Laparoscopic Gastric Imbrication


Gastric Plication is a new laparoscopic procedure available for weight loss. The surgeon reduces the volume of the stomach by about 60 to 70% by sewing large folds in your stomach, essentially folding it in on itself, to reduce the size of the stomach (see picture). There is no cutting, stapling, or removal of the stomach or intestines with the Gastric Plication. A gastric band may also be placed over the Gastric Plication, further limiting the amount of food that can be consumed at one time. The Gastric Plication procedure is minimally invasive and takes approximately one hour to complete. Most patients stay in the hospital for one day after the procedure.

The advantages of Gastric Plication include a safety profile similar to traditional gastric banding and it is thought that the procedure may be reversed or converted to another procedure if needed, although some surgeons dispute the practical reversibility of this operation. The Gastric Plication may potentially be a good option for patients who aren’t good candidates for other weight loss procedures due to their medical or surgical history.

The Gastric Plication is a very “new” operation and very little data regarding expected weight loss, complications, and resolution of weight related medical problems (comorbidities) currently exists. Early results are encouraging and seem to indicate an expected weight loss in the range of 50-60% of excess body weight, a low complication rate, and decent resolution of weight related medical problems but until large numbers of patients have been followed over the span of years, more accurate and long-term results cannot be known. In other words, at the present time, this operation is still considered “investigational” or “experimental”. This procedure is also considered experimental by insurance companies and is therefore not a covered benefit in any insurance plan.

The American Society for Metabolic and Bariatric Surgery has recently released a statement regarding gastric plication procedures:

We currently support the following recommendations regarding gastric plication alone or in combination with adjustable gastric band placement for the treatment of obesity:

1. Gastric plication procedures should be considered investigational at this time. This procedure should be performed under a study protocol with third party oversight (local or regional ethics committee, Institutional Review Board, Data Monitoring and Safety Board, or equivalent authority) to ensure continuous evaluation of patient safety and to review adverse events and outcomes.

2. Reporting of short- and long-term safety and efficacy outcomes in the medical literature and scientific meetings is strongly encouraged. Data for these procedures should also be reported to a program’s center of excellence database.

3. Any marketing or advertisement for this procedure should include a statement to the effect that this is an investigational procedure.

4. The ASMBS supports research conducted under an IRB protocol as it pertains to investigational procedures and devices. Investigator meetings held to facilitate research are necessary and supported, as is the reporting of all data through BOLD, Bariatric NSQIP or a specific research database. The ASMBS does not support CME courses on investigational procedures and devices held for bariatric surgeons for the purpose of use of investigational procedures outside an IRB research protocol.
These recommendations are not intended to impede innovation within our field. Rather, the Society encourages and supports the development of new and innovative procedures that can benefit our patient population. It is imperative, though, that these procedures be conducted responsibly under appropriate supervision and after appropriate training.