gastric-sleeve-risks Learn why we think the risks of gastric sleeve can outweigh the benefits, and why we perform LapBand with gastric plication instead.

Lap Band with gastric plication


There’s a new way to do perform the LapBand. It’s to add a gastric plication. Plication means folding, and in a gastric plication we are folding the stomach to decrease its capacity. Sometimes it used to be called gastric imbrication, now most people refer to it as a gastric plication.

In a gastric plication, we fold part of the stomach in on itself, and then use suture to hold it in. So unlike the gastric sleeve, we are not amputating the stomach. But we end up with a smaller stomach capacity without the risks of stapling and amputating the stomach. It is why some people are calling the gastric plication, "the sleeve without cutting."



Gastric plication with gastric banding is an investigational procedure, but we believe it is a natural extension of current suturing techniques with the LapBand.


Gastric plication is not a new procedure. It was first developed overseas around 2001 by Dr. Talebpour.
 At that time it was done without a LapBand in place simply by folding the stomach. Now, more and more doctors now are adding the gastric plication to the LapBand.


This may help in several ways:

First, it may help secure the LapBand in place, and may reduce the already small chance of LapBand slippage.


Second, by reducing the stomach capacity below the LapBand it can potentially help the LapBand in decreasing a person’s hunger and allowing them to eat smaller meals.


Third, since the stomach’s capacity is decreased, it potentially might mean less office visits for LapBand adjustments. That might helpful for out of town, or busy patients that can’t make as many frequent office visits to the doctor.


The gastric plication does not involve any changes in the routing of the GI tract. There is no stapling, no cutting, no separating of any organs of the GI tract.


Some people call the gastric plication a gastric sleeve without cutting.

The sleeve gastrectomy is a completely different procedure. In gastric sleeve surgery, you end up with a long thin narrow stomach as a result of stapling, cutting, and removing a large portion of the stomach.

Potential benefits of gastric plication over Lap Band (banded gastric plication) when compared with traditional LapBand.


Decreased slippage: LapBand slippage occurs in about 3 - 4% of patients during the life time of their LapBand. Many doctors believe that when it does occur, it is due to a person chronically overeating and stretching out their stomach pouch from above the LapBand, and pulling the stomach from below. The anterior gastric plication introduces more stitches to the stomach below the LapBand and some doctors believe this may help prevent slippage. We have communicated with two high volume LapBand surgeons who have been doing gastric plication over Lap Band for over a year and report a decreased slippage rate.


Better weight loss: By decreasing the volume of the stomach below the LapBand, patients report more of a feeling of fullness after eating their small portions. This might make it easier to adhere to small portions and low calorie intake, enhancing weight loss.


Less need for LapBand adjustments: LapBand patients typically need several LapBand fills to get to the LapBand sweetspot where they can have small meals without hunger. With the gastric plication below the LapBand, there are reports of patients needing fewer LapBand fills, because they feel full faster.


Plication risks


Nausea and/or vomiting. If it does occur it is most common in the first week or two after surgery.


Reflux or heartburn: Generally the risk of this should be low because the LapBand operation often helps pre-existing reflux or heartburn. We find that a significant number of people that we operate upon have a hiatal hernia and didn’t know this prior to surgery. They might have had vague symptoms of occasional heartburn, reflux, mild nausea. When we find a hiatal hernia at the time of LapBand surgery we always fix it.


What if you have previously had a LapBand placed and want a gastric plication because you feel you need extra help with your LapBand weight loss?


Give our office a call at (903)-794-2263. We can perform a gastric plication on a previously placed LapBand.


Gastric sleeve risks

The gastric sleeve is an amputation of the stomach. Up to 80 % of the stomach is cut out and removed. The cutting of the stomach leaves a potential for a big problem in the first few weeks after gastric sleeve surgery.



Because you are stapling and cutting out a large piece of stomach there is a potential for adverse outcomes. After sleeve gastrectomy there are several risks:


Leakage from the staple lines. If your body doesn’t heal perfectly and the two ends of the cut stomach don’t heal to form a watertight seal, you could leak stomach fluids into your abdominal cavity. If this happens it could be life threatening.



Infection. Since you are cutting out stomach and removing a portion of organ from the body, you could potentially develop internal infections.


