Gastric Plication: A Comprehensive Patient Guide

Introduction and Terminology of the Procedure

Gastric Plication, often referred to as Laparoscopic Gastric Plication (LGP), is a minimally invasive bariatric surgery performed to treat morbid obesity. It’s an effective option designed to help patients lose substantial weight by reducing the size of the stomach, limiting food intake without altering the digestive process.

The term ‘Morbid Obesity’ refers to a Body Mass Index (BMI) of 40 or above, or 35 or above with obesity-related health complications. Gastric Plication is typically reserved for patients who have been unsuccessful with traditional weight loss strategies such as diet and exercise.

As per recent data, the utilization of Gastric Plication is steadily increasing in the USA, although it is less common than other bariatric procedures like Gastric Bypass or Sleeve Gastrectomy. It is considered a safer, reversible option with fewer complications.

Indications for Gastric Plication

Gastric Plication might be the right choice if you’re dealing with morbid obesity and have struggled to lose weight with conventional methods. Specific indications for this procedure include:

• A BMI of 40 or higher, or a BMI of 35 or higher with one or more obesity-related comorbidities such as type 2 diabetes, hypertension, sleep apnea, or heart disease.
• Aged between 18 and 65 years old, though exceptions may apply depending on overall health and doctor’s assessment.
• Previous unsuccessful attempts at weight loss through diet and exercise.
• No history of alcohol or drug misuse.
• Understanding the surgical risks and long-term lifestyle commitment required post-surgery.
• Absence of certain medical conditions that may increase surgical risk or affect postoperative weight loss, as assessed by your healthcare provider.

Pre-Op Preparation

Proper preparation before Gastric Plication is crucial for a successful surgery and recovery. While your specific instructions may vary, the following steps are commonly recommended:

• Begin fasting as instructed by your doctor—usually the night before the procedure.
• Discuss any medications you are currently taking with your healthcare provider. You may need to adjust dosages or cease certain medications prior to surgery.
• Undergo any pre-operative labs or imaging as ordered by your healthcare provider.
• Secure pre-clearance authorization for your procedure.
• Arrange for transportation post-surgery, as you will not be able to drive yourself home.
• Obtain necessary work or school notes for your recovery period.

Please consult your doctor for personalized instructions, as certain circumstances might warrant different approaches. Our telemedicine primary care practice is here to assist you with pre-operative clearances and ordering of pre-op labs and imaging, ensuring a smooth and worry-free preparation for your Gastric Plication procedure.

Procedure Technique for Gastric Plication

The Gastric Plication procedure, while complex in its medical terminology, can be understood as a series of steps aimed at reducing the size of your stomach. Below, we’ve broken down the steps in a way that makes them easier to understand:

Step 1: Anesthesia and Preparation

First, you’ll be administered general anesthesia, which means you’ll be asleep and won’t feel any pain during the procedure. Once you are asleep, the surgical area will be cleaned and prepared for surgery.

Step 2: Making the Incisions

Gastric Plication is a laparoscopic procedure, which means it is minimally invasive. The surgeon makes several small incisions, usually five to six, in the abdomen. These tiny incisions are for the insertion of laparoscopic instruments, including a camera that allows the surgeon to view the internal organs on a screen.

Step 3: Inspecting the Abdomen

The surgeon will first inspect the abdomen to ensure that there are no factors that may complicate the surgery. This is done by inflating the abdomen with a harmless gas to create more space and visibility.

Step 4: Stomach Folding (Plication)

The main part of the procedure now begins. The surgeon starts by folding the larger, outer curve of your stomach in upon itself. Think of it like folding a large, flat sheet of paper into a narrower shape. This is done using surgical sutures, which are like very strong thread.

Step 5: Securing the Fold

Once the stomach is folded into a smaller size, the surgeon secures the fold with additional sutures to ensure it stays in place. This results in a significantly smaller stomach, which means you’ll feel full after eating much less food than before.

Step 6: Checking the Stomach

After the stomach is reduced in size, the surgeon will check it to ensure that everything looks as it should. They’ll check that the sutures are secure and that there are no leaks from the stomach. They may also take a sample of your stomach tissue for biopsy, which is a routine procedure to check for any unknown problems.

Step 7: Closing the Incisions

Once the surgeon is satisfied with the plication, they will remove the laparoscopic instruments and close the small incisions in your abdomen. Each incision is typically closed with sutures or staples and then covered with dressings.

Step 8: Recovery Room

After the surgery is complete, you’ll be taken to a recovery room where you’ll gradually wake up from the anesthesia. The medical team will monitor your vital signs to ensure everything is normal following the surgery.

It’s important to remember that while this procedure can be very effective for weight loss, it is not a cure for obesity. It’s a tool to assist with weight loss and will require you to commit to lifestyle changes, including a healthy diet and regular exercise, for long-term success. Your healthcare provider will discuss these aspects with you in detail.

