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WRAP Web | Waldrep WRAP | Page 2

WRAP Web

Cleveland Clinic

(June 2011) This site is by the Cleveland Clinic, a very well respected medical, surgical, and research facility. This appears to be a patient recruitment advertisement for a study investigating the safety and effectiveness of gastroplication, probably similar to the study of 15 patients described in the article found by clicking here; and is probably based on the study described here.Selected observations about this site:- It describes using 5 to 6 small incisions.
We typically use 5 incisions, each 5 mm long to accommodate tubes about the size of a drinking straw.

- It reports reducing the volume of the stomach by about 70%.
While these techniques create significant reduction, this is likely to vary between patients and we can not put a specific number on the percentage of reduction. Surgeon’s techniques vary and the volume of the stomach may change over time.

- It describes the operation as taking one to two hours (60 – 120 minutes) to complete.
In our experience, the operations typically take between 75 to 90 minutes.

- It describes most patients staying in the hospital for 1 to 2 days after surgery.
Based on our experience, we have always performed this operation as a “same-day” or “outpatient” procedure; patients typically return home 1 to 3 hours after surgery.

- It provides excellent drawings of the effect of stomach in-folding.

- It states that insurance companies do not provide coverage for this procedure.
This is not our experience. Like other weight loss procedures, some insurance companies cover some, but not other techniques. You should contact your provider to confirm your specific benefits regarding weight loss surgery. Our insurance specialist can assist you in determining your benefits . If you do not wish to use insurance benefits and are a candidate for WRAP, we expert staff can provide information for several financing companies.

- It refers to complications related to plication surgery.
We have a document that thoroughly outlines the information you should be aware of before having weight loss surgery, written in easy to understand language. You are given the time you need to feel comfortable with this information and to discuss any questions with your surgeon.

- It says that depending on a person’s weight, they may expect to lose 40-70% of his/her excess body weight.
There are few studies about gastric plication. There is indication that these newer studies (less than 500 people to date, almost all outside the United States) lose an ‘average’ of about 60% and eventually to about 50% of excess body weight, but predicting weight loss from gastroplasty should be done with caution. The patient may want to consider differences in weight loss as trade-offs for having no intestinal cutting or rearrangment, or band adjustments or corrective surgeries sometimes required by band or bypass techniques.

- The site states “Many obesity-related comorbidities improve or resolve after bariatric surgery. Diabetes, hypertension, obstructive sleep apnea and abnormal cholesterol levels are improved in more than 75% of patients undergoing a bariatric procedure.”
It is important to emphasize that these sentences refer to generally accepted knowledge about traditional techniques (i.e., bypass, banding, and others). WaldrepWRAP.com feels that while it is likely that gastroplasty will match the benefits of banding and possibly others techniques, there is not yet enough experience to determine how it will affect diabetes, high blood pressure, and other diseases, as the Cleveland Clinic site describes later in the paragraph.

- One of the requirements to enter this study is a Body Mass Index of at least 27.
A BMI of 27 is in the “overweight” category (Overweight BMI is 25-30; Obesity is 30-35, which is a range just approved by the FDA for the gastric banding product Lap-Band™; then Morbid Obesity is a BMI more than 35, which has been the traditional lower limit for all weight loss surgeries). We support the option of certain surgeries for patients with BMI > 25, and the use of this technique in the Cleveland Clinic study for patients with a minimum BMI of 27 may simply be the investigating team’s preference or based on something specific within the protocol of the study.


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