Gastric plication also known as greater curvature plication is a new procedure for weight loss that was introduced few years ago to the United States. The procedure involves reducing the gastric size by folding the stomach wall inside its lumen. Stitches are then placed to hold the folded stomach in place. The surgery mechanism of action for gastric plication is restriction, i.e. forcing the patient to eat less by reducing stomach size. This assumption has never led to any durable weight loss throughout the history of bariatric surgery.

Unlike sleeve gastrectomy or gastric bypass there is no stapling or cutting. The procedure was introduced to the public as safe, less invasive and as effective as a sleeve gastrectomy. Some surgeons went on to add an adjustable gastric band to gastric plication, assuming that the more restriction the better. Within 2 to 3 years, the initial enthusiasm about this novel procedure quickly faded. Weight loss, as expected, was not that great. Patients had excessive nausea and vomiting after surgery. The folded stomach herniated through the suture line causing leaks in certain cases. Hunger feeling was not controlled most likely because gastric plication did not decrease hunger hormones like Ghrelin. As a result weight loss was not sustainable and gastric plication failed to prove itself as a safe, durable and effective weight loss procedure.

Understanding weight loss surgery mechanism of action is crucial for the development of new effective weight loss procedures. Obesity is a complex multifactorial disease that results in functional deficiency of many neuro-hormonal signals that would normally arise after a meal. Restoring these signals, rather than restriction, should be the guiding principle for developing new weight loss procedures.