This step-by-step overview provides a simplified understanding of what your surgeon will be doing during your Gastric Plication procedure. Remember, each person is unique and your surgeon might slightly adjust these steps based on your specific needs. Feel free to discuss any questions or concerns you may have with your healthcare provider.Duration of Gastric Plication

Gastric Plication typically takes between 1 to 2 hours to complete. However, the total duration may vary depending on individual factors and the specifics of the procedure.

Post-Op Recovery from Gastric Plication

Recovery from Gastric Plication is an important phase of your weight loss journey. Following the procedure, you will likely stay in the hospital for 1 to 2 days for observation and care. Initial recovery, when you can return to non-strenuous work, typically takes about 1 to 2 weeks.

Follow-up visits with your surgeon will be scheduled post-operatively, usually after 1 week, then after 1 month, and thereafter every 3 months for the first year. These visits allow your doctor to monitor your progress, address any concerns, and adjust your diet and exercise plan as necessary.

While specific rehab or physical therapy is typically not required, lifestyle modifications are crucial. These include adopting a healthy, portion-controlled diet and regular exercise. Significant lifestyle changes can be challenging, but they are necessary for a successful long-term outcome.

Complete recovery and adjustment to your new diet and lifestyle can take several months. Our telemedicine primary care practice is here to assist you throughout this process, offering convenient, same-day appointments until 9pm on weekdays and 5pm on weekends for your needs, including work or school notes.

Effectiveness of Gastric Plication

Gastric Plication has been shown to be effective in managing morbid obesity, with studies indicating that patients typically lose about 40-70% of their excess body weight within the first year. Additionally, many patients see improvements in obesity-related health conditions such as diabetes, hypertension, and sleep apnea.

The effectiveness of Gastric Plication is heavily dependent on adherence to lifestyle changes post-surgery. Regular physical activity, a balanced diet, and follow-up care are all critical for maintaining weight loss and overall health.

Certain circumstances can potentially lower the effectiveness of Gastric Plication. For example, not adhering to the prescribed diet and physical activity plan can result in inadequate weight loss or weight regain. Similarly, certain medical conditions or medications may impact weight loss.

It’s important to remember that Gastric Plication is not a ‘quick fix’ for obesity. Rather, it’s a tool that, along with lifestyle modifications, can greatly aid in weight management. A committed and proactive approach to your health will maximize the effectiveness of the procedure.

Our primary care practice is here to support your journey, providing expert guidance and care. Remember, every patient’s experience with Gastric Plication is unique, and results will vary based on a multitude of factors. Discuss any questions or concerns you may have with your healthcare provider.

Adverse Events with Gastric Plication

Like all surgical procedures, Gastric Plication is associated with potential risks and complications. While rare, it’s essential to understand these possibilities:

• Bleeding (1-2%): Bleeding can occur during or after surgery. It’s usually minor and can often be controlled without additional surgery.
• Leakage (1-2%): This involves the leaking of digestive juices and partially digested food through the sutures in the stomach. It is a serious condition that may require additional surgery.
• Stomach obstruction (<1%): This is a rare complication where the stomach outlet becomes blocked, preventing food from passing into the small intestine.
• Nausea and vomiting (10-15%): Post-operative nausea and vomiting are common but usually temporary and managed with medications.
• Deep vein thrombosis (DVT) and pulmonary embolism (PE) (<1%): DVT involves the formation of a blood clot in a deep vein, usually in the legs. If the clot travels to the lungs, it can cause a PE, a serious and potentially fatal condition.

The overall mortality rate from Gastric Plication is exceedingly low, less than 0.1%.

Alternatives to Gastric Plication

While Gastric Plication is a promising solution for many, alternative treatments are available for managing morbid obesity. Other surgical options include Gastric Bypass and Sleeve Gastrectomy, both of which have demonstrated significant weight loss results. Each procedure has its own set of risks and benefits and should be considered in consultation with your healthcare provider.

In addition to surgery, non-surgical options like diet and exercise, behavior modifications, and weight loss medications are available. Medical devices for weight loss, such as gastric balloons, can also be an option. These treatments can be beneficial but generally yield less significant weight loss compared to surgical methods.

Experimental or Emerging Technologies

Researchers are continually exploring new treatments for morbid obesity. Aspiration Therapy is one such emerging technology. This outpatient procedure involves placing a thin tube in the stomach that allows patients to remove a portion of their stomach contents after eating, reducing calorie absorption.

While still experimental, preliminary studies suggest potential for significant weight loss with this method. As with all emerging technologies, more research is needed to assess long-term effectiveness and safety.

Conclusion

Gastric Plication is a promising surgical intervention for treating morbid obesity, resulting in significant weight loss and improvements in obesity-related health conditions. As with any procedure, potential risks and complications should be considered. There are alternative treatments available, and emerging technologies are being studied. It’s crucial to discuss these options with your healthcare provider to determine the best treatment plan for your unique situation.

Brief Legal Disclaimer: This article is for informational purposes only and not intended as medical advice. Always consult a healthcare professional for diagnosis and treatment. Reliance on the information provided here is at your own risk.