Laparoscopic gastric wrap (greater curvature plication)

The surgery is performed in an operation theatre under general anaesthesia and lasts about 1 or 2 hours. The procedure involves insufflation of the abdominal cavity with CO2 under standardized, precisely determined conditions, which allows to insert an endoscopic camera and several long special operation tools through the abdominal wall with which it is possible to move aside the left liver lobe. Short gastric vessels are devided starting 5 cm from pylorus and continue along  the greater gastric curvature up to the left diaphragmatic crus. After  the fundus and gastric body are completely mobilised, the greater curvature is folded inward with 2 lines of suture to create a large intraluminal gastric fold. The gastric volume restriction is similar to sleeve gastrectomy  but  without  any gastric resection. After the surgery, the usual procedure is to keep an abdominal drain for one day.

What happens after the surgery?

In the evening after the procedure, patients may usually drink, sit up, get up and even walk with the help of other persons. The usual total hospitalization time is 3 days at the maximum. Pain occurring in the post-operative phase is mostly insignificant and, of course, it is suppressed, so the patient does not have to feel any pain at all.  

Patients  usually report early satiety during meals and pain with any overeating. There is shorter experience  with  this procedure than with sleeve  gastrectomy,  but  early result of weight  loss are similar.

What complications may occur?

Complications during the laparoscopic gastric greater curvature  plication  occur very rarely, nevertheless they may occur – just like in case of any other surgery. Possible complications are: abdominal bleeding, perforation of internal hollow organs, infections, wound healing disorder, venous thrombosis and lung embolism, allergic reaction or any other complication during surgery under general anaesthesia. The patient has to consent to performance of a traditional invasive procedure instead of laparoscopy or to his/her transfer to a larger hospital or, as the case may be, to blood or plasma transfusion, if necessary. Mild to moderate nausea is often,  but  usually resolve within 2 weeks  after operation. Gastro-esophageal reflux  symptoms are possible,  with good effect of conservative  treatment. .

Can the risk of complications be reduced?

To ensure a smooth progress before and after the surgery we carry out many preventive examinations. During hospitalization, the patient is given an antibiotic, anti-stress ulcer medication, analgesics for pain and heparin for thrombosis and embolism. Statistics have shown a lower occurrence of complications and a shorter operation time in patients who managed to lose weight before the surgery. Therefore all patients are recommended to reduce their weight before the surgery by keeping a strict low-fat diet with energy intake of 4,000kJ, increased proportion of proteins up to 40-50% and a significant reduction in the proportion of carbohydrates to 30% from the usual 50-60%. Elimination of carbohydrates will lead to the consumption of the reserves in the liver and, by extension, to reduction of the size primarily of the left liver lobe, which will give a much better access to the stomach during the surgery. To avoid reduction of muscle mass, the diet has to be rich in proteins. The intake of liquids, minerals and vitamins must not decline. This is a concrete way how patients themselves can contribute to a safe progress of their bariatric surgery.

Further post-operative treatment

The patient is discharged (as a rule on 3rd day after the surgery) with the recommendation of a liquid diet therapy – liquid food taken in small portions about 5 times a day. Postoperative  use of proton-pump inhibitors (PPI) once a day is recommended for 1 month. Patients with diabetes, who were on medication reducing blood sugar levels usually have their glucose values dropping to the limit, therefore they have to consult their further therapy with their nutritionists. Also in case of insulin-treated diabetes the dosage has to be adjusted after gastric band procedure. Hypertension does not usually require any immediate change of treatment after a bariatric surgery. After the gastric greater curvature plication, it is recommended to inform your general physician, nutritionist and also an internist – obesity specialist about your condition. 

Post-operative checks involve: removal of stitches 7-14 days after the surgery.

To know if you are a suitable candidate for this procedure, please fill in the medical questionnaire. After having information about you we will be able to offer the best procedure, the best price and the operation date for you. Thank you for your cooperation.

Your SurGal Clinic team