Long term fistula. A fistula is abnormal passage that can occur after gastric sleeve surgery. It is frequently associated with infection and inflammation. In the case of gastric sleeve surgery, a fistula can occur between the stomach and the lungs or the stomach and the abdominal wall. This happens because at some point after surgery, the staple line of the stomach sticks to the abdominal wall or the diaphragm muscle seperating the abdomen from the chest. Then once the staple line is sticking to another part of the body, it slowly eats through the other tissue and gastric juices can then leak into another part of the body, or outside the body through your skin, in an abnormal fashion.

Because of these potential risks of gastric sleeve, we prefer the option of Lap Band with gastric plication to the sleeve gastrectomy.


About The Lap Band

Everywhere you look there are more and more overweight Americans. Most have tried multiple diets in the past - usually with short-term success- but they are unable to keep the weight off for the long term. It is our honor to bring the Lap-Band surgery to the ArkLaTex to help make the weight come off - and stay off. Over 700,000 Lap-Bands have been placed worldwide, and it is the safest, least invasive, least radical surgical option for weight loss.


Operations to treat obesity have been around for many years, but the older operations are much more unsafe than the Lap-Band. Other weight loss surgical procedures involve cutting across the stomach or intestine, which can increase the chance for leaks and post-operative death. The Lap Band is the only minimally invasive, adjustable weight loss surgery.



Gastric bypass risks are generally substantially higher than risks from the Lap Band. "It turns out that the 1 in 500 or 1 in 200 risk of death [from gastric bypass] that people are commonly quoted comes from the best surgeons," says researcher David R. Flum, MD, MPH, assistant professor of surgery at the University of Washington. "In fact, in the real world …the risk of dying within 30 days of [gastric bypass] surgery is about one in 50."

Unlike the gastric bypass ("stomach amputation") or the VBG ("stomach stapling"), the Lap Band does not require cutting across the stomach or intestine. In the gastric bypass, cutting across the stomach or intestines creates a chance for a leak which can be fatal.



Studies have shown that some patients who had weight related illnesses such as diabetes and high blood pressure, have had those diseases cured when they lose weight with the Lap Band, and no longer need to take their medicines for those diseases.


The procedure works by surgically placing the Lap Band across the top of the stomach, creating a small stomach pouch. The band slows down the passage of food into the rest of the stomach, creating a feeling of fullness with only small portions of food. This allows for safe weight loss without any nutritional deficiencies. There is no dumping syndrome, no need for iron or B12 shots as there is with the gastric bypass.


Most Lap-Band operations are performed as "same day" procedures, where the patient leaves the hospital a few hours after surgery. Time off from work varies from person to person, but if no heavy lifting is involved, a patient can usually return to work within 3-7 days after surgery.



  • LapBand

    Lap Band placed across the stomach with the port invisible under the skin.

  • lapband-port-adjustment

    The Lap Band port is accessed for
    adjustments. This is generally
    done in the office.

  • lap-band-unfill

    When the Lap Band's inner balloon is completely deflated, the stomach opening allows a moderate passage of food.

  • lap-band-fill

    When the inner balloon is inflated there is a smaller opening into the stomach creating a greater feeling of fullness and a greater restriction to the amount of food you can eat.



Advantages of the Lap Band:


  • No cutting across the stomach or intestine
  • Safest profile of any weight loss surgery
  • Laparoscopic surgery with small incisions
  • Short recovery time with most patients going home the same day of surgery



It has been gratifying for Dr. Hekier and Dr. Keilin to see cases among their patients who may no longer need take insulin or diabetic pills, may no longer need to take blood pressure medicines and are no longer held back by back, knee and hip pain.


  • Maxcine has lost 89 pounds in a little over a year, and is still going strong! She used to take 15 medication pills per day, and is off of all of them. Way to go Maxcine!
  • We call Jeff "Mr Lap Band Oklahoma!" Jeff lost 130 pounds in the first year after Lap Band surgery. Here he is showing off with the belt he used to wear!
  • Kelli was just 19 years old when she had her Lap Band and lost over 170 pounds in the first year after surgery.
  • Amy has lost 78 pounds since surgery and has more energy and feels better than she did before!