anastomoses. Although internal hernias (due to the
multiple defects created) are routinely closed, their
high incidence from potential leaks from several
gastrointestinal anastomoses, and the prolonged
operating times associated with internal hernias,
have been the source of concern. Reported prospective evaluations of both operations are unavailable,
though they are used internationally.
GP and BGP
Gastric plication (GP), first reported in the U.S. in
the 1970s and repopularized in Iran by Talebpour
in 1999, is an SG that is formed by plicating and/
or infolding the greater curvature of the stomach vertically with nonabsorbable sutures after
the omentum has been transected (see Figure
16A, page 45), as in the regular SG. No transection or resection of the bowel is involved in this
operation. 42-44 Because no staples are used, it is
less expensive and can be performed in parts of
the world where availability or affordability of
staples is a problem. This operation results in
anatomy similar to the SG and the laparoscopic
adjustable banding operations. The main proponents of this operation claim that it saves costs as
a result of not using stapling devices and the complete reversibility of the operation. We now know
from multiple revision reports of GP to SG or
GB that its reversibility is questionable and is no
longer the main reason that this operation is performed. It requires the same amount of time as
an SG and carries essentially the same risks (
perforation, bleeding, and portal vein thrombosis).
Banding the GP operation is akin to banding the
GBP or SG (see Figure 16B, page 45). 45 The band
used with a SG is an adjustable band. Banding
the plication is based on the experience with the
BGB where the banded pouch enhances weight
loss and weight-loss maintenance. The results
are better than with only GP but less than with
the surgically performed SG.
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