Weight Loss Surgery

Gastric Plication Surgery – 14 Ways It Will Affect You

Peter F. Rovito, MD, FACS

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Gastric plication surgery (also called laparoscopic greater curviture plication, gastric imbrication, or pseudo sleeve surgery):

  • Is still considered investigational/experimental
  • Is similar to gastric sleeve in that it creates a smaller stomach
  • Is different from gastric sleeve in that it sews the stomach in on itself rather than removing part of the stomach
    • our gastric plication surgery cost will depend
  • Causes patients to feel full sooner while eating
  • Has the benefit of meaningful weight loss without removing part of the stomach or rearranging the small intestine
  • Results in less weight loss and health improvement than the more established gastric sleeve, gastric bypass, duodenal switch, and LAP-BAND®
  • Has mixed reviews regarding failure anOne study suggests up to ad complication rates

Read the sections below for everything you need to know about the procedure.

TABLE OF CONTENTS

Click on any of the topics below to jump directly to that section

  1. How It Works
  2. Weight Loss & Health
  3. How to Qualify
  4. Cost
  5. Recovery
  6. Diet & Life After
  7. Downsides
  8. Compare Other Procedures
  9. Patient Community & Expert Advice
  10. Find a Weight Loss Surgeon
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01.

How Gastric Plication Surgery Works

SECTION SUMMARY:

  • Gastric plication shrinks the size of the stomach by making large folds in the stomach’s lining
  • You will feel full sooner while eating, eat less, and lose weight, as a result

Laparoscopic gastric plication surgery, also called Laparoscopic Gastric Greater Curvature Plication or Gastric Imbrication, is a restrictive procedure that shrinks the size of the stomach by making large folds in the stomach’s lining, thereby making the patient feel full sooner. The stomach size is reduced by about 75% during the procedure.

The gastric plication procedure is performed laparoscopically, meaning the surgeon makes small incisions in the abdomen through which surgical tools are passed. The procedure typically takes between 40 minutes and 2 hours to complete.

Review the following video for a deeper understanding of how the procedure is performed

02.

Weight Loss & Health Benefits from Gastric Plication Surgery

SECTION SUMMARY:

  • Up to 55% of excess weight within 2 years

While gastric plication surgery is still in the investigational stage, most researchers studying the procedure report positive short-term results that are comparable to the more well-established procedures.

Short-term percentage of excess weight lost ranges from 30 to 55% (lower than gastric sleeve or gastric bypass; comparable to lap band), and comparable improvement to obesity-related health problems including Type 2 diabetes.

Following are the key takeaways from several gastric plication surgery studies

1. Conclusions of Gastric Plication Studies

This table summarizes the results from recent studies of the Gastric Plication Procedure:

Tap here to expand a table of each study’s conclusions.

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Study# of ParticipantsStudy DurationStudy ConclusionsYear Published
Study A1401 yearIn the short term, both techniques [gastric plication and gastric sleeve] were comparable as regards to co-morbidity resolution. However, gastric sleeve appears to have achieved a higher weight loss.2013
Study B136 monthsDuring the initial 6-month postoperative period, LGCP induces significant weight loss and improves the metabolic profile of morbidly obese T2DM patients, while it also decreases circulating postprandial ghrelin levels and increases the meal-induced GIP response.2013
Study C80012 yearThe percentage of EWL in this technique is comparable to other restrictive methods. The technique is safe with 1.6% complication rate (1% reoperated), and 31% regain during 12 years. The cost of operation is less than the other methods. 2012
Study D24418 monthsKOver the short term, LGCP results in effective weight loss and significant T2DM reduction with a very low rate of complications.2012
Study E13531 monthsLGGCP is an emerging technique sparing gastric resection, the use of foreign materials and intestinal bypass. Its effectiveness is satisfactory for patients with BMI 45 kg/m², and the complication rate is acceptable.2011
Study F10018 monthsStudy reports that 38 of 100 gastric plication patients had severe symptoms within 18 months. 30% of patients underwent revisional surgery. Authors conclude “Laparoscopic Gastric Plication presented a high failure rate and an increased number of symptomatic patients.” Study emphasizes that revisional surgery is safe and effective.2016

2. Weight Loss & Co-Morbidity Improvement

Following are the weight loss and improvement in obesity health problems reported by the above-referenced studies:

Tap here to expand a table of health improvements and weight loss.

