In a systematic review involving seven published articles, encompassing 307 patients who underwent LGCP, the mean operative time ranged from 40 to 150 min. Hospital stay length ranged between 1.3 and 1.9 days. Excess weight loss (EWL) at 6 months ranged from 54 to 51 %, while at 12 months it ranged from 67 to 53.4 %. The longest follow-up was 3 years [8, 9, 13, 15, 16, 18–20].

Universal exclusion criteria varied including pregnancy, previous bariatric or gastric surgery, hiatal hernia, uncontrolled diabetes, cardiovascular risks, history of eating disorders, medical therapy for weight loss within the previous 2 months, or any other condition that constitutes a significant risk of undergoing the procedure [12]. A BMI > 50 kg/m² was defined as an exclusion criterion for the Brethauer et al. and Skrekas et al. series [8, 16].

In the study by Ramos et al., 42 patients were operated, with a mean operative time of 50 min and a mean hospital stay of 36 h. No intraoperative complications were documented. The procedure was recommended to patients with morbid obesity, with mean BMI of 41 kg/m². Mean percentage EWL was 20 % EWL at 1 month (42 patients), 32 % EWL at 3 months (33 patients), 48 % EWL at 6 months (20 patients), 60 % EWL at 12 months (15 patients), and 62 % EWL at 18 months (9 patients) (Fig. 3). In the first postoperative week, however, nausea, vomiting, and sialorrhea occurred in 20 %, 16 %, and 35 % of patients, respectively. In all cases, these symptoms were resolved in no more than 2 weeks. No weight regain was recorded during the follow-up period [15]. In the follow-up of this group of patients, the stabilization of the weight loss in between 18 and 24 months is common, and they start to gain some weight in the third year post-surgery. By the end of the third year after the procedure, the mean EWL was 48 %, much similar with our results with adjustable gastric banding [21].

Talebpour et al. in 2012 published the longest gastric plication follow-up in medical literature, with a case series involving 800 patients, with an average time of follow-up of 5 years (range 1 month–12 years). Different techniques of plication were used. One-row plication was performed during the first 6 years of experience, followed by 6 years of two-row plication. The mean excess weight loss was 70 % (40–100 %) after 24 months (n = 356) and 55 % (24–100 %) after 5 years (n = 134). Weight regain was a complaint in 31 % of cases after the 12-year follow-up. Outside displacement of plicated fold was seen in 25 out of 38 cases of regain or failure that were reoperated. They concluded that the main reason for weight regain and failure group consisted of cases with wrong selection of technique, mainly males without good motivation. Reoperation was required in 8 patients (1 %), due to complications like microperforation, obstruction, and vomiting following adhesion of His angle. Complications were more common with the one-row plication technique. The authors concluded that the percentage of EWL in LGCP is comparable to other restrictive methods, with 1.6 % of complications, 31 % weight regain, and a lower financial cost [11].

It is important to note that Talebpour et al. used strict inclusion criteria. Gastric plication was selected for cases with potential for continuous diet and exercise after operation. In cases with less motivation, gastric bypass or a malabsorptive technique was chosen [11].

In a study focused on weight loss and type 2 diabetes outcomes, LGCP was performed in 55 morbidly obese diabetic patients, with a 1-year follow-up. BMI ranged from 35 to 52 kg/m² (mean 43.5 kg/m²). Mean EWL was 35 % (30–65 %) after 12 months, with a mean BMI of 38 kg/m². A total of 23 % of patients stopped losing weight 6 months after the procedure, and 11 % began regaining about 14 % (12–20 %) of their EWL 9 months after the procedure. Mean HbA1c was 7.5 % (5.5–8 %) after 12 months. All patients were on oral diabetes medications preoperatively, and none had more than 5 years of disease. No patients stopped their diabetes medications after surgery. These results may indicate that LGCP has a weaker metabolic effect compared with other restrictive procedures [22]. Skrekas et al., on the other hand, showed inadequate weight loss (EWL < 50 %) in 21.48 % and failure (EWL < 30 %) in 5.9 % [16].

