Introduction:
Obesity is a serious chronic disease and a growing epidemic, approximately doubling since 1980 and affecting millions worldwide. The prevalence of obese children and adolescents increased from four percent to 18 percent globally from 1975 to 2016. The increasing widespread presence of obesity and associated medical conditions have raised the demand for weight loss surgery. There are multiple types of weight loss surgery, such as Roux-en-Y gastric bypass, laparoscopic sleeve gastrectomy, and gastric banding. Laparoscopic gastric plication is a recently introduced surgery for dealing with the problem of obesity and related comorbidities.
What Is Laparoscopic Gastric Plication?
Laparoscopic gastric plication is a surgical procedure performed to decrease the stomach size that controls the food intake among people suffering from extreme obesity. This procedure reduces the stomach volume without resecting or implanting a foreign object like staples. This procedure is reversible as there is no cutting and stapling of the stomach and can be converted to another procedure in the future. Gastric plication was first described by Tretbar et al. in 1976. It was later reintroduced in 2006 and performed laparoscopically by Talebpour and Amoli. This procedure is still in the experimental stage as it is a recent medical breakthrough.
Why Is Laparoscopic Gastric Plication Performed?
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It is performed to reduce weight in obese people. A person with a body mass index (BMI) of 30 or more is considered overweight.
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It is done if other less invasive strategies, such as exercise, diet, and behavioral therapy, have failed to achieve desired weight loss.
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If a person has obesity-associated medical conditions and is dedicated to losing weight to improve health and make lifelong changes in lifestyle habits can go for this surgery.
What Are the Preoperative Assessments Done for the Surgery?
A team of bariatric surgeons, internists, psychiatrists, and nutritionists decides whether the patient meets the criteria and is eligible for the surgery. After that, routine evaluations are done, which involve upper gastrointestinal endoscopy (a procedure used to visualize the upper digestive system using a thin, flexible instrument with an attached camera and light), barium swallow (an imaging test that uses special), and an ultrasound scan (an imaging test that uses sound waves to create images of the structures inside the body) of the liver. The patient is asked to sign the consent form before the surgery.
How Is Laparoscopic Gastric Plication Performed?
Before the surgery, the patient is asked not to eat or drink anything. Eating or drinking before surgery can choke the patient on stomach contents during anesthesia. The patient is also directed to stop any medications that the doctor may feel interfere with the procedure.
Laparoscopic gastric plication surgery is performed under general anesthesia to make the procedure painless. The procedure is guided by a camera attached to a laparoscope (a thin, flexible tube with an attached camera and light). It involves five to six cuts or incisions through which small surgical instruments and the laparoscope are inserted into the abdomen to perform the procedure. Then the outer curvature of the stomach is folded through sutures using these instruments. The stomach folds reduce the stomach size by approximately 70 percent. This procedure does not affect the stomach's anatomy and does not lead to malabsorption, as no intestinal bypass is done, and a part of the stomach remains intact. The entire procedure is completed in one to two hours.
What Are the Advantages of Laparoscopic Gastric Plication?
Since laparoscopic gastric plication is a recent procedure, its long-term benefits can be mentioned now. However, the patients who have undergone this surgery have shown significant weight loss of up to 50 to 65 percent in about 12 to 18 months. This weight loss has proven to improve associated health conditions such as type 2 diabetes, high blood pressure, liver problems, high cholesterol levels, joint pain, and asthma.
What Is the Possibility of Weight Regain After the Surgery?
Regardless of the reduced stomach size, it can still stretch when eating a lot of food, resulting in weight gain. Hence, it is important to have a restrictive diet and change lifestyle to maintain the desired weight.
What Are the Risks Involved?
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General risks of surgery such as an allergic reaction to general anesthesia, breathing difficulty, bleeding, blood clot formation, and infection.
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Leaks from the stitches create stomach folds, which may require additional correctional surgery.
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Damage to the surrounding organs and blood vessels.
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Separation of the stomach fold, which requires additional surgery to correct.
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Unsatisfactory weight loss.
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Nausea and vomiting.
What to Expect After the Surgery?
After the laparoscopic gastric plication surgery, a patient is required to stay in the hospital for one or two days. The patient starts on a liquid diet in the hospital. Gradually, he can transition to thick and soft food and finally solid food. This can take up to 12 weeks. The recovery from this surgery is usually easier when compared to other bariatric surgeries as there is no stomach removal, stapling, or diversion of the digestive system. The recovery period generally depends on the age and the overall health of the patient. Physical therapy can help the patient regain strength and stamina, minimize pain, and return to activities more easily than without it.
Most patients return to normal activities and work within ten days. However, full recovery can take several weeks. The concerned doctor should be informed if the patient experiences breathing problems, chest pain and tightness, drainage of pus from the incision site, fever, inability to urinate or move the bowels, and unexpected bleeding. Some people may have difficulty with their new appearances after weight loss. The way others will look at them also changes. This can strain physical and social relationships and trigger issues with body image. The emotions regarding these changes can interfere with exercise habits and diet. The counselor on the bariatric team can help deal with these challenges and stay on track with treatment.
Conclusion:
For laparoscopic gastric plication, more research work is required before it can become a standard bariatric treatment. Nevertheless, the benefits of weight loss surgery are well worth the journey. The surgery can improve the medical conditions associated with obesity and reduce the risk of death. The patients after the surgery tend to have a better quality of life than those who are obese and did not go for the surgery.