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StudyAverage Short-Term Excess Weight LostAverage Long-Term Excess Weight LostEffect on obesity-related health problems
Study AAfter 6 months: 40% After 12 months: 52%n/aGastric sleeve surgery and gastric plication surgery showed similar results in co-morbidity improvement at 1 year.
Study B6 month: 30%n/aFasting hyperglycemia and hyperinsulinemia improved significantly at 6 months with parallel improvement in insulin sensitivity and HbA1c levels
Study Cn/a2 years: 70% 5 years: 55%n/a
Study D6 months: 32% 18 months: Almost 50%n/aAt 6 months, 96.9% of patients’ Type 2 Diabetes was significantly improved/resolved.
Study En/an/an/a
Study FAfter 13.5 Months: 42 of 100 patients had less than 50%n/an/a
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03.

Requirements to Qualify for Gastric Plication Surgery

SECTION SUMMARY:

  • You need a body mass index (BMI) of at least 30
Click Here to See Your BMI

You could be a good candidate for gastric Plication surgery if:

  • You have a body mass index (BMI) of 40 or more, OR
  • Your BMI is between 30 and 39.9 and you have a serious obesity-related health problem

Serious obesity-related health problems most commonly include:

  • High blood pressure
  • High cholesterol
  • Type 2 diabetes
  • Sleep apnea
  • Many others (see Health Benefits section below)

If you do not meet one of the above two BMI requirements, you still might qualify for one other less invasive procedure: the Gastric Balloon. See our Gastric Balloon Patient Guide for more information.

04.

Cost of Gastric Plication Surgery

SECTION SUMMARY:

  • Gastric plication is NOT covered by insurance
  • The surgery costs $15,000, on average
  • If you take out a medical loan to pay for surgery, the average monthly cost is $334
  • Discounts & tax savings are usually available to help offset the costs of the surgery

Your gastric plication surgery cost will depend on a number of factors including which surgeon and hospital you choose and in what part of the country or world you receive the procedure.

A limited number of surgeons are performing the procedure, so average cost information is not available. However, given the less invasive nature of the procedure, it is likely to be in the cost range of gastric band surgery (lap band): around $15,000 (USD).

Click here to see our cost data for lap band surgery by region which should give you a general idea of what gastric plication will cost.

Since gastric plication is still considered investigational, it will probably not be covered by insurance. However, many surgeons offer affordable “self-pay” options, including payment plans, and there are other financing arrangements that can make the procedure more affordable.

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05.

Recovery from Gastric Plication Surgery

SECTION SUMMARY:

  • You'll be in the hospital 1 or 2 days
  • You'll need to take a week off from work
  • You'll be "fully recovered" in 4 weeks

Following surgery, most patients make a full recovery within one month.
As with the other bariatric surgery procedures, your diet will consist of the following in the weeks after surgery:

  • Weeks 1 & 2: Mostly smooth liquids like water, milk and juice
  • Weeks 3 & 4: Vegetable and other soups that do not contain carbs
  • Weeks 5 & 6: Heartier soup, fruit and yogurt
  • Weeks 7 & 8: Adopt your new regular bariatric diet in limited quantities (e.g. no more than 3 or 4 spoonfuls) as directed by your bariatric dietician

Daily light exercise such as walking should begin about one month after surgery.

06.

Diet & Life After Gastric Plication Surgery

SECTION SUMMARY:

  • You'll go on a restricted diet with supplementation (details below)
  • You'll have to make exercise a part of your life
  • Your personal relationships may change in ways you haven't considered

Weight loss after gastric plication surgery often takes center stage for new patients. It’s also important to consider what day-to-day life will be like.

Your surgery is only a tool. Long-term success requires diligence and sometimes difficult change in other areas.

The following sections give you an idea about what to expect before and after surgery. Every surgeon is different, and every patient is different. Please talk with your surgeon before acting on any of the following advice.

Food & Drink: Your New Diet

Following your recovery diet, you will slowly begin to introduce new foods in increasing quantities until about 6 months after surgery when your new bariatric diet will be in full swing. All weight loss surgery procedures require a complete change in diet for your procedure to continue to be effective, and gastric plication is no different.

See our Bariatric Diet (what you eat) and Bariatric Eating (how you eat) pages for all of the details.

