Is gastric sleeve surgery safe or does it carry risks

Gastric Plication Surgery has become one of the most popular weight-loss surgeries because it offers a relatively safe way to lose weight. However, it always raises an important question: Is it risky?The procedure works by reducing the size of the stomach without removing any part of it, making it less invasive than some other bariatric surgeries. Nevertheless, like any surgical procedure, complications can occur if the patient doesn’t follow the doctor’s instructions or has pre-existing health conditions. we’ll discuss the risks of gastric plication, its benefits, who qualifies for the surgery, and when it is considered safe, so you get a complete idea before considering the procedure.

What is Gastric Plication?

In recent years, Turkey has become one of the top global destinations for obesity treatment and weight-loss surgeries. Among these innovative procedures, gastric plication stands out as a safe and effective option for those seeking a healthier life and ideal weight.

Gastric Plication: A Simple Definition

Gastric plication, also known as non-surgical sleeve or internal stomach folding, is a medical procedure aimed at reducing the stomach size without removing any part of it.
Using endoscopic techniques, the surgeon folds the stomach walls inward and secures them with special stitches that reduce its capacity, allowing the patient to eat smaller amounts of food and gradually lose weight.

Difference Between Gastric Plication and Stomach Folding

There is no difference between the terms “gastric plication” and “stomach folding”—both refer to the same procedure.
The main goal is permanently reducing stomach size, which helps control appetite and safely lose excess weight.

Advantages of Gastric Plication

No part of the stomach is removed.
Less invasive compared to traditional sleeve gastrectomy.
Relatively faster recovery period.
Effective in improving weight and overall health.

Stomach Shape After the Procedure

After gastric plication, the stomach changes from a large, extended shape to a smaller, folded form.

Stomach volume is reduced by approximately 30–70%, limiting the amount of food per meal.
Unlike surgical sleeve gastrectomy, the stomach remains fully intact but folded inward with permanent stitches.
The stomach continues to function normally, including digestion and secretion of digestive juices.

Weight Loss After Gastric Plication

Patients typically lose about 15–20% of total body weight in the first year.
Results largely depend on adherence to a healthy diet and regular physical activity.

Is Gastric Plication Risky?

Gastric plication is relatively safe compared to traditional bariatric surgeries, but like any surgery, potential risks include:

Infection
Bleeding
Anesthesia complications

Safety depends heavily on:

The surgeon’s expertise
The patient following post-operative instructions

When Do Results Appear?

Results appear gradually after the procedure.
Noticeable weight loss typically occurs within 6–12 months, especially with a healthy diet and lifestyle.

Suitable Age for Gastric Plication

Recommended for adults 18–60 years old.
Suitable for patients with obesity (BMI ≥ 30) who have not succeeded with traditional weight-loss methods.
A full medical evaluation is necessary to ensure safety.

What is a Stomach Filler?

A stomach filler is a non-surgical procedure in which a gel-like material is injected into the stomach via an endoscope.

It temporarily reduces stomach volume, helping the patient feel full faster.
Effects last 6–12 months.
Suitable for people with moderate weight gain.

Success Rate of Gastric Plication Revision

Depends on patient commitment to a healthy lifestyle and adherence to medical advice.
About 85% of patients achieve positive weight-loss results and improved symptoms after revision.

Difference Between Sleeve Gastrectomy, Gastric Resection, and Gastric Plication

Procedure	How it Works	Reversibility
Sleeve Gastrectomy / Gastric Resection	Surgically removes a large portion of the stomach to reduce size	Irreversible
Gastric Plication	Reduces stomach size using surgical stitches without removal	Stitches can be undone; stomach can return to original size

Summary: Gastric plication is less invasive, adjustable, and reversible, while sleeve gastrectomy is permanent.

Stages of Gastric Plication Surgery

Gastric plication is a surgery that reduces stomach size by folding the inner wall, usually via laparoscopic (minimally invasive) techniques. The procedure includes several key stages:

1. Pre-Operative Preparation

Health evaluation: Blood tests, abdominal imaging, and heart checkups.
Medication adjustments: Stop blood thinners or other drugs as advised.
Fasting: Typically 8–12 hours before surgery.
Special diet: Low-calorie or liquid diet to reduce stomach size.

2. Anesthesia

General anesthesia ensures the patient feels no pain.
Continuous monitoring of vital signs: blood pressure, pulse, respiration.

3. Accessing the Stomach (Surgical Incisions)

Laparoscope: Small incisions in the abdomen (usually 4–5, 0.5–1 cm).
Camera: Provides a clear view of the stomach.
Surgical tools: Used to fold the stomach and place stitches.

4. Folding the Stomach (Plication)

The large stomach wall is folded inward to significantly reduce size.
Folds are secured with strong surgical sutures to prevent unfolding.
Fold size can be adjusted based on patient weight and health for optimal results.

