Overweight patients no longer need to have large sections of their stomach surgically removed or have devices inserted into the body as part of weight loss procedures at Hamad Medical Corporation. Gastric Plication surgeries introduced at HMC last month have been successful and some 500 gastric procedures will be done this year, said an expert.
Gastric Plication is a new restrictive weight loss surgery procedure that involves no devices or stomach resection while offering patients faster, more intense weight loss than most of the similar procedures. The procedure involves the use of sutures to fold a part of the stomach making it a reversible procedure without much tissue damage.
“The procedure which originated in Iran in 2006 is done in cases of obesity, obesity with diabetes, obesity with hypertension, and obesity with cholesterol,” said Dr Micheal Gagner, Clinical Professor of Surgery, Hamad general Hospital. “Gastric Plication is same as gastrectomy but does not involve the removal of the stomach. There is huge risk associated with removing stomach or its parts like leakage, bleeding, strictures, and the mortality risk is about 0.3 percent. When we do a plication, we remove the risks by using sutures and folding the stomach.”
With a very less amount of risk associated with the procedure, it can replace many other weight loss procedures like gastric sleeve and bypass, and also
gastric banding. “With the procedure, one does not have to remove the stomach, there is no foreign body — like in banding — causing less scarring of tissues, and above all it is a reversible procedure as the sutures can be cut bringing the stomach back to its normal position. If you perform it on adolescents, the beauty of this operation is that as the person gets older, the sutures can be removed and the stomach can go back to its original position. If there’s a new drug that comes out in 10 years, we can remove the sutures and the stomach will go back.”
“In gastric sleeve, at least 70 percent of the stomach is cut and the capacity at the end is same to that we have in plication which is around 100 ml. In plication, because there’s no stomach removed, we fold the stomach inside to take the volume inside, and hence no foreign body is used,” he said.
At least four people have undergone the procedure at HMC.
While two of them underwent gastric plication alone, other two cases involved removal of gastric band along with placation, which has never been reported. All the procedures had no complication and patients are showing good recovery.
“The operation can be done in one hour and as we get used to it, this procedure will be anywhere between 30 to 60 minutes. We will be able to do more cases because of the number of patients that need help. It is important to find a procedure that has low risk, is reproducible, that can be done by many operators with low complication rates.”
“There are talks of doing this as an outpatient or less than 24 hours stay, they will stay one night and be discharged in the morning. Currently, we keep them, because this is new, we are doing x-rays the next day, we are making sure that we are keeping them extra days to make sure there’s no problem,” Dr Gagner said.
Bariatric surgery is usually used as the final option. Drugs can only result in 10 percent weight loss or so. “Surgeries can help in 70 percent weight reduction. We plan to have some 500 operations this year. Over the last five years, there has been a significant increase in these surgeries and the plan is to reach a thousand cases a year may be by next year.”
“Weight loss surgeries are becoming more popular than ever. There are patients in the waiting list, even as young as 17 years old. We have more than 200 on the waiting list, and maybe another 400 just waiting for their medical tests,” he said.
According to Dr Gagner, the country is also facing an epidemic of having to remove gastric band every week.
“We are removing the bands because they have been placed over a period of seven to ten years and now the patients are having problems. There have been band erosions, band eroding into the stomach, there have been obstruction with slippage, there have been inability to lose weight, weight regain with the band in place, and inability to adjust the band correctly, and now we’re having a lot of patients in our clinic coming wanting to have the band removed and go to another procedure. Due to heavy scarring of tissues round the stomach and the organ being less amenable to more healing there are more complication when we have to revise the surgery.”
Currently some nine to 10 cases come each week to the department for band removal. The section is pressured with less capacity and less time for doing operations
“The average age of patients undergoing gastrectomy here is usually closer to 40 and majority three-quarters of the cases are females. Often they have gone through pregnancies, gained weight, tried exercise, t tried diet, and they fail when they come for the surgery.
We would like to operate before they have pregnancy, because we recently discovered that if we operate before pregnancy, the children do not become morbidly obese. Thus we can stop the vicious cycle of parents and children becoming morbidly obese. We would be able to attack the problem on the parents as well as the children”.
By Huda NV
The Peninsula