Lap Band with gastric plication
There’s a new way to do perform the LapBand. It’s to add a gastric plication. Plication means folding, and in a gastric plication we are folding the stomach to decrease its capacity. Sometimes it used to be called gastric imbrication, now most people refer to it as a gastric plication.
In a gastric plication, we fold part of the stomach in on itself, and then use suture to hold it in. So unlike the gastric sleeve, we are not amputating the stomach. But we end up with a smaller stomach capacity without the risks of stapling and amputating the stomach.
It is why some people are calling the gastric plication, “the sleeve without cutting.”
Gastric plication with gastric banding is currently considered by some an investigational procedure, but we believe it is a natural extension of current suturing techniques with the LapBand.
Gastric plication is not a new procedure. It was first developed overseas around 2001 by Dr. Talebpour.
At that time it was done without a LapBand in place simply by folding the stomach. Now, more and more doctors now are adding the gastric plication to the LapBand.
This may help in several ways:
First, it may help secure the LapBand in place, and may reduce the already small chance of LapBand slippage.
Second, by reducing the stomach capacity below the LapBand it can potentially help the LapBand in decreasing a person’s hunger and allowing them to eat smaller meals.
Third, since the stomach’s capacity is decreased, it potentially might mean less office visits for LapBand adjustments. That might helpful for out of town, or busy patients that can’t make as many frequent office visits to the doctor.
The gastric plication does not involve any changes in the routing of the GI tract. There is no stapling, no cutting, no separating of any organs of the GI tract.
Some people call the gastric plication a gastric sleeve without cutting.
The sleeve gastrectomy is a completely different procedure. In gastric sleeve surgery, you end up with a long thin narrow stomach as a result of stapling, cutting, and removing a large portion of the stomach.
Potential benefits of gastric plication over Lap Band (banded gastric plication) when compared with traditional LapBand
Decreased slippage: LapBand slippage occurs in about 3 – 4% of patients during the life time of their LapBand. Many doctors believe that when it does occur, it is due to a person chronically overeating and stretching out their stomach pouch from above the LapBand, and pulling the stomach from below. The anterior gastric plication introduces more stitches to the stomach below the LapBand and some doctors believe this may help prevent slippage. We have communicated with two high volume LapBand surgeons who have been doing gastric plication over Lap Band for over a year and report a decreased slippage rate.
Better weight loss: By decreasing the volume of the stomach below the LapBand, patients report more of a feeling of fullness after eating their small portions. This might make it easier to adhere to small portions and low calorie intake, enhancing weight loss.
Less need for LapBand adjustments: LapBand patients typically need several LapBand fills to get to the LapBand sweetspot where they can have small meals without hunger. With the gastric plication below the LapBand, there are reports of patients needing fewer LapBand fills, because they feel full faster.
Nausea and/or vomiting. If it does occur it is most common in the first week or two after surgery.
Reflux or heartburn: Generally the risk of this should be low because the LapBand operation often helps pre-existing reflux or heartburn.
Unlike the gastric sleeve, the plication does not involve cutting across the stomach with hundreds of staples, and amputating and removing part of the stomach.
What if you have previously had a LapBand placed and want a gastric plication because you feel you need extra help with your LapBand weight loss?
That can be done, and some patient with a LapBand previously placed are having a second procedure to get a gastric plication.
Gastric sleeve risks
The gastric sleeve is an amputation of the stomach. Up to 80 % of the stomach is cut out and removed. The cutting of the stomach leaves a potential for a big problem in the first few weeks after gastric sleeve surgery.
Because you are stapling and cutting out a large piece of stomach there is a potential for adverse outcomes. After sleeve gastrectomy there are several risks:
Leakage from the staple lines. If your body doesn’t heal perfectly and the two ends of the cut stomach don’t heal to form a watertight seal, you could leak stomach fluids into your abdominal cavity. If this happens it could be life threatening.
Infection. Since you are cutting out stomach and removing a portion of organ from the body, you could potentially develop internal infections.
Long term fistula. A fistula is abnormal passage that can occur after gastric sleeve surgery. It is frequently associated with infection and inflammation. In the case of gastric sleeve surgery, a fistula can occur between the stomach and the lungs or the stomach and the abdominal wall. This happens because at some point after surgery, the staple line of the stomach sticks to the abdominal wall or the diaphragm muscle separating the abdomen from the chest. Then once the staple line is sticking to another part of the body, it slowly eats through the other tissue and gastric juices can then leak into another part of the body, or outside the body through your skin, in an abnormal fashion.
Because of these potential risks of gastric sleeve, ask your surgeon about the option of Lap Band with gastric plication compared to the sleeve gastrectomy.