5. Ensuring Safety

Stomach checked for leaks or bleeding.
Sometimes dye or endoscopic checks are used to verify fold integrity.

6. Closing Incisions

Small incisions closed with sutures or surgical adhesive.
Scars are small and gradually fade.
A clean dressing is applied to prevent infection.

7. Post-Operative Recovery

In hospital: Monitor vitals for 24–48 hours; start with clear liquids before moving to soft foods.
At home: Follow prescribed diet, watch for complications like bleeding, persistent vomiting, or severe pain.
Regular follow-ups to monitor weight loss and stomach condition.

Advantages of Gastric Plication

Effective weight loss
- Reduces food intake per meal.
- Helps control calorie intake and promotes significant weight loss.
Less invasive procedure
- No stomach removal, unlike sleeve gastrectomy.
- Lower risk of vitamin and mineral deficiencies compared to gastric bypass.

3. Adjustability

The fold can be undone or adjusted if necessary, giving greater flexibility compared to permanent stomach removal.

4. Improvement of Obesity-Related Conditions

Gastric plication helps improve or control conditions such as:

Type 2 diabetes
High blood pressure
High cholesterol
Sleep apnea

5. Short Recovery Period

Recovery time is usually shorter than more invasive surgeries.
Patients can return to daily activities after a brief rest and follow-up.

6. Higher Safety

The risk of serious surgical complications, such as leakage or severe bleeding, is lower compared to gastric bypass or sleeve gastrectomy.

Types of Gastric Plication

Greater Curvature Plication (Lateral Plication)

Folds the larger outer wall of the stomach inward.
Stitches secure the fold to reduce stomach volume.
Suitable for severe obesity and significant weight loss.

Vertical Gastric Plication

Folds the stomach from top to bottom.
Significantly reduces stomach size while maintaining a relatively natural shape.
Supports weight loss without affecting stomach motility.

Partial Gastric Plication

Only part of the stomach is folded, usually the upper or middle portion.
Ideal for those who need moderate weight loss or have health limitations preventing full plication.

Total Gastric Plication

The entire stomach wall is folded inward from top to bottom.
Significantly reduces stomach size and achieves maximum weight-loss results.
Requires close post-operative monitoring.

Laparoscopic Gastric Plication

The most modern and commonly used technique.
Performed through small incisions using a laparoscope.
Benefits: less post-operative pain, faster recovery, and minimal scars.

Candidates for Gastric Plication

Gastric plication is suitable for specific groups to ensure safety and effective weight loss:

Severely Obese Individuals

BMI ≥ 35: Difficulty losing weight through diet or exercise.
BMI 30–35 with obesity-related conditions: diabetes, high blood pressure, high cholesterol, or sleep apnea.
Goal: Reduce stomach volume, decrease food intake, and improve health conditions.

Those Who Failed Non-Surgical Weight-Loss Methods

Tried diet, exercise, or medication without success.
Provides a safer, more effective weight-loss solution.

Individuals with Normal Stomach Anatomy Wanting to Avoid Resection

No stomach removal is performed.
Ideal for those who want weight loss without permanent anatomical changes, unlike sleeve or bypass surgery.

Patients Fit for Surgery

Must be able to undergo general anesthesia.
No chronic infections or digestive disorders that would prevent proper stomach healing.

Individuals Committed to Post-Operative Follow-Up

Adherence to the new diet and regular exercise is essential.
Attend all follow-up appointments to monitor weight loss and prevent complications.

Age Requirements

Typically 18–65 years old.
Older patients may be considered after risk-benefit assessment.
Not recommended for children or adolescents except in special cases under strict medical supervision.

Risks and Complications of Gastric Plication

Although less invasive, gastric plication carries some potential risks:

1. Immediate Surgical Complications

Bleeding: During or after surgery; usually controllable.
Infection: At the incision site or inside the abdomen; minimized by hygiene and wound care.
Stomach leakage: Rare, may cause peritonitis.
Anesthesia-related risks: Heart or respiratory complications, especially in older patients or those with chronic conditions.

2. Delayed Complications

Reflux: Heartburn or food regurgitation, especially if diet is not followed.
Nausea and vomiting: Common in the first few weeks, usually improves.
Stomach or fold obstruction: Rare; may require medical intervention or endoscopy.
Vitamin or mineral deficiencies: Less common than sleeve or bypass, but possible without proper diet.
Excessive or unbalanced weight loss: If dietary guidelines and follow-up are not followed.

3. Lifestyle Impacts

Dietary adjustments: Smaller portions; may initially feel uncomfortable or frustrating.
Psychological effects: Anxiety or mild depression if results are slow; psychological and family support recommended.
Temporary pain: Mild to moderate abdominal discomfort, usually resolves in days or weeks.

4. Factors Increasing Risk

Chronic conditions: diabetes, high blood pressure, heart problems.
Smoking or extreme obesity before surgery.
Poor adherence to dietary instructions or doctor’s recommendations.

