Banded Plication?

[FXDF2008 14]

I went to the surgeon who originally placed my lap band today to talk about the surgery I need to have to remove it due to erosion and subsequent revision surgery. I had my head completely reconciled with having vertical sleeve revision and then he threw in a new option.

For the past year, he has been doing banded plication surgery. In my particular situation, due to the erosion, we would do the surgery to remove my band first, give my stomach time to heal, and then I would have a second surgery to revise to the banded plication.

For those of you who are not familiar with this procedure, it involves folding the stomach in on itself and stitching it to achieve a sleeve like effect. This is a similar procedure to the old stomach stapling procedure but much more effective due to technique and the usage of sutures as opposed to staples. Then, he will place another band at the top of the sleeve thereby essential having two weight loss surgeries at one time.

My understanding is that the plication is better for achieving immediate weight loss, the band is better for long term weight loss. Combining them is essentially the best of both worlds with a few added benefits.

First, because you have restriction from the plication, you don't have to fill the band as fast or as much in order to achieve satisfactory restriction.

Second, because of the more slender shape of the stomach, incidences of slippage are greatly reduced.

Third, there is no need to dissect 90% of your stomach.

Fourth, if you do have a problem with the band, it can be removed and you will still have restriction from the plication.

As always, there can be complications. Sutures can come undone. There can be necrosis of the upper part of the stomach right below the band. My understanding is that so far, the complication rate is extremely minimal and weight loss results have been comparable to the sleeve.

I have to admit that the thought of not having to cut my stomach is appealing to me. At the same time, the thought of putting in another band after my first one eroded is a little unnerving. My surgeon is not pressuring me to do either one. He wants me to do what I'm comfortable with but he is very excited about the results he has seen with this surgery.

I am 52 and this is more than likely my last chance at getting to be where I want to be. This is still considered to be investigational and is not covered by insurance but I believe the majority of the costs will be covered by research study funds.

I have complete confidence in my surgeon. He secondary specialties are liver transplants and pediatric surgery and he is always at the cutting edge (pardon the pun) of the latest and greatest bariatric surgeries. I just want to do the right thing for me.

My instinct is to let him get in there and take out my band, take a look around and see what kind of damage my band did to my insides. Then, make a more educated decision about which surgery would be right for me. As an aside, he completely refuses to do gastric bypass.

What would you do??

[IowaAndy 95]

Interesting.....never heard of that one but keep me posted. I had my band removed and the sleeve done. Happy with the results so far.

[Cobrargc 25]

Wednesday I spoke with the surgeon that will be going my sleeve. He does not do the plication sleeve nor recommend it. He said the surgery is nothing more than the old "stomach stapling" surgery that was done and discontinued many years ago. They've replaced the staples with stitches is all. The stomach, since it is still "whole", is subject to stretching as it was in the early days with stapling. I was considering having the plication surgery, but have decided against it. I am doing the regular sleeve instead.

I'm sure there are success stories out there, but the procedure seems to be too new to see any long term results.

Good luck with whatever procedure you chose.

[M2G 1,836]

This is just my opinion and that is what you asked for.

I would NOT do the band OR the plication and I certainly wouldn't do them together. I personally don't believe that the band is a permanent weight loss surgery. I feel as if it has a shelf-life, due the the incidences of erosion, slipping, ports flipping, tubing cracking, etc. I believe that most people WILL not keep their bands until they are in their 90's.

As far as the plication alone as a WLS, I don't think that it has proven to be as effective as the sleeve. But time will tell as it is still such a new surgery. I personally (again JUST my opinion) do not like the idea of the stomach being folded on itself. I know for a short period of time that surgery can be reversed, but I think after the window closes, then it is permanent. I don't like the idea of my tissue being folded and growing together and there are incidences of the tissue not being folded correctly and dying (the necrosis that you mentioned.) But of course their are risks with ANY WLS or any surgery for that matter, and you may not be one that ends up with a necrotic stomach tissue.

Now, putting them together, the banded plication is definitely new and I'm sure that there are success stories out there. I just worry that anything dealing with a band is temporary. I know that people have a hard time with cutting and losing a good portion of their stomach, but once you are healed, you are done. I do not lay awake at night worried that my sleeve won't hold or that I will need another future surgery to fix or otherwise replace my sleeve (like many have had to do with the band.)

I think you are wise to do your research and learn all that you can. I know for me I wanted ONE surgery and to be DONE.