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WRAP Web | Waldrep WRAP | Page 3

WRAP Web

http://wn.com/gastric_plication_imbrication_surgery_after_lap-bandmpg?orderby=published

This site displays a video from the “World News” website. It describes the use of a WRAP type technique in a patient who lost weight with a gastric band, but was eventually unsatisfied with her ultimate body weight. In the past, such a patient would usually need to commit to a gastric bypass or other more aggressive surgery. Now a patient may have the option to “salvage” their band by choosing to have a WRAP type surgery and adjust the band later if needed. The band may be adjusted to attempt to achieve more weight loss in addition to that from gastroplasty, or possibly to control reflux.Approximately 12% of our patients have a combination of WRAP with a gastric band. When we perform the WRAP, we leave the band completely deflated. Patients most often report feeling adequately — and more importantly — comfortably restricted with the WRAP alone.In making a decision to pursue this treatment (WRAP + gastric band), it is important to remember that all of the risks associated with the band are still present even if the band is never adjusted.

The most significant difference between WRAP and the technique shown in this video is that we do not use a running suture, but individual hand-tied sutures as many as 2 to 3 rows of as many as 15 – 20 sutures per row. We currently feel this provides the most reliable ‘closure’, while allowing the blood flow to the folded stomach to remain intact. The technique in this video shows a single “running” suture similar to heavy fishing line. It’s possible that if any of this suture breaks, the entire suture line gives way. It’s also possible that a running suture limits the blood supply to the tissue on the other side. At this time, we feel these differences in technique have significant impact in weight loss, resolution of co-morbidities, and complications.

Be sure to ask your surgeon which techniques they endorse and why.

http://gastroplicatura.com.br/plication/Gastroplicatura.html

This site is in Portuguese and can be translated by Google software or other web tools.This site was created by Dr. Pedro E Fusco whose important research we cited in the WRAP History / WRAP Wrap Up section.There is an excellent graphic on the site, the “circle-in-circle” illustration that depicts in a very elegant way, the relationship of the inner lining of the stomach to the outer surface. This picture is also in our Images from the Web section.

Notice how the inner lining remains in continuity. The anatomy and function of the stomach is essentially the same, it is simply shaped differently. A camera put down the throat into the stomach, or an X-ray that involves drinking contrast, is still able to show any abnormalities on the stomach surface; however, after a gastric bypass, most of the stomach is separated and “walled off” making examination for ulcers or cancers very difficult.

There are also videos of WRAP type techniques from surgeons whose works are listed in the WRAP History / WRAP Wrap Up section. In the video by Dr. Skrekas, the sutures are tied from outside the body as opposed to inside as in our technique. Also, the second layer is closed with a “running suture” similar to that of a fishing line. We do not use a running suture, but individual hand-tied sutures as many as 2 to 3 rows of as many as 15 -20 sutures per row. We currently feel this provides the most reliable ‘closure’, while allowing the blood flow to the folded stomach to remain intact. It’s possible that if any of this suture breaks, the entire suture line gives way. It’s also possible that a running suture limits the blood supply to the tissue on the other side. At this time, we feel these differences in technique have significant impact in weight loss, resolution of co-morbidites, and complications.


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