A new keyhole operation to support weight-loss in people who are severely obese could be considered by UK doctors more routinely. This comes as the National Institute for Health and Care Excellence (NICE) publishes the first evidence-based guidance for the NHS on its safety and efficacy.

The procedure - known clinically as laparoscopic gastric plication - involves folding part of the stomach inwards and stitching it together. It can make the space that holds food in the stomach up to two-thirds smaller, which reduces a person's food intake. It is carried out using keyhole surgery through five or six small cuts in the abdomen. None of the stomach is removed during the operation.

Weight-loss (bariatric) operations are considered by doctors and their patients if other options such as diet, exercise and lifestyle changes and medication have been ineffective. Common weight-loss procedures include gastric banding and gastric bypass.

There is no published research from the UK on laparoscopic gastric plication, but international studies (from the USA, Greece, Iran, Lebanon, and Brazil) show that it could be a further treatment option for people with severe obesity. For example, in a study of 100 people who had the procedure, half had lost 60% of their excess weight after two years. However, there are some uncertainties in the published studies regarding the safety and efficacy of the procedure, particularly in the long term (i.e. beyond two years) as the available research does not go beyond this period.

Now that NICE has published the first evidence-based guidance for the NHS on laparoscopic gastric plication, this could encourage clinicians to consider the procedure as a further option for their patients with severe obesity. In these instances, NICE advises them to:

• submit data to the National Bariatric Surgery Register and make special arrangements to monitor what happens to their patients after the procedure
• take special care to explain the uncertainties and risks to their patients before obtaining their consent, such as how it could affect future operations on the stomach, and to
• inform their clinical governance leads (usually the hospital's medical director) that they would like to perform the procedure

Professor Bruce Campbell, Chair of the independent committee that develops NICE's interventional procedures guidance said: “Although there is evidence that laparoscopic gastric plication is safe in the short term and could help people with severe obesity to lose weight, there are a number of uncertainties from the published research regarding its long term implications.

“In particular, we would like to find out if there are potential risks associated with plication being reversed, how the procedure could affect future operations on the stomach, and whether it really is an effective weight management option long term.

“Our guidance encourages further research on the procedure for severe obesity by advising doctors to monitor the long term outcomes of their patients and to submit data to a national register. Comparison with alternative procedures would also be useful, so that patients who do require surgery can be offered the most suitable option.”

NICE's new guidance does not advise on the funding of the procedure or on how widely it should be offered; these decisions continue to be made at local NHS levels.

Ends

Notes to Editors

1. The interventional procedures guidance will be available from the NICE website on Wednesday 28 November 2012. Embargoed copies are available on request from the NICE press office.

2. The clinical definition for severe obesity is when someone has a Body Mass Index (BMI) of 40kg/m² or more, or 35 kg/m² and above if they have related conditions, such as high blood pressure or diabetes.

3. Around 1,146,600 adults (aged 16 and over) in England are believed to be severely obese (2.7% of the adult population). Source: Health Survey for England 2010.

4. NICE's clinical guideline 43 on the prevention, identification, assessment and management of obesity outlines the specific criteria that healthcare professionals should bear in mind when considering patients with severe obesity for bariatric surgery. For further information, please read Section 1.2.6 of the guideline.

5. According to NHS Choices, 4,211 weight loss procedures were carried out on the NHS in April 2008 to April 2009.

6. A study of 100 patients reported a mean excess weight-loss of 54% 6 months after they had laparoscopic gastric plication and a mean excess weight-loss of 60% 24 months after they had the procedure (72 and 50 patients respectively). Source: Talebpour M and Amoli BS (2007). Laparoscopic total gastric vertical plication in morbid obesity. Journal of Laparoendoscopic & Advanced Surgical Techniques (6): 793-8.

7. This type of NICE guidance considers evidence on safety and clinical efficacy; it does not consider cost effectiveness. For further information about NICE's Interventional Procedures guidance, please read the factsheet.

About NICE

1. The National Institute for Health and Care Excellence (NICE) is the independent organisation responsible for providing national guidance and standards on the promotion of good health and the prevention and treatment of ill health

2. NICE produces guidance in three areas of health:

• public health - guidance on the promotion of good health and the prevention of ill health for those working in the NHS, local authorities and the wider public and voluntary sector
• health technologies - guidance on the use of new and existing medicines, treatments, medical technologies (including devices and diagnostics) and procedures within the NHS
• clinical practice - guidance on the appropriate treatment and care of people with specific diseases and conditions within the NHS

3. NICE produces standards for patient care:

• quality standards - these reflect the very best in high quality patient care, to help healthcare practitioners and commissioners of care deliver excellent services
• Quality and Outcomes Framework - NICE develops the clinical and health improvement indicators in the QOF, the Department of Health scheme which rewards GPs for how well they care for patients

4. NICE provides advice and support on putting NICE guidance and standards into practice through its implementation programme, and it collates and accredits high quality health guidance, research and information to help health professionals deliver the best patient care through NHS Evidence.