Laparoscopic Gastric Band Plication

A New technique in Surgical Weight Loss

The Gastric Band plication or “banded plication”procedure was introduced in an effort to find a durable and extremely safe weight loss procedure that can decrease the complication rate of the procedures that are currently being used for surgical weight loss.  One of the safest and most effective procedures at the present time in surgical weight loss is the adjustable gastric band.  However, up to 23% of patients will have complications associated with either the band or the port over the life of the band placement. Complications such as slippage, port flippage, port infection and ineffective weight loss are some of the problems seen in patients who elect to have the band.

A recent study suggests that gastric-banded plication may be just as effective in weight loss as the gastric bypass without the associated complications.

A recent study performed by Huang et al showed that combining the adjustable gastric band with a gastric plication procedure might allow more weight loss than either procedure alone.

The gastric plication is a relatively new concept for surgical weight loss that reduces the volume of the stomach by “plicating” the outside wall of the stomach into the inside of the stomach, making much less room for food forcing the individual to eat smaller amounts.  Because there is no cutting or re-routing of the intestinal tract and no foreign body that needs adjusting, the complication rate with this surgical procedure may prove to be less than all the currently available surgical procedures.  The plication procedure also has early data to suggest that the weight loss with the plication only is just as much as with the band, the sleeve and in some instances the gastric bypass.

Recently, the idea of combining the two procedures sort of a “belt and suspenders” type approach was introduced.  The theory behind this technique is that the plication is performed to begin the initial weight loss process.  The weight loss continues as the patient changes their behavior through proper eating habits and exercise.  If the patients then down the road, usually 8 months to a year later, slows to lose all the weight that they would like or if the weight loss plateaus, then the band adjustments begin.  This theoretically might decrease complications associated with the band might as many of the bands complications i.e. port site infection, flippage etc, are related to adjustments of the band.

Furthermore, although the patient still needs to be followed closely, there are far less adjustments needed in that 1^st year of weight loss than with just having the band alone.  In addition, with this technique, since the fundus of the stomach has been plicated, there could be less risk of band slippage or erosion, which is one of the most dreaded complications of the band that usually results in additional surgery.  Lastly, some of the early data suggests that this novel approach of combined “gastric band plication” may allow patients to lose weight in less time than that seen with the band alone, comparable to what’s seen with the gastric bypass.

All in all, the authors note that although early results appear encouraging, larger series and longer follow-up is needed to determine the durability and long-term success of this combination procedure.  They do note that the early results of this procedure are extremely encouraging.

The laparoscopic adjustable gastric band has been shown to be safe and effective for weight loss surgery.   The gastric band has however produced variable results and though safe, effective weight loss depends on adjustments on a frequent basis.  Gastric plication is also known as a safe and minimally invasive procedure that requires no cutting or stapling and does not require adjustments.  Both procedures help in effectively achieving over 50% weight loss.  The question remains as to whether combining the two procedures can effectively allow greater weight loss similar to gastric bypass while at the same time decrease complications.

Read More:

Gastric Band Plication, The Best of Both Worlds?
Gastric Band Plication for Failed Gastric Band