banded plication V. plication V. sleeve

[nikki c 16]

I had originally set my heart on banded plication. I wanted just the band, but then discovered plication and band can be combined for more immediate results (plication being faster, band for longevity). Also a plus side that, if I have problems, the plication is a great back up for the band and vice versa (can get fill if plication not working). I've been reading horror stories on here about banding, and now i'm unsure. I dont feel like the problems are widespread, however. While they are serious - I think the vast majority of bandsters have success. I feel like just plication isn't enough, and I don't want to have staples and a severed stomach (sleeve).

Do I really need both the band and the plication? Has anyone had this? I'm definitely doing plication, just unsure about the band. I know it's relatively new, but my surgeons are in love with the procedure because it's had excellent results in their practice. Both are tried and true...just up in the air, i guess. Opinions are welcome.

Thanks,

Nikki

[SC~Amanda 0]

There is a forum for plication....I had considered this becuase my surgeon said it was a new procedure but when I started reading all the complications witht he band I became concerned...then I read this post and decided against the plication altogether:

After speaking with bariatric surgeons around the country I have learned about several reports of perforation due to gastric necrosis in patients that had plication surgery. These patients have presented within the first few days of surgery and complained of severe abdominal pain. To my knowledge, there are no reports of this presenting beyond the first few days after surgery. What is unclear is why this occurs in some patients and not others. The issue appears to involve impaired blood circulation in the crowded stomach tissue that has been folded in on itself. The cardia portion of the stomach (the upper part) seems to be susceptible to this. Since plication is a new procedure, at this stage it is important to know about this as a potential complication. I will continue to post updates on this forum as we learn new information……

You should know that one of the perforations due to gastric necrosis happened to one of my patients. I have since contacted many bariatric surgeons to inform them of this and in doing so learned that there have been several other cases in other clinics as well, some of whom had their surgery outside the U.S. As soon as I learned this I posted the information on this forum as well as our plication patient's private message board.

Will I continue to recommend plication surgery? The short answer is not right now. Regarding full length plication as a primary operation I think we need more information on why some patients are developing gastric necrosis and some are not. We've had many successful plication patients with excellent weight loss. Certainly perforation is a known potential complication of stapled sleeve gastrectomy as well, but considering that relatively small numbers of plications are being performed around the world, a few perforations is too high of an incidence for me especially given the magnitude of the complication. When a perforation occurs in a plication, this stomach has to be removed, the end result of which is essentially a stapled sleeve gastrectomy.

One of the things that attracted me to the plication is that it seemed like it would avoid the possibility of perforation since there were no staple lines. These perforations are occuring through a different mechanism - compromised blood flow to the stomach. In speaking with many bariatric surgeons in the U.S. we would not have anticipated this based on our knowledge of the stomach's blood supply. We do not think this is an arterial problem (inflow of blood) - it seems to be a problem of venous congestion or impairment of venous drainage in the crowded stomach. In simple terms, if the venous blood can't flow out of the tissue, this ultimately impairs the arterial inflow of blood from coming into the tissues. The end result is necrosis of the tissue which can perforate. This is the best theory we have currently on why this has occurred.

It is possible that a much looser plication or a single row plication instead of two rows might prevent this from occurring but would likely also reduce average weight loss success. An early study in a small number of patients at the Cleveland Clinic showed that anterior plication (only plicating the front part of the stomach) had disappointing weight loss results and they subsequently abandoned the technique. It is likely that tighter plications have better weight loss but higher risk for perforation and a looser plication might reduce the chance for perforation but also reduce weight loss success.

We have not had the experience that necrosis shows up later in the post-operative course. If you currently have a plication consult or surgery scheduled I would recommend that you discuss this with your surgeon. If I learn additional important information I will post it on this forum. <BR style="mso-special-character: line-break"><BR style="mso-special-character: line-break">

Brad M Watkins MD FACS

Cincinnati Weight Loss Center

Center of Excellence

American Society of Metabolic and Bariatric Surgeons

Brad.Watkins@CincyWeightLoss.com

[nikki c 16]

There is a forum for plication....I had considered this becuase my surgeon said it was a new procedure but when I started reading all the complications witht he band I became concerned...then I read this post and decided against the plication altogether:

thanks, I saw the plication forum but there were like 5 posts altogether... doesn't seem very popular. Did you end up with VSG? I'm still unsure about having my stomach cut up and stapled...it just seems barbaric. I'll definitely bring this up with my surgeon, though. Where did you find this article?

[SC~Amanda 0]

I am scheduled to have my VSG June 13th. After many many months of consideration I have decided the VSG is the most safe and best option for me. I understand your concerns about the cutting but to me you are going to be cut regardless of which surgery you choose. With the band there is a strong chance you will need a revision surgery sometime in your banded life....I want to have one surgery and that is it....not go in knowing I will have to have my band replaced, fixed, or removed later in life.

The plication is such a new procedure I do feel comfortable with it. A surgeon posted this in the plication forum in March...i was really alarmed by it and decided I would not have this done weather i got the band or not.

Gastrectomies have been preformed for well over 50 years. I understand the fear of the cutting and removing of the stomach...I have dealt with that and feel this is the best choice with the best results.

Good Luck with you decision.

[Rainydayz 27]

Thanks for sharing that article. I haven't really considered the plication but I do like to learn all I can about the various procedures.

I was looking into the band at first as well, but decided against it after seeing so many people getting it removed and revised to sleeve or rny, and so many people having trouble eating healthy foods like meat and vegetables. I decided on the sleeve because while it is not reversible I believe that it is safe and it does away with part of the stomach that produces ghrelin. That sounds wonderful to me. With the band, rny or plication that part is still there producing ghrelin. The sleeve is the only one that gets rid of it.

But it is an individual choice. It's just good that we have resources like this board where we can see the good, the bad and the ugly then make our choice.