What is lap-band over gastric plicaton?

[PhotoNut]

I was recently invited to sit on Allergan Lap-Band Patient Executive Council and attended the first symposium last week in San Francisco. During the meetings, we were told about the upcoming clinical trials of a procedure called Band Over Plication (BOP) which sounds very exciting. I'll share that information with you and open the discussion for question and answers. If I don't know the answer to a question, I know where to get the answers!

Plication is weight loss surgery procedure that is similar to the gastric sleeve. The primary difference is that with plication there is no cutting or removal of the stomach. The greater curvature of the stomach is folded inward and then stitched into place to form the sleeve. This procedure has been used as a stand alone weight loss surgery with results equal to the sleeve or gastric bypass. However, after a few years, the surgery typically fails due to stretching of the plicated stomach.

Band Over Plication is a fairly new idea which is currently in clinical trials, led by Dr. Helmuth Billy, in Los Angeles. In this procedure, the stomach is banded and then plicated. Typically, the band needs no adjustment as the plication offers rapid initial weight loss. Once the weight loss from plication begins to slow or stop, band adjustments are made to either continue weight loss or assist the patient with weight loss maintenance by providing the restriction that the plication no longer offers.

No staples are used, and there is no cutting of the stomach, so it should be fully reversible.

I spoke with Dr. Billy at length regarding the potential benefits of plication for a person who was already been banded but has struggled with their weight loss. He felt that it would be an excellent choice for someone who has followed the bandster rules but still struggled to lose weight because of genuine hunger. He said that those who are not losing with the band because of their unwillingness to follow the bandster rules would see no real benefit from the surgery, which makes sense to me because if the band doesn't stop ice cream and candy from going through, then neither will a plicated stomach.

This new method of combining the lap-band with gastric plication will offer patients a faster rate of weight loss in the first year or two where we have seen the greatest amount of overall weight loss. I was also very excited about this surgery as an alternative form of revision for people who have been banded but have struggled with extremely slow losses because of the hunger issues.

I look forward to hearing more about the clinical trials, and will keep everyone informed on the data coming from Dr. Billy's patients. In the meantime, here are a few links which offer more information on plication. Keep in mind that most of these sites are focused on plication as a stand alone procedure.

Bariatrics & Metabolism Initiative (http://www.bmi-india.com/gastric-plication-a-new-wls-procedure/)

A doctor's description of the plication procedure along with a video of the procedure being performed. More information can be found by reading the discussion posts below the video.

Laparoscopic gastric plication for treatment of severe obesity (https://weightloss.clevelandclinic.org/images/file/Articles/Laparoscopic%20Gastric%20Plication_inpress.pdf)

A report published with the American Society for Metabolic and Bariatric Surgery in September 2010.

[MoOrLess]

I'm definitely going to read up and watch the video...I would think this might be a good answer for people who can't exercise consistently due to disability issues (like me!) and will be following this idea. It gives me hope.

from the first link: some things to know and consider....surgery IS surgery, afterall

"Lap Gastric Plication
In the same vein, if someone wants to reverse the procedure, the stitches may be removed by laparoscopy (making this a potentially reversible procedure like the Lap Band), though this would neither be a good thing nor a great experience!
Some patients have significant reflux symptoms after LGP, as after the sleeve, as we have discussed before.
It is possible that the stitches may give way later and hamper the weight loss, but preliminary results, as presented in the recent International Conference of Obesity in Stockholm, show good results akin to the sleeve."

From the second link: important criteria - we really do need to educate ourselves prior to having any surgery and these are good things to know:

"Exclusion criteria
The exclusion criteria included pregnancy or lactation at screening or surgery, a documented history of drug and/oralcohol abuse within 2 years of the screening visit, previous malabsorptive or restrictive procedures performed for the treatment of obesity, the participation in any other investigational device or drug study (nonsurvey-based trial) within 12 weeks of enrollment, and any condition that would preclude compliance with the study. Such conditions included inflammatory diseases of the gastrointestinal tract within the previous 10 years, congenital or acquired anomalies of the gastrointestinal tract (e.g., atresias or stenosis), severe cardiopulmonary disease or other serious organic disease making the subject a high-risk surgical candidate, uncontrolled hypertension, and portal hypertension. Additional exclusion criteria included treatment with 50 U/day of insulin, chronic or acute upper gastrointestinal bleeding conditions
(e.g., gastric or esophageal varices), cirrhosis, congenital or acquired intestinal telangiectasia, esophageal or gastric disorders (i.e., moderate severe preoperative reflux, dysmotility, or Barrett’s esophagus), hiatal hernia, previous surgery of the foregut (i.e., hiatal hernia repair or previous gastric surgery), pancreatitis, an immunocompromised status or autoimmune connective tissue disease, and the use of prescription or over-the-counter weight reduction medications or supplements within 30 days of the screening visit or during study participation."

I appreciate having this information, it is so important that we all make decisions by being "informed"

thank you Susan for posting about this surgery :)

[PhotoNut]

You're absolutely right, Mo. Before jumping into any decisions one should fully educate themselves about every detail of the surgery. Just so everyone knows without a doubt - I am not supporting this surgery, yet. I do have high hopes for the possibility of it's success because it would offer many people an alternative to more radical surgerys, which are all known to fail over time. So at this point, I am approaching this subject with curiosity and hopefulness. As I previously said, I will be passing along more information as the clinical trials progress.

There is a lot to learn through further collection of data. It will be interesting to see how things progress. Dr. Billy told me that they are still in the early stages of determining just how much of the greater curvature of the stomach should be folded in and how best to place the sutures. It will be purely expermental in the early stages, though they already have some good data to go on based upon the results of the stand alone plications. What excites me is that there is no removal of the stomach - no cutting, no staples.

I believe that the exclusions were based on the criteria for the clinical study, which is not uncommon because they are trying to collect unhampered data regarding the success of the surgery. I believe that many of those listed issues would also be game changers for people seeking to be banded.

It will be interesting to see if the band over the plication will resolve any reflux issues. Remember, the information that is being reported to date is primarily based upon the stand alone plication surgery.

As for the removal of the stitches.. unless there was a medical complication that required the removal, I'm not sure it would ever be necessary. Over time the plicated stomach will stretch out again, and the stitches will either work their way out or break. The doctors are fully aware of the limited time frame of success with plication.

[MoOrLess]

Interesting points Susan - about reflux with plication vs reflus and lapband w/plication...I caught that on my first read of the study also -- and the fact that it is a short-term frame of time -- without a lap band - then what? Would the patient re-gain their weight? It's definitely a lot to ponder and watch and learn about. But it's also exciting.