Gastric Plication to Sleeve Gastrectomy Revisional Surgery

In fact, this procedure—commonly known among the public as stomach folding, stomach stitching, or gastric banding—is medically referred to as gastric plication. It is typically performed laparoscopically and involves reducing the volume of the stomach.

What Is the Success Rate of Gastric Plication Surgery?

This procedure was widely performed before the development of today’s modern bariatric surgeries. However, due to its low success rate, it is no longer preferred today. The main reason for this is that patients often fail to achieve sufficient long-term weight loss. This is because the surgery only reduces stomach volume, while the hunger hormone ghrelin continues to be secreted, preventing patients from reaching their desired weight.

What Is Endoscopic Gastric Plication?

A more recent variation involves entering the stomach through the mouth and reducing its size using sutures. The only difference from the laparoscopic approach is that it is performed endoscopically. However, the outcomes of this method are also not very satisfactory. Despite requiring significant expertise, it is both technically challenging and relatively expensive.

How Is Gastric Plication to Sleeve Gastrectomy Revisional Surgery Performed?

This is one of the most common revision surgeries performed after gastric band procedures. In gastric plication revision, the operation is usually performed through the same entry points. One of the biggest challenges is the lack of standardization, as each surgeon may have performed the initial procedure differently.

A commonly encountered issue is that, despite plication, the stomach is left too wide. In such cases, performing sleeve gastrectomy is relatively straightforward. However, if some areas are narrow while others are wide, the sutures in the narrowed sections must first be released. This increases the complexity and duration of the surgery.

As with all surgical procedures, experience is extremely important. Patients naturally have high expectations, and if weight regain occurs again, they may lose trust in surgical treatment altogether. Therefore, before performing revision surgery, the surgeon must carefully evaluate every detail and clearly communicate all aspects of the procedure to the patient.

Should Patients with Weight Regain After Gastric Plication Undergo Sleeve Gastrectomy or Gastric Bypass?

This is a question that often confuses both surgeons and patients. A thorough evaluation of the patient is essential. If the patient has diabetes or metabolic disorders, gastric bypass may be a more appropriate option. Otherwise, sleeve gastrectomy is generally recommended.

The reason is that long-term outcomes of sleeve gastrectomy and gastric bypass are quite similar. However, gastric bypass may have some disadvantages, such as limited endoscopic access to the stomach, the need for long-term vitamin supplementation, and potential issues like malodorous diarrhea.

For more detailed explanations, you can watch the video below:

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