It is likely that LGCP reduces the possibility of gastric leaks. Talebpour and Amoli report one case of a gastric leak associated with a more aggressive version of LGCP, which the authors attributed to excessive vomiting in the early postoperative period [9]. In the study by Ramos et al. the adverse events described by patients were minor, such as nausea, vomiting, and hypersalivation, which were resolved quickly [15]. These events may be related to the severity of the restriction induced by the invagination of the greater curvature and/or edema caused by venous stasis. A key difference between LGCP and LSG is the presence of the endoluminal fold. Qualitative endoscopic findings suggesting that the greater curvature fold gets smaller may be related with the resolution of the initial edema, although the radiological findings did not reveal significant dilation of the LGCP at 6 months [15].

In the systematic review done by Abdelbaki et al., 8 % developed complications, with individual author complication ranging from 7 to 15.3 %. Nausea and vomiting occurred in all studies, ranging from mild to moderate, usually resolving within 1–2 weeks. Twenty patients (6.5 %) were readmitted, of whom 14 (4.6 %) required reoperation, mostly due to gastric obstruction [13].

Skrekas et al. had three cases of acute gastric obstruction, in a series of 135 patients [16]. In one of them, the fundus prolapsed in between the sutures, which was reduced and reinforced with sutures. The other two had serous fluid collection within the cavity formed by the gastric plication, both of which treated with reversal of plication. The overall complication rate in the case series was 8.8 % (12/135), including vomiting (n = 4), GI bleeding (n = 2), and abdominal pain attributed to a micro-leak from the suture line (n = 2), one patient had a portomesenteric thrombosis leading to partial jejunal necrosis, and the three cases of gastric obstruction already described. Brethauer et al. had to reoperate on the first patient in their series due to a gastric obstruction 2 days after surgery [8].

Tsang et al. report a case of complete gastric obstruction after LGCP. At laparoscopy, no evidence of gastric necrosis or suture line leak/perforation was found. The plication sutures were removed and the stomach unfolded [20].

In one analysis of early complications in 120 patients submitted to LGCP, the major intraoperative complication was bleeding, with hemostasis achieved in all cases without the need for blood transfusion (n = 13). During postoperative week 1, nausea, vomiting, sialorrhea, and minor hematemesis occurred in 40 %, 25 %, 22 %, and 15 % of patients, respectively. Symptoms disappeared spontaneously within 4–5 days and patients returned to normal activities 5–7 days postoperatively. In the first postoperative month, complications were mainly due to the complete obstruction of the residual gastric pouch by fold edema (5 %), extrinsic compression by intramural gastric hematoma (2 %), or elastic gastric effect of suturing and gastric tube distortion (0.8 %). Peritonitis, which occurred in one patient on POD 3 from gastric leak, was managed laparoscopically by suturing the leak hole and cleaning the whole peritoneal cavity [17].

Watkins published a case report of a 29-year-old patient who underwent LGCP, with intraoperative EGD showing a symmetric plication with an appropriately sized lumen. Postoperatively, the patient experienced liquid dysphagia, consistent with gastric edema. She was discharged home on the second POD after slight improvement. On POD 3, she returned to the emergency room with severe abdominal pain and dyspnea. An abdominal CT showed free intraperitoneal air, and the patient suffered respiratory failure. Surgical exploration revealed significant gastric necrosis in the fundus of the stomach, extending from high on the cardia down along the greater curvature to the midbody of the stomach, with a large perforation. The plication was converted to a stapled sleeve gastrectomy. Patient was discharged in good conditions. The likely cause of this complication was a lack of blood flow to the gastric wall due to edematous compression, similar to the high pressures of abdominal compartment syndrome. Although the endoscopic appearance of the initial operation was good, it likely became too tight with the edema that ensued [19].