Assuming you follow the diet and exercise guidelines of your surgical team, all indications are that weight loss and health improvement following gastric plication surgery may be permanent. However, as with gastric sleeve surgery, some patients are likely to experience weight regain as a result of your stomach stretching over time.

Relationships After Weight Loss

Over time, many patients experience a significant improvement in the quality of their sex life after weight loss surgery (1). This improvement is related largely to changes in the way a patient perceives their body and the resulting increases in self-confidence.

Relationship changes are another great reason to participate in a bariatric surgery support group. These support groups can provide insight and encouragement throughout your weight loss journey.

See our Relationships After Weight Loss page for real stories about relationships after weight loss… and please share your advice and experiences as well.

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07.

Downsides of Gastric Plication Surgery

SECTION SUMMARY:

  • There are nixed reviews on the failure and complication rates; some studies say plication is riskier, other studies say the risks are similar to gastric sleeve and gastric bypass
  • The side effects may include digestion issues & sagging skin
  • You could regain some of the weight you lose

Like the more established weight loss surgery procedures, gastric plication carries a relatively low risk of complications. Short-term complication rates range from 1% to 9%, while none of the studies reviewed reported any deaths as a result of the surgery. Major complication rates appear to be very low at less than 1%.

Other data suggests a more complicated safety profile and questionable weight loss efficacy. A study out of Mexico City reported that 30 of 100 gastric plication patients reversed the procedure due to poor weight loss or complications from surgery. The study reported that 38 of the 100 patients experienced severe symptoms from the procedure (1).

The most common minor short-term complication reported was nausea and/or vomiting which was controlled with medicine and usually resolved within one week following surgery.

The technique used during the procedure does seem to make a difference. For instance, one study reported that “the modification of the technique reduced early complications dramatically”.

The takeaway: if you choose this procedure, work with an experienced surgeon who is familiar with multiple techniques (especially before a universal standard has been adopted). Have him or her explain why they have chosen their particular technique over others.

Complication Data from Studies Reviewed

Tap here to expand a table of complication rates.

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StudyComplication RateReoperation RateMortality Rate% of Patients Experiencing Weight RegainYear Published
Study AShort-term readmission rate: 6.5%Short-term reoperation rate: 3.2%None reportedn/a2013
Study Bn/an/aNone reportedn/a2013
Study CShort-term: 1.6%1%n/aAfter 4 Yrs: 5.5% After 12 Yrs: 31%2012
Study DMajor complication rate: 1.2%n/a0%n/a2012
Study EOverall complication rate: 8.8%n/aNone reportedn/a2011
Study FMajor Complication Rate: 38%Revision Rate: 30%None Reportedn/a2016
08.

Gastric Plication Surgery Vs. Other Available Weight Loss Procedures

SECTION SUMMARY:

  • Gastric plication results in less weight loss & fewer health improvements than sleeve, bypass, DS, or band
  • Gastric plications results in more weight loss than the AspireAssist Device or the gastric balloon
  • Gastric plication is still considered "investigational"

Gastric plication surgery is most similar to gastric sleeve surgery in that both reduce the size of the stomach into a banana shape that connects the esophagus with the small intestines. While gastric sleeve surgery accomplishes this by removing part of the stomach and stapling the remaining part closed, gastric placation does so by folding the stomach in on itself and holding the folds in place with sutures (stitches).

At a high level, gastric plication surgery appears to carry the benefits of the more established procedures:

  • Substantial weight loss, but not as effective as gastric sleeve surgery (2)
  • Improvements and/or remission in comorbidities like Type 2 Diabetes (3)

…and fewer of the downsides:

  • No rerouting of the intestines like gastric bypass or duodenal switch
  • No implanted device left in the body like gastric banding
  • No removal of part of the stomach like gastric sleeve (and, in theory, the lack of a staple line should reduce the risk of leakage after the surgery)

So far, the primary downsides reported as compared to other procedures include:

  • Less short-term weight loss
  • Higher risk of postoperative nausea/vomiting (which, if it occurs, usually subsides within a few days)
  • One study suggests up to 38% experience severe symptoms

The procedure also appears to be more effective for patients with a lower body mass index (BMI). For example, one study found that the percentage of excess weight loss was significantly higher for patients with a BMI below 45, while another study reported greater weight loss for patients with BMI under 40.

