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Laparoscopic Gastric Plication: Procedure and Advantages

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Laparoscopic gastric plication is a weight loss surgery resulting in faster recovery and less scarring. Read the article to know in detail.

Written by

Dr. Akanksha

Medically reviewed by

Dr. Ghulam Fareed

Published At April 12, 2023
Reviewed AtFebruary 27, 2024

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?

  • It is performed to reduce weight in obese people. A person with a body mass index (BMI) of 30 or more is considered overweight.

  • It is done if other less invasive strategies, such as exercise, diet, and behavioral therapy, have failed to achieve desired weight loss.

  • 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?

  • General risks of surgery such as an allergic reaction to general anesthesia, breathing difficulty, bleeding, blood clot formation, and infection.

  • Leaks from the stitches create stomach folds, which may require additional correctional surgery.

  • Damage to the surrounding organs and blood vessels.

  • Separation of the stomach fold, which requires additional surgery to correct.

  • Unsatisfactory weight loss.

  • 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.

Frequently Asked Questions

1.

What Is Considered the Safest Weight Loss Surgery?

Laparoscopic adjustable gastric banding (LAGB) is often considered one of the safest weight loss surgeries. It entails placing a band around the stomach to decrease its dimensions. While generally having lower risks, effectiveness varies, and careful post-surgery management is crucial for successful outcomes.

2.

How Does Morbid Obesity Differ From Obesity?

Morbid obesity is an extreme form of obesity, characterized by a much higher body mass index (BMI) typically exceeding 40. Regular obesity usually refers to a BMI of 30-35. Morbid obesity poses more serious health risks, including cardiovascular issues, diabetes, and reduced life expectancy, demanding more intensive medical attention.

3.

What Represents the Primary Risk Linked to Obesity?

The primary risk linked to obesity is the elevated likelihood of developing chronic health problems such as heart disease, diabetes, and hypertension. Obesity significantly raises the chances of these conditions, impacting one's well-being and longevity.

4.

How Can Obesity Be Naturally Reduced?

Achieving a decrease in obesity can occur organically by combining wholesome eating patterns with consistent physical exercise. Introducing a well-rounded diet abundant in fruits, vegetables, lean proteins, and whole grains, all while being conscious of portion sizes, is crucial. Engaging in consistent exercise, such as aerobic and strength training, further aids in weight management.

5.

What Kinds of Foods Tend to Increase Obesity Risk?

Consuming foods that are abundant in added sugars, refined carbohydrates, and detrimental fats tends to elevate the likelihood of obesity. Beverages loaded with sugar, fast food, packaged snacks, and excessive intake of calorie-dense foods all play a role in adding pounds. Such selections can lead to overindulgence and disturbances in metabolic functions, ultimately fostering the development of obesity.

6.

Can Weight Loss Lead to Diabetes Reversal?

Yes, weight loss can lead to the reversal of type 2 diabetes in some cases. Shedding excess weight through a balanced diet and increased physical activity can improve insulin sensitivity and blood sugar control, potentially allowing individuals to manage or even eliminate their diabetes medications.

7.

What Mental Issues Can Follow Weight Loss Surgery?

Weight loss surgery can lead to various mental health challenges, including body image dissatisfaction, depression, anxiety, and adjustment issues. Rapid weight loss and altered body perceptions may trigger emotional struggles. Adequate psychological support and counseling are crucial to address these concerns and ensure holistic well-being post-surgery.

8.

How Long Does Post-Gastric Bypass Depression Typically Last?

Post-gastric bypass depression duration varies widely among individuals. It can persist for several months to a couple of years. Factors such as pre-existing mental health conditions, support systems, and effective coping strategies influence the timeline. Seeking professional help and maintaining open communication with healthcare providers are essential for managing this aspect of recovery.

9.

Which Group Displays the Highest Obesity Prevalence?

The group with the highest obesity prevalence tends to be adults, specifically middle-aged individuals (40-59 years old). This age group commonly faces increased rates of obesity due to factors like reduced metabolism, lifestyle changes, and hormonal shifts, highlighting the need for targeted interventions and health promotion strategies.

10.

What Are the Effects of Obesity on Children?

Childhood obesity can result in a variety of health outcomes, including an increased susceptibility to conditions like type 2 diabetes, cardiovascular issues, joint complications, and sleep apnea. Additionally, psychological ramifications such as diminished self-esteem and depressive tendencies may also emerge. Preventive measures through healthy eating, physical activity, and family support are crucial to mitigate these impacts.

11.

What Distinguishes Obesity From Being Overweight?

Obesity and being overweight are distinguished by body mass index (BMI) ranges. Overweight is defined as a BMI of 25-29.9, while obesity starts at a BMI of 30. Obesity involves a higher degree of excess body fat and carries increased health risks, including chronic diseases, compared to being overweight.

12.

What Kind of Risk Is Associated With Childhood Obesity?

Childhood obesity is associated with a higher risk of developing various health issues, including type 2 diabetes, heart disease, asthma, and joint problems. Additionally, obese children are more likely to carry their weight-related problems into adulthood, leading to a lifelong burden of chronic diseases and reduced quality of life.

13.

How Does Obesity Impact Various Body Systems?

Obesity negatively affects multiple body systems. It strains the cardiovascular system, leading to hypertension and heart disease. It disrupts metabolic processes, contributing to insulin resistance and diabetes. Obesity increases joint stress, and respiratory problems, and elevates the risk of certain cancers, emphasizing the importance of weight management for overall health.

14.

What Characterizes Sarcopenic Obesity?

Sarcopenic obesity is characterized by the coexistence of muscle loss (sarcopenia) and excess body fat. This condition often occurs with aging and can lead to reduced mobility, increased frailty, and metabolic complications. Addressing both muscle mass and fat content becomes crucial in managing sarcopenic obesity.

15.

What Measurement Assists in Determining a Patient’s Obesity Level?

The Body Mass Index (BMI) is a common measurement used to determine a patient's obesity level. It calculates the ratio of weight to height and categorizes individuals as underweight, normal weight, overweight, or obese. However, while BMI is useful, it doesn't consider factors like muscle mass or distribution of body fat.

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Dr. Ghulam Fareed
Dr. Ghulam Fareed

Medical Gastroenterology

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