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Bariatric surgery · UK

Laparoscopic greater curvature plication, explained honestly.

A historic bariatric procedure that folds in the greater curvature of the stomach with sutures - no cutting, no stapling. UK use is limited and declining. We explain when it might still fit, and why sleeve, bypass or ESG usually don’t.

A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Indicative pricing

What plication costs - and what modern alternatives cost.

Indicative ranges across UK private providers.

In short

Plication is £6,000–£9,000, sleeve is £9,000–£14,000, bypass £11,000–£16,000.

Procedure Indicative range
Laparoscopic greater curvature plication (LGCP) £6,000–£9,000
Endoscopic sleeve gastroplasty (ESG) £7,000–£11,000
Sleeve gastrectomy £9,000–£14,000
Roux-en-Y gastric bypass £11,000–£16,000
Gastric band £6,000–£9,000
Consultation only £200–£400

Plication is rarely NHS-commissioned in the UK. Prices vary by surgeon, clinic, calibrating bougie and any hiatal repair added on the day.

The problem

A procedure with real trade-offs - not a cheaper sleeve.

Plication was once promoted as a reversible, tissue-preserving, less-expensive alternative to sleeve gastrectomy. The long-term outcomes told a different story. We put the numbers alongside the marketing.

  • Weight loss is modest

    Around 30–40% excess weight loss at 12 months - meaningfully less than sleeve (55–65%) or bypass.

  • Regain is common

    Roughly half of patients regain to under 20% EWL by three to five years as the plication stretches.

  • Alternatives usually win

    ESG matches the concept endoscopically; sleeve, bypass and duodenal switch outperform on durable weight loss.

When it fits

The narrow situations where plication might still fit - and where it doesn’t.

The specific patient preferences plication was designed for, plus the situations where a different procedure is clearly better.

  • BMI 30–40 with comorbidities

    Historically offered to patients seeking a stapler-free, tissue-preserving option in this range.

  • Reversibility is a priority

    In principle the sutures can be released, though in practice this is rarely done.

  • Concern about staple-line leaks

    No cut edge means no staple-line leak - a specific worry some patients raise about sleeve gastrectomy.

  • Cost-sensitive private choice

    Slightly cheaper than a sleeve in some UK centres, though the price gap has narrowed.

  • Not suitable - BMI over 50

    Very high BMI is better treated with duodenal switch or bypass - plication under-delivers here.

  • Not suitable - severe reflux

    Plication can worsen reflux. Bypass is usually the better option if you already have GORD.

  • Not suitable - T2 diabetes remission

    For durable diabetes remission, bypass and sleeve outperform plication.

  • Red flag: emergency after surgery

    Severe abdominal pain, persistent vomiting, fever or breathlessness after surgery - same-day A&E, not a clinic call.

Alternatives

Plication is one option - there are better ones for most patients.

What each modern bariatric option involves - and where plication actually sits alongside them.

  • Laparoscopic greater curvature plication (LGCP)

    The procedure this page is about - greater curvature folded in with sutures over a bougie. Historic option with weaker long-term data.

  • Endoscopic sleeve gastroplasty (ESG)

    The analogous concept done through the mouth with no laparoscopy. Growing evidence base including the MERIT trial. See our ESG page.

  • Sleeve gastrectomy

    The current UK workhorse - around 55–65% excess weight loss at 12 months and durable comorbidity resolution. See our sleeve page.

  • Roux-en-Y gastric bypass

    Comparable weight loss to sleeve and superior for type 2 diabetes remission and reflux. See our bypass page.

  • Duodenal switch / SADI-S

    For BMI over 50 or where sleeve alone has failed to deliver. See our duodenal switch page.

  • Gastric band

    Adjustable and reversible. Use has declined but suits some patients who want the least anatomical change.

  • Gastric balloon

    A temporary, non-surgical option for 6 to 12 months. Useful as a bridge or trial before committing.

Safety and outcomes

What plication really delivers - and where it falls short.

The honest picture on weight loss, regain, complications and where UK practice now sits.

  • Modest weight loss - 30 to 40% EWL

    At 12 months plication delivers around 30–40% excess weight loss, meaningfully less than sleeve gastrectomy at 55–65%.

