Definition & Overview

Laparoscopic greater curve plication is the surgical procedure of folding in and sewing the greater curvature, which is the large, curving part of the stomach located on its left border. The folding in or plication leads to the narrowing of the stomach, allowing the patient to feel full despite eating only a small meal. It is sometimes referred as pseudo sleeve surgery or gastric imbrications.

Obesity is a rising public health concern all over the world. More and more people suffer from health consequences resulting from being overweight. These conditions include diabetes, high blood pressure, gallbladder diseases, osteoarthritis, sleep apnoea, and many others. When all other weight loss regimen has been tried and no significant change in body weight and body mass index has been observed, some people may consider bariatric surgery.

More than half of the stomach size is reduced through laparoscopic greater curve plication. The procedure of folding the stomach into itself is one of the restrictive procedures of bariatric or weight loss surgery. The goal is to restrict stomach capacity and reduce the amount of food being eaten. Over time, the procedure is expected to result in significant weight loss. Its touted advantages include not removing any tissue and its possible reversibility if the situation calls for it.

Who Should Undergo and Expected Results

Laparoscopic greater curve plication is suitable for obese adult patients with a body mass index of at least 35, especially if there are severe co-morbid conditions involved. Most of these patients are taking maintenance medications to manage these comorbidities and are looking for ways to reduce their pharmaceutical drug intake. The severity of the patient's obesity may also be indicated by being more than 100 lbs. over the ideal weight.

The procedure can also be recommended to obese patients who are diagnosed with gastroesophageal reflux disease and those who have a history of trying other means of reducing their weight and were largely unsuccessful.

However, there are several contraindications for this type of bariatric surgery, such as pregnancy, previous bariatric surgery, eating disorder, uncontrolled diabetes, and even a body mass index of more than 50, in which this procedure may prove unsuitable for reducing weight.

Laparoscopic greater curve plication is considered a relatively simple and safe procedure. Patients are typically allowed to go home after an overnight stay in the hospital. A liquid diet is a necessity for several weeks after surgery to help the stomach cope with the structural change. The goal is to gradually introduce semi-solid food after some time to ease the transition to eating solid meals. Patients also need to adhere to a low carb diet until they achieve their desired weight. After a few months to a year, most patients achieve significant weight loss. Some even report losing as much as 50% or more of their weight before surgery and experience improvement of comorbidity symptoms and lesser dependency on maintenance drugs. Those who underwent this procedure are also required to adopt healthy lifestyles, stick to a sustainable exercise regimen, and eat a balanced diet to enjoy long-term benefits.

How is the Procedure Performed?

The patient is administered with general anaesthesia before the surgeon makes several small incisions in the abdominal area. The procedure is carried out using the standard five-trocar technique. A laparoscope is inserted through the incisions to provide visualisation of the stomach area as well as specialised surgical tools to dissect the greater omentum using bipolar forceps. Gastric adhesion to the posterior part of the abdominal cavity is also removed. The edges of the greater curve of the stomach are folded inward and the first layer of sutures is applied. A second layer is also added to significantly reduce stomach size and volume to create the stomach pouch. After modifying the shape and size of the stomach, the laparoscope and the rest of the specialised tools are withdrawn.

Some surgeons may also opt to include a third row of sutures to secure the folded part. This variation of the usual technique is termed triple plication.

Possible Risks and Complications

Although considered a simple, straightforward procedure, laparoscopic greater curve plication can result in:

  • Adverse reaction to the anaesthesia used
  • Bleeding
  • Infection and the formation of abscess
  • Damage to nearby gastric parts, such as the mesentery, small blood vessels, and the intestine
  • Hematoma
  • Gastric fold oedema
  • Rupture of the folder part of the stomach
  • Gastric leak and obstruction, which may require immediate medical attention

    References

  • Keating CL, Dixon JB, Moodie ML, et al. Cost-effectiveness of surgically induced weight loss for the management of type 2 diabetes: modelled lifetime analysis. Diabetes Care. 2009 Apr. 32(4):567-74.

  • Sjöström L, Peltonen M, Jacobson P, Sjöström CD, Karason K, Wedel H, et al. Bariatric surgery and long-term cardiovascular events. JAMA. 2012 Jan 4. 307(1):56-65
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