What Does WRAP Look Like?
Images From The Web
Here is a photo album of WRAP type surgeries and/or concepts. If you know of a source that is incorrectly credited here, please let us know.
The upper left shows the normal stomach; the upper right shows the normal stomach in cross-section. The bottom left shows the relative size and shape after a WRAP type technique while the lower right illustration shows a cross section of a “WRAP’d” stomach, showing the inverted stomach held in place by two rows of suture (represented by black dots). Notice the significant reduction in the amount the stomach can hold as represented in this picture.
This schematic illustrates the concept of how the inside lining (red) and outside surface (gold) remain whole and continuous with WRAP techniques as there is no cutting, rearranging, or discarding of the stomach or intestinal tissues. Imagine pushing in a balloon; the balloon is whole and the inside and outside remain the same except for shape.
On the left, the stomach with a line showing the area that will be inverted. The middle image shows the first of two (or more) rows completed. On the right, a second row of sutures has been added with a further decrease in the space within the stomach. Notice that the inner lining of the stomach, although now shaped differently, is still intact.
This illustration shows the concept of inverting one side of the stomach and holding it in place with sutures (in this case individual or “interrupted” sutures). This particular illustration shows more of the stomach inverted than most techniques show. For our WRAP, we do not fold the lower 1/5 of the stomach with the goal of leaving enough of a reservoir for food and to allow the accommodation of some normal pressure build-up in the stomach, thereby decreasing unpleasant side-effects.
This series show the basic sequence in creating a WRAP type technique. It does not show the portion of the surgery that prepares the stomach to be “WRAP’d”.
On the left is the normal stomach. Remember, this is very simplified and does not show many of the organs or ligaments the surgeon must work around with great care.
In the middle shows the placement of individual or “interrupted” sutures. This illustration shows four sutures, but we actually place approximately 10 to 20 in each row, and place two rows (or in some areas, three rows).
On the right is a completed WRAP type surgery with the outer row of sutures showing, as well as the significant reduction in stomach size and its ability to hold food.
This is an actual “before” picture from a case performed by Dr. Waldrep. Note the extent of the major (blue) blood vessels on the left side of the stomach opposite the instruments holding the stomach; these will be the landmarks of the imbrication (below photo).
Completed WRAP. Note the (blue) blood vessels that were on the viewers left in the picture above, originally extending across perhaps 25% of the width of the stomach, now mark the entire width. This may look similar to a “Sleeve” gastrectomy in which most of the stomach is cut off and thrown away; but in the WRAP, cut into, rearrange, or throw away any of the stomach or intestine – so it is still possible to reverse a WRAP if needed. Although the WRAP and Sleeve look about the same size, the stomach space in the WRAP is “full”.
This is an example of the WRAP suture line. Notice how the stomach is now about the width of the veins that originally extended about ¼ of the width of the stomach. The suture ends are left slightly long to help identify them later, if needed.
The appearance from inside the stomach after a WRAP (gastric plication). The view is looking down from the top of the stomach toward the ‘downstream’ end. The in-folded portion, on the left side of the screen, now fills most of the inside space of the stomach, limiting how much food it can hold before feeling ‘full’.
This patient had a gastric band surgery approximately a year-and-a-half prior to the above picture. Patient sometimes develop concerns after band surgery such as 1) swallowing difficulties with even minor adjustments to the band, and 2) a seeming limit to further weight loss. In the past, patients with similar concerns who were unsatisfied with the band experience might need to consider having the band removed and having a more aggressive procedure such as a gastric bypass. Now, a possible option to consider is the addition of a WRAP procedure to the existing band, such as illustrated below:
This photo was taken about 45-minutes after the first picture above. The band has been deflated and the WRAP has been completed. Note how the stomach is now about as wide as the extent of the veins on the left side of the picture. An x-ray approximately one-year after this surgery showed the WRAP to be intact. While a band may remain un-inflated, it is possible that a patient could experience any band related complications.