Gastric Plication and Gastric Sleeve are stomach surgeries which reduce stomach volume and do not involve any bypass of the small intestine. They are designed mainly for weight loss, but may also help with obesity-related diseases such as high blood pressure, diabetes, obstructive sleep apnea and abnormal cholesterol. Gastric Bypass (RNY) and Metabolic Bypass Surgery, however, involve reducing the stomach size by stapling or cutting, then cutting and reattaching the resulting pouch lower in the small intestine, bypassing the first part of the small intestine (the "foregut"). It is this "bypass" of the first part of the small intestine that is thought to provide the excellent results in reversing the Type II diabetes. This may be due to the hormonal changes that take place when the foregut is bypassed. In normal disgestion, the body produces hormones that stimulate insulin production. In diabetic patients, hormone levels can be low and cause the body not to produce enough insulin. Bypassing the foregut increases the production of these hormones, which in turn stimulates insulin production, leading to the reversal of Type II symptoms.
Gastric Plication Surgery (GPS) is an alternative to traditional lap band surgery and results in loss of 30% - 70% of excess weight within the first year. Other names for this surgery include Gastric Imbrication, Gastric Sleeve Plication, Vertical Gastric Plication, Laparoscopic Gastric Plication (LGP) and Laparoscopic Greater Curvature Plication (LGCP).
This procedure is the simplest of the weight loss surgeries and is generally an outpatient procedure. There is no cutting of the stomach, stapling or removing stomach tissue. The surgery is performed laparoscopically with only five or six small incisions in the abdomen, and patients usually return to normal activities within five days. After two weeks on a liquid diet, patients begin to add solid foods to the diet.
The technique is to fold the outer wall of the stomach on itself (imbrication), then hold it together with sutures (plication), creating a long, narrow tube-shaped stomach with approximately 70% less volume. Patients feel full after eating a small amount of food, and may also experience a decrease in appetite. Unlike the bypass procedures, this procedure does not cause decreased absorption and because the stomach is not cut and kept intact, gastric plication is reversible if necessary.
Like any laparoscopic surgery, there are risks, such as bleeding, infection, injury to other organs or the need to convert to an "open" procedure. There is also a small risk of a leak from the suture line used to fold the stomach. However, the complication rate is less than 1%. Gastric Plication requires a one-week stay in Costa Rica for pre-op testing, surgery and recovery. Package prices for the procedure and the recovery center accommodations are available.
Gastric sleeve is also known as Sleeve Gastrectomy, and like the Gastric Plication, the surgery is performed laparoscopically. This procedure is an alternative for higher BMI patients who may not be good candidates for the Gastric Plication. Patients stay one night in the hospital and five days at the recovery hotel. Like with the gastric plication, patients stay on a liquid diet for a few weeks, gradually adding solid foods.
The technique is to divide the stomach in half vertically, staple it, then remove the excess, allowing for a reduction of 85% of stomach volume. Because some of the stomach is removed, this procedure, unlike the Gastric Plication, is not reversible. There is no bypass of the small intestine as with the Gastric Bypass or Metabolic Bypass Surgery. Patients can lose 70%-80% of their excess weight within 6-12 months following the surgery. The risks are similar to the Gastric Plication, and package pricing is available.
Metabolic Bypass Surgery is designed for less-obese Type II diabetes patients. Ideal candidates are between the ages of 16 and 60, have a BMI of under 35, and have been diagnosed with the Type II disease less than 10 years. It is not appropriate for anyone with a higher BMI or with Type I diabetes. Candidates may not have a past or present history of ventral hernias, duodenal ulcers or gall bladder disease, hepatitis C, HIV, or cirrhosis of the liver. Other conditions may also prevent you from being a candidate for the surgery, and should be discussed prior to scheduling with the bariatric surgeon.
This surgery was developed specifically to give Type II diabetes patients with lower BMIs (and therefore lower weight) an alternative to full gastric bypass surgery. A less radical procedure than the regular gastric bypass, this surgery reduces stomach size and bypasses only the first 60 centimeters (about 2 ft) of the small intestine vs. bypassing a little less than two meters (about 6 ft.)
Gastric Bypass Surgery is recommended for seriously obese patients. Patients can lose up to 85% of excess weight within two years through gastric bypass, which is also referred to as "RGB".
The procedure uses the involves reducing the size of the stomach by vertical banding or stapling, leaving a small reservoir for food of approximately 30ml. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the duodenum (first part of the small intestine) as well as the first portion of the jejunum (the second part of the small intestine), approximately two meters (6 ft) of bypass in all. This causes reduced calorie and nutrient absorption, which gives the weight loss results. Because of this bypass of the foregut, this surgery also gives good results in reversing Type II diabetes symptoms. The surgery does, however, present more complications due to the large bypass involved and malabsorption issues.
Patients should be aware that the surgery severely restricts stomach size, and because so much of the small intestine is bypassed, nutrients are not absorbed as they were due to a change in certain secretions. After surgery, the patient must follow special diets and take vitamins to maintain health and lose weight properly. Diligent follow-up and monitoring are required.
Additional risks and concerns include: stretching of the reservoir pouch, breakdown of banding or staple lines (which reverses the process), leakage of stomach content into abdominal cavity, and nutritional deficiencies that can cause anemia or osteoporosis. The nutritional deficiencies are addressed by adding vitamin supplements. In some cases, patients may experience "dumping syndrome", which results from food moving too quickly through the lower intestine. Symptoms include nausea, fainting, inability to eat sweets, sweating, weakness and occasional diarrhea. Some patients are also at risk of developing gallstones due to the rapid weight loss, and medication to prevent them may be indicated.
