Conversion to Laparoscopic Sleeve Gastrectomy After Gastric Plication: Clinical Presentation, Intraoperative Findings, and 5-Year Outcomes

Abstract Introduction: Laparoscopic greater curvature plication (LGCP) was adopted for its low cost and reversibility, but high rates of recurrent weight gain and complications have led to its abandonment. Evidence on the management of patients after LGCP remains scarce. We describe the clinical presentation, intraoperative findings, and 5-year outcomes of conversion to laparoscopic sleeve gastrectomy (LSG) after LGCP. Methods: Single-center retrospective analysis of a prospectively maintained database (2014–2020). Adults with a history of LGCP who underwent laparoscopic conversion to LSG were included. Clinical presentation, intraoperative and pathological findings, complications, and body mass index (BMI) at 6, 12, 24, 36, and 60 months were analyzed. Results: Seventeen patients were included (mean age 39.7 ± 10.6 years; 52.9% male), a mean of 26 ± 12.3 months after LGCP. The main complaints were recurrent weight gain (88.2%) and abdominal pain (82.4%). Adhesions were found in all patients, chronic inflammation in 41.2%, gastric perforation in 17.6%, and a gastroesophageal fistula in one patient (5.9%). Two patients (11.8%) underwent concomitant hiatal hernia repair. No early or late complications occurred. Mean BMI decreased from 31.2 ± 4.5 to 28.5 ± 4.1 kg/m² at 6 months and 23.8 ± 1.7 kg/m² at 5 years (n = 13; p < 0.001). Conclusion: Complications after LGCP presented mainly as recurrent weight gain and abdominal pain. Laparoscopic conversion to LSG was safe and achieved sustained BMI reduction at 5 years in this series.