Laparoscopic Gastric Plication (Wrap)

Gastric Plication surgery is a relatively new operation and is therefore currently considered “experimental“. It is performed under general anaesthesia using keyhole (laparoscopic) surgery. Small incisions are created in the abdominal wall to allow small instruments to be passed into the abdominal cavity, guided by a special surgical telescope with a video camera, in order to perform the operation. Using sutures, the volume of the stomach is considerably reduced by folding in (plication) of the stomach along its outer curvature. Its main advantage is that it is reversible, as it does not involve removal of any part of the stomach or bypass of the intestine.

The average operating time for gastric plication is 40-60 minutes.

Most patients will be able to go home within two days after surgery, and some will stay longer should they develop prolonged vomiting or other issues or should they have other health problems such as with their mobility, or should they lack support at home.

Like other bariatric operations, gastric plication surgery is indicated for the following groups of people:

  • When appropriate non-surgical measures have been tried but failed to achieve or maintain adequate, clinically beneficial weight loss in patients whose:

    BMI is 40 kg/m2 or more
    Or between 35-40 kg/m2 in association with other significant disease (for example, type 2 diabetes, heart disease or high blood pressure)

  • Surgery is also recommended as a first-line option (instead of lifestyle interventions or drug treatment) for adults with a BMI of more than 50 kg/m2 in whom surgical intervention is considered appropriate (National Institute for Clinical Excellence (NICE)).

However, the need for surgery to aid weight loss and the choice of surgical procedure is dependent on discussion with the bariatric team who will provide you expert and comprehensive advice.

The laparoscopic introduction of this procedure is relatively recent, and the World experience with it is very limited. Therefore, there are no long-term results.

  • Considerable weight loss of 50-65% of excess body weight within 12-18 months.
  • Heavier patients (BMI >45 kg/m2) don’t do as well as lighter patients and are more likely to fail in achieving satisfactory weight loss.
  • Weight loss is associated with marked improvement or resolution in health conditions related to obesity, particularly type-2 diabetes, hypertension, gastro-oesophageal reflux, obstructive sleep apnoea, asthma, liver disease, high cholesterol, and painful osteoarthritis.
  • Improvement in overall physical and psychological health

As with any surgical operations there are associated short and long-term complications such as prolonged vomiting, late stomach obstruction, stomach perforation and leak (less than 1%), internal bleeding, blood clot in the legs (deep vein thrombosis; DVT), blood clot in the lung (pulmonary embolism), infection, and weight regain.

Professor Basil Ammori (based in Manchester, UK) always gives his personal number to all his private patients (this is in addition to the contact numbers of the bariatric nurse, dietitian and the ward) so that they might reach him without delay in case of emergency.

As this operation is relatively new, here are no long-term data available. However, as with other weight loss operations, there is the potential for durable weight loss but some patients are likely to stretch the stomach and regain weight. It is essential therefore to adopt a new life style and carry it on for a durable result.

Modern life, stress, long hours and irregular eating times, I have for years been overweight, I never wanted to admit I was obese, but I was and I felt tired all the time and hated the affects it was having on me and indirectly on my friends and family.
Diets alone and trying to change my lifestyle wasn’t working, so I looked into weight loss surgery as a new helping tool to get me on the right track, I didn’t’t feel I wanted to go the whole way with bypass or sleeve surgery but needed that kick start to a new me or an older slimmer version. I discovered Plication or wrap surgery on the internet a few years back but this was only done in American or some parts of Europe and as much as they are probably all great places and companies to deal with I wanted to stay firmly at home for something like this. Then earlier this year wow Dr Ammori was starting to do plication surgery in the UK. A quick phone call later and I’m sitting in his office discussing treatment and booking myself in for the procedure. Meeting in person gave me the right feeling and calmed those nerves about having surgery. Time flew and I had the surgery early in October all went well and I was up and walking about the following morning, feeling a little sore but fine. Well its now coming up to 6 weeks post-surgery for my check-up appointment and I have already lost 20kg (that’s a bag of cement) I feel great, sleep much better and for less hours, have more energy than I have had in a long time and people have commented on how much healthier and younger I look and being in my 40’s that’s good.
people have commented on how much healthier and younger I look and being in my 40’s that’s good.

Overall the care I received and support that I still have is first rate, everyone I have come into contact with from the hospital staff to the dietician and members of Dr Ammori staff have been very professional, relaxed and friendly. Thank you all from me Andy K