Gastric Plication

[kirstabelle]

Hi all,

I have tried to research this but I trust all of you more than I do what I find. So......
Sleeve is back to pre-op levels of restriction a.k.a none..... unless I eat too much rice which I only eat rarely.

What are your thoughts and experiences on plication?

TIA

K

 

[Elizabeth N.]

The plication is new, experimental, unproven. I would be MEGA wary of such a procedure.

How about considering a "resleeve" instead? (Assuming, of course, that you have gained enough weight to justify the risk of another surgery.)

 

[kirstabelle]

Thanks Elizabeth,

I contact the surgeon and he responded as below.
When indeed there is a dilation of the sleeve than you have two possibilities:
1. A re-sleeve with stapler (this is an expensive procedure and the complication risk is high, leak)
2. A plication of the sleeve, in this case we need no expensive material and the risk for a leak is low. But on this time we don’t know the results on long term.

I found this paper on long term results for plication:
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3444326/

 

[Elizabeth N.]

What ho, N of 800! That's a decent size study. Now to look at the other numbers and bits of info....

• The mean EWL 5 years out was a mere 55%. That would have left me more than 100 lbs. overweight and very pissed off.
• Although this paper claims to be a 12-year followup, the mean followup was only five years. That's one of those bits of information that makes a stats class a worthwhile investment . (Don't mind my editorializing; I'm doing a bit of self-soothing because a thought about my student loan just popped into my head.)
• The poor SOB's who had the surgery were expected to live on 800 calories daily. That's about what people in Nazi concentration camps got fed.
• Look at Table 3 to wonder about the quality of the long term followup data. This is pretty typical of a long term study; I'm not sneering at the tiny number of patients followed the whole 12 years. BUT it's important to understand that with the normal attrition of participants over time, this has an impact on the data. For example, I have to wonder if their 5-year EWL of 55% might be artificially high due to participant attrition. If *I* had regained most of my weight after WLS, I don't know if I would show my face for a long term followup assessment. Just something to keep in mind while you're reading this stuff...
• I'm scratching my head at Table 6. Maybe MO Iranians have fewer comorbidities than do MO North Americans..... Hmmm.
• I don't see one single mention of complications occurring further down the road. Don't believe for a minute that this is because there were no complications to report. This is a weakness of the study and worthy of further assessment.
• The statistical analyses in this study were simple means and percentages. This was clearly sufficient for the authors' purposes, but I just want to caution that this is a limited amount of information.

Okay, those are my thoughts on a quick read-though. (EDIT) Duh, I just looked at your sig line, so I had to change my comments about VSG and DS .

If I were in your shoes, depending on the amount of regain/return of co-morbidities, I'd be thinking about a resleeve or even a full DS-to-stouter-DS revision. I would NOT be comfortable going with a procedure like gastric plication.

 

[kirstabelle]

Thanks for having a look and for your comments.
I am 10yrs post op DS. SW was 378 Got to 210 for about 1 week. Maintained 220 for the next 5 years and have gained 35 in the last two years. I have no restriction at all and I am scared.

 

[Elizabeth N.]

Thanks for having a look and for your comments.
I am 10yrs post op DS. SW was 378 Got to 210 for about 1 week. Maintained 220 for the next 5 years and have gained 35 in the last two years. I have no restriction at all and I am scared.

Yeah, I'd be scared too. It sounds like you didn't get the most wonderful results on the planet from the outset :-(. All the more reason to be considering a full DS revision. What does your insurance situation look like? You paid cash for your original surgery, right?

 

[kirstabelle]

You mean have cc shortened too?

 

[Elizabeth N.]

If I were doing it, I'd want my intestinal configuration redone "Hess method," which is alimentary limb 40% of total length, BP limb 60%, with 10% of alimentary limb being the CC length.

 

[huneypie]

Hi Kirstabelle, what's your current CC? Who are you considering for a revision?

I read that reductions in stomach size seem to generate superior results over shortening the length of the common limb. Of course the 2 together would be most effective.

This stat on the plication may be of interest:

"overall weight loss was considered satisfactory in 78.6% of the patients who underwent gastric plication and in 97.5% of those who underwent sleeve.

http://www.skrekas.net/surg_hemstatistics.htm"

It's a question of stacking the cards in your favour and a re-sleeve/CC shortening is more likely to give you the outcome your looking for.

 

[kirstabelle]

Understood Elizabeth.
I've been speaking to Jacques Huney Pie. NHS won't touch me and any surgery looks to be out of my reach financially.
I think the sensible option at this point is therapy which my insurance will cover.
Thanks
K

 

[huneypie]

Dr Baltasar in Spain is a fan of re-sleeving, but he's expensive so that's another option you could explore.

 

[huneypie]

Dr Sonneville in Belgium is a good price, but I think he likes a 100cm CC. Bugirl had him so she should be able to give you more info on him (I'm not sure if I've seen her on here yet).

 

[Larra]

I didn't read the article carefully, so just a couple thoughts...

1. the average weight loss was much higher after 1 or 2 years than it was at 5 years - I think 70% which then dropped to 55%. My best explanation for this is that a plicated stomach can stretch out, just as a sleeve can. There is nothing magical about this procedure.

2. the patients in this study were not re-do's from prior sleeves or other bariatric operations, they were first timers. Do their results, even somewhat mediocre, apply to you, as a re-do? No way to know.

 

[Elizabeth N.]

Understood Elizabeth.
I've been speaking to Jacques Huney Pie. NHS won't touch me and any surgery looks to be out of my reach financially.
I think the sensible option at this point is therapy which my insurance will cover.
Thanks
K

If only money were no object....In so many parts of life.