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09.

Patient Community & Expert Advice

SECTION SUMMARY:

  • You can read about the experiences of other gastric sleeve patients
  • You Can "Ask the Expert"

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10.

Find a Gastric Plication Surgeon

SECTION SUMMARY:

  • You can ask a local bariatric practice for a free insurance check or cost quote

  • You should schedule a phone or in-person consultation (both often free), if you are interested in learning more about weight loss surgery

Bariatric Surgeons Specializing in Gastric Plication Surgery

Gastric plication surgery is still in the “investigational” and “early adoption” phase, so the number of surgeons performing the procedure is limited. Those who do offer it may only make it available if you are willing to participate in a clinical trial (studies set up to determine the outcomes and effectiveness of new procedures).

As with many new procedures, you may find a higher adoption rate by surgeons outside the country. See our Medical Travel page for more information about having surgery abroad.

Ask A Top Bariatric Surgeon About the Possibility of Receiving Gastric Plication Surgery

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Do You Qualify for a Bariatric Procedure?

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Do You Qualify for a Bariatric Procedure?

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Do You Qualify for a Bariatric Procedure?

Patients who qualify for bariatric surgery usually:

  • Are at least 80 lbs (36 kg) overweight
  • Are between 18 and 75 years old
  • Have a history of failed weight loss attempts (e.g., failed diets)
  • Thoroughly understand that the procedure is just a tool; long-term success requires significant diet and lifestyle changes

The minimum bariatric surgery qualifications include:

  • A body mass index (BMI) of 40 or more
  • OR a BMI between 30 and 39.9 with a serious obesity-related health problem like diabetes, high blood pressure, sleep apnea, high cholesterol, joint problems, or others
  • OR a BMI of 30 to 40 with or without health issues for the gastric balloon procedure

To calculate your BMI, enter your height and weight into the tool, then click the “Calculate BMI” button.

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Check My Insurance Tool

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Bariatric surgery insurance coverage varies by insurance policy:

Individual/Family Plans & Small Group Plans – Coverage varies by state; coverage is required by the Affordable Care Act in some states

Large Group Plans – Coverage depends on whether your employer has chosen to add it to your policy

Medicare and Medicaid – Bariatric surgery is covered

If your policy covers it and you meet the qualification requirements, your plan will likely include 4 procedures:

  • Gastric sleeve
  • Gastric bypass
  • LAP-BAND®
  • Duodenal switch

Your surgeon may be able to get partial coverage for the other procedures.

Use the tool to find out if your insurance covers bariatric surgery.

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Bariatric Surgery Weight Loss Estimator Tool

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Bariatric Surgery Weight Loss Estimator Tool

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Bariatric Surgery Weight Loss Calculator

You will start losing weight fast after any bariatric surgery procedure, but the total amount lost varies based on:

  • The procedure you choose
  • How closely you follow your doctor’s instructions

Enter your information into the tool to get an idea about how much weight you’ll lose after each procedure.

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Bariatric Procedure Cost Compare Tool

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Bariatric Procedure Cost Compare Tool

Your out-of-pocket bariatric surgery cost can range anywhere from $0 to $20,000 or more depending on several factors, including:

Whether your insurance covers it – many insurances (including Medicare, Medicaid, and many individual/family and employer-provided policies) cover the majority of costs for gastric sleeve, gastric bypass, LAP-BAND®, and duodenal switch. The other types of bariatric surgery are less likely to be covered, although you may be able to get insurance to pay for some of the costs. Tap the “With Insurance” button in the tool to see average out-of-pocket costs per procedure after insurance pays. See our Insurance Tool to find out if your plan covers it.

Which procedure you choose – if insurance won’t pay, costs range anywhere from $8,000 to $20,000+, depending on the procedure. Tap the “Without Insurance” button in the tool to compare the national average self-pay costs for each procedure. (NOTE: Some surgeons offer each procedure for as low as half of the national average).

How competitive your surgeon and hospital fees are – there is often a substantial difference in costs between different doctors and hospitals, even within the same town.

Whether you qualify for tax write-offs – Bariatric surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if your out-of-pocket costs are more than 10% of your adjusted gross income. See our Tax Tool to find out if your bariatric procedure will be tax deductible.

