What is plication, including its technique, indications, contraindications, and postoperative considerations?

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Last updated: September 29, 2026 • View editorial policy

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Gastric Plication in Bariatric Surgery

Laparoscopic gastric plication (LGP) is a reversible, investigational bariatric procedure that is NOT recommended for routine clinical use, as it remains investigational according to the American Society for Metabolic and Bariatric Surgery (ASMBS) and demonstrates inferior weight loss outcomes compared to standard sleeve gastrectomy. 1

What is Gastric Plication?

Gastric plication is a restrictive bariatric technique that involves folding the greater curvature of the stomach inward upon itself and securing it with sutures, creating a tubular gastric pouch similar in shape to a sleeve gastrectomy—but without actually removing any stomach tissue. This makes the procedure theoretically reversible, which distinguishes it from sleeve gastrectomy.

Technique

The laparoscopic greater curvature plication involves:

  • Laparoscopic approach with standard port placement
  • Inward folding of the gastric greater curvature
  • Suture fixation to maintain the plication
  • No gastrectomy or tissue removal
  • Can be combined with laparoscopic adjustable gastric band (LAGBP) for enhanced effect

Current Evidence and Limitations

Weight Loss Efficacy

The procedure demonstrates significantly less weight loss at 2 years compared to conventional sleeve gastrectomy 1. This inferior outcome is the primary reason for its limited adoption.

Combination Approach

When LGP is performed with adjustable gastric banding (LAGBP), outcomes improve:

  • Greater weight loss at 36 months compared to LGP alone
  • Less band slippage compared to banding alone
  • Weight stability maintained beyond 1 year (unlike sleeve gastrectomy where weight regain begins at 1 year) 1

Indications (Investigational Only)

Given its investigational status, LGP should only be performed in research protocols. Theoretical candidates would include:

  • Patients seeking reversible bariatric intervention
  • Those concerned about permanent anatomic alteration
  • Patients willing to accept lower weight loss outcomes

Contraindications

Absolute contraindications:

  • Any patient seeking standard-of-care bariatric surgery with proven efficacy
  • Patients requiring maximal weight loss outcomes
  • Those with severe obesity-related complications requiring aggressive intervention

Relative contraindications:

  • Gastroesophageal reflux disease (GERD)
  • Previous gastric surgery
  • Unrealistic expectations about weight loss outcomes

Why LGP Has Not Gained Acceptance

The procedure has not gained popularity in the United States for several critical reasons 1:

  1. Inferior weight loss compared to sleeve gastrectomy at 2-year follow-up
  2. Lack of long-term outcome data on durability and complications
  3. Investigational status by ASMBS—not an endorsed procedure
  4. Availability of superior alternatives (sleeve gastrectomy, RYGB) with extensive safety and efficacy data

Postoperative Considerations

If performed in a research setting, postoperative management would mirror standard bariatric protocols:

Nutritional Management

  • Protein intake: minimum 60-80 g/day or 1.0-1.5 g/kg ideal body weight 2
  • Texture progression specific to the procedure
  • Slow eating, thorough chewing, avoiding drinking with meals 2

Supplementation

  • Lifelong vitamin and mineral supplementation required
  • Monitor for deficiencies: iron, folate, vitamin B12, vitamin D, zinc, copper, selenium 2
  • Risk of thiamine deficiency in early postoperative weeks, especially with vomiting 2

Pharmacologic Prophylaxis

  • Proton pump inhibitors: Consider for 3 months to reduce marginal ulcer risk (though data specific to plication is lacking) 2
  • Ursodeoxycholic acid: 500-600 mg for gallstone prophylaxis in patients without preexisting gallstones 2

Clinical Bottom Line

Do not perform gastric plication outside of approved research protocols. For patients seeking bariatric surgery, recommend evidence-based procedures with proven efficacy: sleeve gastrectomy (58% of US procedures) or Roux-en-Y gastric bypass (18% of US procedures), which have extensive safety data, superior weight loss outcomes, and established postoperative management protocols 1.

The theoretical advantage of reversibility does not outweigh the documented inferior weight loss outcomes and lack of long-term safety data. Patients deserve procedures with the highest likelihood of achieving meaningful, durable weight loss and resolution of obesity-related complications.

References

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This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.