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Gastric plication is a laparoscopic weight-loss operation in which the stomach wall is folded in on itself from outside and held with one or two rows of stitches, so the cavity narrows and holds less food. It differs from sleeve gastrectomy in that **no part of the stomach is removed and no cutting stapler is used**, and from gastric bypass in that the intestine is not rerouted. Its apparent appeal is that nothing is cut or removed and that it can, in theory, be reversed. That does not make it a first choice: **long-term results are less well documented and less durable than sleeve gastrectomy**, and it is performed less often in centres worldwide. Its particular complications include the fold coming undone or settling out so the cavity widens again, obstruction, twisting or fluid collection, and nausea and vomiting that last longer in the early weeks than is usual after a sleeve. What the operation does not do: it does not tighten loose skin or remove localised fat and it is not a cosmetic procedure. It does not treat binge or emotional eating without psychological, behavioural and dietetic support. It does not guarantee the loss you have seen in someone else. And it does not replace a permanent change in the type and amount of food eaten and in physical activity. Anyone who continues with liquid calories and soft, energy-dense meals may not lose weight however well the surgery was done. Candidacy is determined by multidisciplinary assessment: a bariatric surgeon, a dietitian, psychological evaluation, blood tests and an upper endoscopy, with a frank discussion of every alternative and its advantages and drawbacks. **Clinical examination is what decides whether the procedure suits you**, and commitment to long-term follow-up is what separates a lasting result from one that fades.
Body mass index is calculated and coexisting problems such as diabetes, sleep apnoea and reflux are reviewed, with blood tests, upper endoscopy and nutritional and psychological assessment. The differences between plication, sleeve, bypass and endoscopic options are made clear before any decision.
The operation is performed under general anaesthesia through several small abdominal incisions with carbon dioxide insufflation. The laparoscope and instruments are introduced, and the stomach and diaphragm are inspected for a hiatal hernia that may need repair in the same session.
The vessels and attachments along the greater curvature are carefully divided while preserving the blood supply of the wall. This mobilisation allows the wall to be folded inwards without excess tension and is a step that demands precision to limit bleeding risk.
The wall is invaginated into the stomach cavity as a longitudinal fold and secured with one or two rows of non-absorbable sutures along its length. A calibration tube inside the stomach is used to set the remaining capacity and to avoid excessive narrowing.
The fold, the suture line, and the absence of leak or twisting are verified endoscopically or with a dye solution, then the incisions are closed. The patient is monitored for one to two days and starts a staged diet with scheduled dietetic and periodic follow-up.
Tell the team about every medicine and supplement, especially blood thinners, diabetes drugs, contraceptive pills and heartburn medicines, and do not stop or adjust a dose yourself. Mention drug allergies, previous abdominal surgery and any past problem with anaesthesia or clots in the legs. Complete blood tests, upper endoscopy and the nutritional and psychological assessments and bring the reports. Follow the preparatory diet if one is prescribed, since it shrinks the liver, eases laparoscopic work and reduces complications. Stop smoking before and after surgery. Follow the anaesthetist's fasting instructions. Arrange a companion and about two weeks off work, prepare fluids, protein supplements and a weighing scale at home, and book your first dietetic follow-up before the operation.
Nausea, vomiting and a full feeling are more common and last a little longer after plication than after a sleeve; take the prescribed anti-nausea and stomach-protective medicines and do not neglect fluids. Follow the staged diet under dietetic supervision: clear fluids, full fluids, puree, soft food and then solids over several weeks, sipping small frequent amounts spread through the day. Chew thoroughly, stop at the first sense of fullness, and avoid fizzy drinks, straws and liquid calories. Take the prescribed vitamins and minerals and keep up with follow-up blood tests. Walk from the first day to reduce the risk of clots and increase exercise gradually with your surgeon's approval. **Seek care immediately for: severe or increasing abdominal pain, fever, rapid heartbeat, breathlessness or chest pain, persistent vomiting or inability to drink fluids, vomiting blood or black stools, or pain with redness and swelling in the leg.**
Usually 60 to 90 minutes, with a hospital stay of one to two days.
الدكتور داوود محمود داوود — استشاري جراحة السمنة والمناظير والجراحة العامة في الأردن، وحاصل على البورد الأردني في الجراحة العامة، وعضو في جمعية الجرّاحين الأردن…
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