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WRAP Web | Waldrep WRAP | Page 5

WRAP Web

http://iranobesitysociety.com/english/subject.aspx?sbid=f0147ad2-0647-479d-b56a-4fb65d9760ca

This is an interesting presentation by Dr. Talebpour whose seminal study we presented in the WRAP History / WRAP Wrap Up section as the first “modern” clinical presentation of gastroplasty results. This site is an informal, possibly non-peer-reviewed presentation of as many as 320 patients; 8 of the patients were seven years out from their surgery. The ‘average’ weight loss as reported appears to be fairly stable in the 60% to 50% range.The appearance of the suture line shown on this site is significantly different from our WRAP technique.

http://www.myfoxtampabay.com/dpp/health/doctor_jo/gastric-imbrication-dr-jo-10012010

This site shows a Tampa Bay, Florida television news show’s story on gastric imbrication (a WRAP type surgery). The patient shown in this feature was hospitalized after her surgery; we perform this technique as an out-patient, or ‘same day’ surgery, with patients returning home a few hours after surgery.The doctor is quoted as saying “there is less surgery time” but does not say compared to which technique. It is unlikely to be shorter than a band (which for our clinic averages about 20 minutes), but may be shorter than a bypass (for our clinic they each take about 60 minutes to perform).

http://www.verticalsleevetalk.com/topic/14816-gps-update-important-new-information/page__p__125678__fromsearch__1#entry125678

This is a controversial message board thread. We include it here, not because it has any legitimate clinical value, but because we feel the site is so emotionally charged and sometimes confusing – to the point of being, at best, misleading and you may have come across it in your own web research.Random observations:The initial entry by the surgeon, on a public forum such as this is a little unusual. Some people on the thread are grateful and some irritated by it. Gastric perforation is a known, but rare complication of stomach surgery, but there is no standardization of this procedure, and the report here is anecdotal with no information about which specific surgical techniques, including suturing, that were employed. There is no indication of the experience, credentials, location, or number of surgeons who reported this complication.

The surgeon initiating this thread had originally made some claims on his own website concerning gastric imbrication that appear to have since been redacted. So this may have been a significant event in his practice or he was deeply affected by it.

There is a link to another weight loss surgery support group where a patient describes a complication of a perforation approximately 6 months after a gastric plication surgery performed in Mexico. We sympathize for the patient who experienced this complication, but there are some descriptions of clinical issues that are open to interpretation. The patient also quotes a surgeon as stating that the perforation was due to the way the stomach was sutured during the imbrication. This may be true, and is one reason we don’t use a ‘running suture’ as we feel it may contribute to decreased blood flow across the entire suture line. However, a perforation may be due to other reasons (including scenarios such as sudden or gradual enlarging of the top portion of the stomach, eventually rupturing like a bleb on a tire – this can be seen in gastric band obstructions, or ulceration by acid, or as a delayed effect of an injury during surgery). The patient also states she was never informed of the possibility that holes may form in her stomach due to her surgery; this possibility should be part of every written consent form for any weight loss surgery, including banding and bypass as it can and does happen.

In a post of March 13, 2011 the surgeon states that he could no longer recommend plication surgery, however within 3 months, his website is noted to be advertising gastric plication; so perhaps he feels the risks were not a significant as he once believed, despite stating that bariatric surgeons he respects are ‘anti-plication’.

The idea that this complication was unanticipated is unlikely, as this is a known complication of any gastric surgery, and was reported in the first peer-reviewed paper by Talebpour (2007). Delayed ‘leaks’ have been reported many times for sleeve gastrectomy procedures as well as perforated ulcers after gastric bypass as reported in surgical journals for the first time by our own clinic.

Unfortunately, the remainder of the messages delve into emotionally charged exchanges, allegations, and insults.
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If, ultimately, you are interested in a WRAP type technique and the message board discussed above is affecting your decision about proceeding, we would be happy to talk about it with you about our credentials and experience.


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