inward and places sutures to secure the folds. This reduces the stomach’s functional volume, meaning the patient feels full after eating less food and supporting weight loss without removing any portion of the stomach.
- Nissen Fundoplication: This procedure is designed to treat gastroesophageal reflux disease (GERD), which occurs when stomach acid flows upward into the esophagus. A surgeon wraps the upper part of the stomach around the lower esophagus and sutures it in place, tightening the junction and reinforcing the natural barrier to prevent acid reflux.
- Diaphragmatic Plication: Used for respiratory problems, this surgery treats a paralyzed or weakened diaphragm. An elevated diaphragm can compress the lung and cause shortness of breath, so the surgery pulls the lax muscle down and secures it in a flatter position, allowing the lung to expand more fully.
- Penile Plication: A standard procedure for correcting the abnormal curvature of Peyronie’s disease, caused by inelastic scar tissue (plaque). To straighten the penis, the surgeon places sutures on the side opposite the curvature, creating tucks that counteract the bend. This procedure shortens the longer side to match the length of the scarred side, resulting in a straighter erection.
The Recovery Process
Following a plication procedure, the recovery experience is highly dependent on the specific organ involved and the surgical method used. A patient’s hospital stay can range from a single day for less invasive procedures to several days for more complex open surgeries. Pain management is a primary focus after the operation, with medication administered to ensure the patient is comfortable.
Activity restrictions are standard, with patients advised to avoid strenuous exercise and heavy lifting for several weeks to allow the internal sutures to heal without strain. The timeline for returning to work and other normal daily activities varies; it might be one to two weeks for a laparoscopic procedure or up to six weeks for a major open surgery.
Dietary changes are a specific part of recovery for certain plications. After a gastric plication or Nissen fundoplication, patients must follow a strict dietary progression to allow the stomach to heal. This usually starts with a clear liquid diet, slowly advancing to full liquids, then pureed foods, and finally soft foods over several weeks. Adhering to this diet is necessary to prevent putting pressure on the suture lines.