Gastric Plication

• The major curvature of the stomach is released.
• The stomach pouch is folded into two consecutive layers.
• The folds are fixed with permanent suture material.
• The first line of points plica 85% of the bag. The second dotted line occupies 15% and protects the main line from possible reopening.
• When the stomach is full, the points betray from the outside, homogeneously, preventing failures.

• Stomach capacity decreases: the patient feels full with what fits in a dessert plate.
• The stomach loses the ability to distension, avoiding excessive intake.

• It forces the patient to change their habits, eating 5 times a day.
• Digestive function is normal.
• Everything you eat is absorbed.
• It is not necessary to take dietary supplements.

• Excessive and repeated intake could open up part of the plication, increasing gastric capacity.
• Patients should take care of themselves and limit the maximum amounts of intake for life.
• Technique under clinical supervision.

• Both techniques are definitive.

In the Gastric Plication:

• The stomach is NOT sectioned.
• In case of repeated abuse it could be partially opened over the years.
• No experience for more than 10 years

In the Gastric Sleeve:

• Cut off the bag.
• The possibility of dilations is much less.
• The decrease in Ghrelin is greater.
• Long-term weight loss is greater than in Gastric Plication.
• More than 10 years of experience.

Gastric Plication by Mini-invasive Laparoscopy (PGL)

• It is a procedure that is considered definitive.
• It is performed by mini-invasive laparoscopy and general anesthesia. First the greater curvature of the stomach is released from its attachment to the epiplon or "fatty apron", and that allows the plication or invagination of the stomach. An orderly double intussusception of the gastric pouch is carried out by means of transmural and continuous stitches, distributing the tensile force throughout the tissues in a homogeneous manner.
• A homogeneous, solid and PERMANENT tubular shape is achieved. (The stitches do not break the tissue over time as is the case with the Endoscopic method).
• There's no nooks and crannies in the stomach. It can be explored by gastroscopy.
• It is a definitive technique, although no studies have been carried out for more than 7 years.
• The stitches may "loosen" in the fundus area in 10 - 15% of cases, due to the patient forcing and vomiting.

Endoscopic Gastric Plication (EGP)

• It is not a definitive procedure (therapeutic efficacy of about 18 months).
• It is performed by endoscopy and general anesthesia. Due to its duration and technical difficulty, it is necessary to perform the procedure in the operating room and under general anesthesia. It has a duration similar to the Laparoscopic Gastric Plication.
• When performed by endoscopy, the major curvature of the stomach cannot be released, so a true orderly plication of the pocket is NOT performed, but one that are points that join the anterior face with the posterior face of the stomach, trying to achieve a tubular form of the residual stomach.
• When the stomach fills with food, the tension pulls on each independent point that joins both sides of the stomach, until over the months the points are released and the stomach returns to its original size.Endoscopic Gastric Plication lasts about 18 months and the stomach returns to normal size ALWAYS. This time can be longer or shorter, depending on the patient: a good discipline avoiding excessive intake can allow a much longer durability of the restriction.
• As the stomach is not plicated but facing or united the anterior and posterior walls, it can produce bacterial overgrowth, gastrictis..., etc., which may require pharmacological medical treatment.

• Patients with still not very advanced obesity (BMI 35 to 40).
• With BMI between 31 and 35, if the patient suffers from diseases that would improve or cure with weight loss (surgery out of protocol, requiring a detailed study).
• Large eaters, little peckers and few sweets, and willing to change habits.
• Ability to be active, and willing to change habits
• Little family burden of obesity.
• High-risk patients who need a simple operation.