How you choose to pay for your procedure – If insurance covers it, you’ll only be responsible for any copays, deductibles, and coinsurance required by your specific plan. If you pay for the procedure without insurance, total costs will depend on how you pay. For example, your surgeon may offer a discount if you pay the full amount up front, and you can make the costs more affordable by applying for bariatric surgery financing.

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Bariatric Surgery Tax Write-Off Calculator

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction.

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof. Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
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Bariatric Surgery Tax Write-Off Tool

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Bariatric Surgery Tax Write-Off Tool

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Bariatric Surgery Tax Write-Off Calculator

Weight loss surgery is tax deductible, which can have a big impact on the total cost of surgery. You can deduct medical expenses if the costs are more than 10% of your adjusted gross income.

Use the tool to find out if you qualify for a tax deduction

To receive the deductions, you’ll need to complete Schedule A of the IRS Form 1040. You’ll also need to save your medical bills and payment statements as proof.

Money in one of the following special savings accounts (or even your IRA) may also be a way to pay for part of surgery tax-free:

  • Health Savings Account (HSA)
  • Archer Medical Savings Account (Archer MSA)
  • Health Reimbursement Account (HRA)
  • Flexible Spending Account (FSA)
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Bariatric Surgery Recovery Timeline Tool

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Bariatric Surgery Recovery Timeline Tool

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Bariatric Surgery Recovery Timeline Tool

Bariatric surgery recovery varies by procedure. Here are the ranges:

  • Timeline Range: from 3 days to 6 weeks to full recovery
    • Hospital Stay: from outpatient (return home same-day) to 3 days
    • Back to Work: from 3 days to 3 weeks
  • Pain Range: from mild discomfort to manageable with medication
  • Diet Range: from no restrictions to slow transition from clear liquids to solid foods
  • Activity Range: from no restrictions to slow transition back to regular activity and exercise

Use the tool to learn more about each stage of recovery.

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Bariatric Procedure Summaries

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

Bariatric Procedure Summaries

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Below is a brief explanation of how each bariatric surgery procedure works. Tap the icons for more information.

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Bariatric Procedure Comparison Tool

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Bariatric Procedure Comparison Tool

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Bariatric Procedure Comparison Tool

There are 6 types of bariatric surgery (also called “weight loss surgery”) available, including:

  • Gastric Sleeve – feel less hungry & full sooner while eating
  • Gastric Bypass – feel full sooner while eating & absorb fewer minerals
  • Duodenal Switch – feel less hungry & full sooner while eating, absorb fewer calories and minerals
  • LAP-BAND® – feel full sooner while eating
  • Gastric Balloon – temporarily feel full sooner while eating (balloon removed after 6 months)
  • AspireAssist – drain a portion of stomach contents after eating

Use the tool to compare each procedure.

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

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Bariatric Surgery Quiz: Learn Your Top 2 Procedures

The best weight loss surgery options for you depend on:

  • How much weight you want to lose
  • Your current age, weight, health issues, habits, and lifestyle
  • Your expectations for life after surgery
  • Whether you want a reversible procedure
  • What “trade-offs” you are willing to make

Take the quiz to find out which two procedures are best for you and why.

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Bariatric Surgery Health Benefits Tool (Gastric Sleeve)

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Bariatric Surgery Health Benefits Tool (Gastric Sleeve)

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Bariatric Surgery Health Benefits Tool

Bariatric surgery “cures” or significantly improves many obesity-related health conditions, including:

  • Diabetes
  • Sleep apnea
  • Hypertension
  • Joint issues
  • … and many others

Select your health conditions in the tool, then click the Submit button to find out the impact a procedure like gastric sleeve can have.

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* Disclaimers: Content: The information contained in this website is provided for general information purposes and your specific results may vary depending on a variety of circumstances. It is not intended as nor should be relied upon as medical advice. Rather, it is designed to support, not replace, the relationship that exists between a patient/site visitor and his/her existing physician(s). Before you use any of the information provided in the site, you should seek the advice of a qualified medical, dietary, fitness or other appropriate professional. Advertising: Bariatric Surgery Source, LLC has entered into referral and advertising arrangements with certain medical practices, original equipment manufacturers, and financial companies under which we receive compensation (in the form of flat fees per qualifying action) when you click on links to our partners and/or submit information. This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply. Read More

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