  • Regain is common by 3 to 5 years

    Around half of patients regain much of the loss by year three to five as the plication stretches or partially unfolds.

  • Persistent nausea and vomiting

    Very common in the first weeks - the pouch can be extremely tight. It usually settles but is more marked than after a sleeve.

  • Suture dehiscence and unfolding

    If the sutures give way the plication unravels, symptoms recur, and revision surgery is often needed.

  • Reflux may appear or worsen

    New or worsened GORD is a recognised issue. If you already have reflux, bypass is usually a better fit.

  • Rare but serious complications

    Gastric obstruction from an over-tight plication, gastric ischaemia, port-site hernia, DVT and PE are all recognised.

  • BOMSS 2020 position

    The British Obesity and Metabolic Surgery Society noted limited and declining use in the UK, with inferior long-term outcomes vs sleeve.

  • Not routinely NHS-funded

    Most UK NHS bariatric services do not offer plication. It is a private-sector procedure at a small number of centres.

  • Red flags

    Severe pain, persistent vomiting preventing fluids, fever, breathlessness or spreading redness after surgery are reasons for same-day help.

Reading your operation note

Your operation note in four parts. Read the last one first.

The note the bariatric surgeon sends you keeps to the same shape whether plication, sleeve or bypass was performed.

A UK bariatric surgeon reviewing a patient’s operation notes

A quiet reminder

Surgical language is precise and can read coldly - we translate it for you.

If you would like us to talk you through the note before your review, just ask.

  1. 01 Header

    Indication and technique chosen

    Why plication was agreed rather than a sleeve, bypass or ESG - and the size of bougie used to calibrate the pouch.

  2. 02 Technique

    Sutures, rows and bougie size

    The number of rows (usually 2–3), suture material (non-absorbable braided), and the bougie size (typically 32–40 Fr).

  3. 03 Findings

    Anatomy, adhesions and any incidental notes

    Notes on the greater omentum, gastric arteries, any adhesions from previous surgery, and hiatal anatomy.

  4. 04 Impression

    Diet stages, follow-up and when to worry

    Read this first: liquid to puree to soft to normal timeline, dietitian follow-up dates, and red flags that mean same-day help.

Recognised by major UK insurers

BupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealixBupaAXA HealthVitalityAvivaWPACignaHealix

Bariatric cover varies widely by insurer, policy and BMI threshold.

Frequently asked

Everything we get asked about laparoscopic plication.

Quick answers on weight loss, regain, reversibility, alternatives and cost.

  • What is laparoscopic greater curvature plication?

    A bariatric operation that folds in the greater curvature of the stomach with two or three rows of non-absorbable sutures placed over a calibrating bougie. It creates a tube-shaped pouch similar to a sleeve gastrectomy but without cutting or removing any tissue.

  • How much weight will I lose after plication?

    Typically around 30–40% of excess weight at 12 months, which is meaningfully less than sleeve gastrectomy (55–65%) or bypass. A significant proportion of patients regain much of the loss by three to five years.

  • Is plication reversible?

    In principle yes - the sutures could be released and the stomach would return to its original shape. In practice reversal is rare and revision is usually to a sleeve or bypass rather than a return to normal anatomy.

  • Why is plication less common in the UK now?

    The BOMSS 2020 position statement noted limited and declining use because long-term weight loss is inferior to sleeve gastrectomy and complication rates were higher than initially promoted. Most UK bariatric MDTs now recommend sleeve, bypass or ESG.

  • How does plication compare with endoscopic sleeve gastroplasty (ESG)?

    ESG achieves a similar concept - an invaginated tube-shaped stomach - but is done through the mouth without laparoscopy. It has a growing evidence base including the MERIT trial and is generally preferred if a tissue-preserving option is what you want.

  • How much does laparoscopic plication cost privately in the UK?

    Roughly £6,000–£9,000 depending on the surgeon, clinic and anaesthetic. Sleeve gastrectomy is £9,000–£14,000 and gastric bypass £11,000–£16,000 in the same clinics.

  • What are the alternatives to plication I should consider?

    Endoscopic sleeve gastroplasty, sleeve gastrectomy, Roux-en-Y gastric bypass, duodenal switch or SADI-S for very high BMI, gastric band, and gastric balloon as a temporary option. We compare all of these against plication before you commit.

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