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Session 6 on Gastric Plication was a total success if you measure it by how many congress goers attended. The room was full, all seats were occupied with many surgeons standing in the back and isles. They came to see the top leaders in their field talk about Gastric Plication and their initial experiences with the procedure. One of the presenters and well known surgeons from Argentina, Dr Carlos Casalnuovo and former Congress President spoke about his experience with Gastric Plication combined with gastric banding. The initial question to the audience: If one procedure is good, will two make it better? This is our problem question. He then presented his data on his patients undergoing a gastric band placement where once positioned he then turned to perform a plication of the stomach distally to the band. In his methods he discussed how he would let the gastric plication take effect early on after the procedure and not adjust the gastric band until the patient had lost the early satiety and restriction related to the plication.He presented a follow-up of a year with a handful of cases and discussed the difficulty in standardizing the approach. The Gastric Band with a Plication group had less than desirable weight-loss and concluded in his presentation that more follow-up is needed, a better more standardized reproducible technique is necessary and he finalized the talk by leaving the question still un-answered:Is combining to techniques better for the patient or will it only be adding the risk of a second surgery without the benefit of more weight-loss?