Gastric Sleeve Plication
Frequently Asked Questions
What is the gastric sleeve plication?
Laparoscopic gastric sleeve plication is a relatively new restrictive bariatric surgical technique for the treatment of morbid obesity. The operation is an advanced laparoscopic procedure and often described as an evolution of the well - known vertical sleeve gastrectomy.
With gastric sleeve plication, gastric capacity is diminished without the removal of stomach tissue and without foreign implants. Due to the lack of gastric strictures, plication does not cause any food intolerance nor impair patient’s dietary habits. The restriction is carried out by invaginating the stomach with the use of pure non - absorbable surgical sutures.
Is gastric sleeve plication called anything else?
The gastric sleeve plication appears in the peer-reviewed medical literature by several different names, including gastric imbrication, super sleeve, gastric plication, gastric pleat, and greater curvature plication.
What are the benefits of gastric sleeve plication?
The gastric sleeve plication procedure is less invasive than the RNY gastric bypass as well as vertical sleeve gastrectomy procedures; as a result, there is a much lower risk of early or acute complications.
There is no resection (tissue cutting/removal) with the gastric sleeve plication; the digestive tract remains intact, eliminating the risk of ‘leaks’ at the suture line, which is a serious potential complication of the gastric bypass and sleeve procedures.
As compared with the gold standard procedure RNY gastric bypass, the gastric sleeve plication features no malabsorption- the patient experiences no nutritional deprivation or risk of malnutrition.
Finally, the gastric plication requires no medical device implantation or adjustment, providing patients who are not achieving optimal weight loss with adjustable gastric band a non-invasive alternative that has the additional benefit of (typically) greater, faster weight loss.
How much weight will I lose with the gastric sleeve plication?
In general weight loss after gastric sleeve plication is greater, sooner and more immediate than average weight loss reported after adjustable gastric band (LAP-BAND) placement.
Weight loss among plication patients has been comparable to the greater levels of weight loss observed by gastric sleeve or bypass patients. A typical gastric sleeve plication patient can expect to lose about 70% of his or her excess weight. This average weight loss result has been consistently observed for three years.
How long will I be in the hospital?
Gastric sleeve plication is an ambulatory procedure and requires only 24 hours of hospitalization, as compared to the RNY gastric bypass, or vertical sleeve gastrectomy, both of which require 3-5 days of post-surgical hospitalization for the identification of leaks.
With gastric sleeve plication, there is no risk of leaks since there is no cutting/opening of the stomach. Patients experiencing post-procedure nausea may be kept by the surgeon for an additional night of observation at no extra charge to the patient.
What are the risks associated with gastric sleeve plication?
Overall the plication is less invasive than the most commonly performed laparoscopic procedures, i.e. adjustable gastric band, gastric bypass and sleeve gastrectomy, which leaves only 20% of the stomach intact.
Complications from stitches rupturing due to extreme vomiting following premature ingestion of solid foods within the first 60 days, however this is less than .1%.
The gastric sleeve plication involves from forty-five to sixty minutes in the operating room, compared to just 20-30 minutes for the adjustable gastric band.
More OR time means greater exposure to anesthesia. Because the gastric sleeve plication is a new procedure, patients are encouraged to have the surgery performed at a full-service hospital with a strong obesity surgical staff and program.
What is the incision size?
There are five small incisions that are slightly smaller than utilized for other weight loss surgeries.
Is gastric sleeve plication available in the U.S.?
Clinical trials have occurred in Turkey, Brazil, Mexico, and in less than one dozen hospitals in the U.S. The most experienced North American gastroenterologist surgeon performing gastric sleeve plication is gastroenterology surgeon Dr Juan Lopez Corvala at the Obesity Surgery Center at Hospital Angeles Tijuana, the largest private hospital network in Mexico.
Dr. Lopez Corvala has trained more than 50 surgeons from the US and abroad on the gastric plication surgery technique. He has also presented his findings at obesity surgical conferences in the United States.
How many patients have had the gastric sleeve plication procedure?
About ~350 US patients have had a gastric sleeve plication procedure at Hospital Angeles.
What is revision surgery?
Revision surgery refers to a patient who is undergoing a second weight loss surgery procedure.
More than a third of bariatric patients will return for a revision surgery, which is no way a negative or failure or drawback – the stomach is a muscle that is continuously working and adapting and can grow and stretch.
Can I have a gastric sleeve plication if I’ve already had a different weight loss surgery?
Yes. Today, a patient having a bypass and needing a second surgery are typically only candidates for band. A patient having a sleeve and needing a second surgery often can get only a bypass revision.
A patient having a gastric sleeve plication may get either the band, sleeve or bypass, or another plication, because we have a return to the virgin stomach. It is expected that there will be even less instances of the minor scarring and erosion we see with band.
A revision with the gastric sleeve plication provides the patient with the opportunity for a less invasive procedure that provides a better outcome and fewer complications, because of the virgin state of the stomach.
Will the part of my stomach that is ‘rolled’ atrophy or otherwise create a complication for my health?
The gastric sleeve plication procedure is very similar in its specifics reflux surgery which results in no such complications. Some scarring would be normal/expected, although this is not expected to be more significant than what typically occurs with band.
What is the green zone?
Green zone is a term used to describe an optimal restriction for the weight loss surgery patient - a too-tight restriction can cause discomfort and reflux, while a restriction that is too loose can inhibit the rate of weight loss. An optimal restriction - a ‘green zone’ restriction - is one that enables maximum weight loss with no discomfort to the patient.
The Green Zone is achieved through the use of a medical device that when employed by the bariatric surgeon provides 16 real time pictures of the patient’s gastrointestinal tract and stomach, enabling the surgeon to precisely measure the optimal restriction created during the suturing process.
How much does the gastric sleeve plication cost?
Nuehealth offers the gastric sleeve plication medical travel program at Hospital Angeles, the largest private hospital network in Mexico, for $6,500. The Green Zone Gastric Sleeve Plication program is $7,500. This all-inclusive price covers:
- All preliminary pre-surgery lab work (conducted at the hospital)
- Two nights hospital stay
- Private hospital room (a companion may stay with you at the hospital)
- Round trip ground transportation from San Diego International Airport to the Weight Loss Surgery Center at Hospital Angeles Tijuana
- Free full-service travel concierge for patients and travelling companions
- One year follow up from the Nuehealth's Patient Care Coordination team