Recovery Duration

Recovery varies depending on age, health status, and adherence to medical instructions.

1. Hospital Recovery

Typically 24–48 hours for monitoring.
Monitoring includes: vital signs, checking for bleeding or leaks, starting clear liquids.

2. First Days at Home

Usually discharged after 2 days if stable.
Clear liquids for 2–3 days.
Mild-to-moderate surgical pain, slight nausea or vomiting.
Light walking recommended to improve circulation and digestion.

3. Weeks 1–3

Gradual transition from clear liquids to full liquids and pureed foods.
5–6 small meals daily.
Monitor surgical sites for redness or discharge.
Resume light daily activities; avoid heavy lifting or vigorous exercise.

4. Weeks 4–6

Introduce soft foods: boiled eggs, mashed potatoes, boiled chicken.
Continue small, slow meals.
Gradually begin light exercise such as walking or stretching.

5. After 6 Months

Transition to regular foods while maintaining healthy eating habits.
Continuous weight loss and adjustment to new stomach size.
Regular doctor follow-ups to monitor progress.

6. Factors Affecting Recovery

Age and overall health.
Adherence to dietary instructions.
Physical activity for faster recovery.
Possible complications may prolong recovery.

7. Final Advice

Strict adherence to doctor’s instructions and follow-up is essential.
Full return to normal life usually occurs within 4–6 weeks, while the body continues adjusting to the new stomach size for several months.

Post-Operative Guidelines to Ease Recovery

Eat small, frequent meals to reduce stomach stress.
Avoid fatty, spicy foods; choose easy-to-digest meals.
Reduce caffeine and carbonated drinks.
Drink water regularly to aid digestion and reduce bloating.
Avoid smoking and alcohol.
Engage in light exercise like walking.
Manage stress through meditation and deep breathing.
Chew food thoroughly and eat slowly.
Avoid lying down immediately after eating; wait at least 2 hours.
Contact your doctor immediately if symptoms persist or worsen.

Post-Operative Diet Instructions

Phase 1: Clear Liquids (Days 1–3)

Water, diluted juices, clear broth, caffeine-free drinks.
Small, frequent sips, avoid carbonated or alcoholic beverages.

Phase 2: Full Liquids & Pureed Foods (Days 4–14)

Diluted natural juices, milk or substitutes, mashed potatoes, oatmeal, plain yogurt.
5–6 small meals daily, chew thoroughly.

Phase 3: Soft Foods (Weeks 2–4)

Boiled or scrambled eggs, boiled or steamed chicken/fish, well-cooked vegetables.
Eat small, slow meals; drink fluids between meals.

Phase 4: Regular Foods (After 1 Month)

Healthy proteins, vegetables, fruits, whole grains.
5–6 small meals daily; avoid fatty, sugary, fried foods.
Chew food very slowly.

General Dietary Tips

Focus on protein for muscle support and healing.
Drink 1.5–2 liters of water daily in small amounts.
Avoid carbonated and alcoholic drinks.
Take vitamin and mineral supplements as prescribed.
Regular check-ups with your doctor or dietitian.

Post-Operative Physical Activity Guidelines

Start walking and light activity immediately after surgery.
Avoid vigorous exercise or heavy lifting for 4–6 weeks.
Gradually resume regular exercise after incision healing.

Incision Care

Keep incisions clean and dry; change dressings as instructed.
Watch for redness, swelling, or discharge.
Avoid applying creams or lotions unless approved.

Monitoring Weight and Health

Track weight weekly.
Monitor vital signs if chronic conditions exist.
Regular lab tests for vitamins and minerals.

Supplements

Take prescribed vitamins and minerals to prevent deficiencies.
Emphasize protein intake for muscle preservation.

Avoiding Common Complications

Nausea/vomiting: Eat small, slow meals.
Reflux/heartburn: Avoid fatty/spicy foods, don’t lie down immediately after eating.
Stomach/fold obstruction: Chew food thoroughly and follow diet.

Communication with Medical Team

Report severe pain, bleeding, fever, or persistent vomiting immediately.
Attend all follow-up appointments to ensure optimal healing.

Signs of Successful Gastric Plication

Continuous, appropriate weight loss: 0.5–1 kg/week during the first months.
Improved appetite: Smaller meals and faster satiety.
Improved obesity-related conditions: Lower blood pressure, cholesterol, blood sugar; better sleep and reduced joint pain.
Adaptation to new diet: Ability to follow a healthy diet with small meals without vomiting or digestive issues.
Increased energy and vitality: Enhanced ability for daily activities and exercise, improved mood and confidence.
Absence of major complications: No persistent vomiting, severe reflux, stomach obstruction, or infection; normal healing of surgical incisions.
Long-term results maintenance: Continued weight loss or weight stabilization after reaching the goal; adherence to a healthy lifestyle to prevent weight regain.