Technical Information – Laparscopic Greater Curvature Plication Surgery – The Gastric Wrap
What is the Gastric Wrap, and how does it work? PLEASE READ – IMPORTANT!
The Gastric Wrap procedure is the least complicated of all weight loss surgeries. Although it is a relatively new procedure statistical evidence in scientific studies over 3 years show patients are able to achieve greater weight loss than can be achieved with the gastric band, and the procedure is safe with fewer potential problems long-term.
We recommend it in the following cases:
- For patients who are hoping to lose a significant amount of weight quite rapidly and permanently and who are willing to learn to work with this tool to get the best results.
- Like the sleeve gastrectomy it is a very good “revision” procedure for patients whose bands have failed.
- Psychologically, many patients feel more comfortable with a procedure which involves no cutting and removal of stomach tissue, and is reversible. The Gastric wrap meets both these conditions
- The procedure requires no adjustment after surgery – unlike gastric banding. There will be no need to make arrangements to attend adjustment (band fill) clinics. With this procedure significant weight loss should begin to be experienced as soon as the surgery has been completed. Adjustment of a Gastric Band, by means of filling through the port, has to be done very gradually and patients usually have to wait several months to get to a point of optimum restriction before they achieve significant weight loss. Weight loss results from Gastric Wrap are closer to those achieved by more complex surgeries such as sleeve gastrectomy and gastric bypass – significantly better than the gastric band, yet like the band this procedure is reversible.
How It Works
Like the band or the sleeve gastrectomy, this procedure enables weight loss purely through restriction – limiting the amount of food which can be consumed. There is no effect on the body’s ability to absorb nutrients from the food which is eaten (this only occurs with the gastric bypass)
With the gastric band restriction is achieved by the placing of a mechanical device around the top of the stomach, creating a small pouch which can be quickly filled when eating. The Wrap technique achieves restriction in a different way.
Dr Cierny will perform the surgery through very small incisions – it is a “keyhole” or laparoscopic surgery, just as the band or sleeve operations. Then, the stomach is folded in on itself, and the two outer edges are sutured together – see diagram – to create a narrow tube shaped stomach, similar to the small banana shaped stomach achieved by the sleeve gastrectomy.
Reducing the capacity of the stomach enables the patient to feel full after only a very small amount of food, but the procedure differs from the sleeve gastrectomy in that there is no cutting or removal of stomach tissue. Because the entry to the stomach is not reduced in diameter, patients who have this procedure will not encounter the same problems as band patients with food morsels “getting stuck” in the band restriction and causing regurgitation. Also patients who have the Wrap report an instant reduction of feelings of hunger after the surgery, and do not have to wait several months until a band can be adjusted sufficiently to give the correct amount of restriction.
The weight loss is usually rapid within the first months.
Currently studies show very promising 3-years results in significant and lasting weight loss similar to Sleeve Gastrectomy, and significantly greater than the Gastric Band. Also the loss of feelings of hunger is similar to the Sleeve.
Here are some extracts from a 3 year scientific evaluations of the procedure published in 2010.
(*Ramos et al -April 2010 Brethauer et al – October 2010 with acknowledgements to Bariatric times 2010-7)
“Since 2006, the authors have been evaluating the safety and initial results of the laparoscopic greater curvature plication (the Gastric Wrap technique), a restrictive bariatric surgical technique that has the potential to eliminate the complications associated with Adjustable Gastric Banding and Vertical Sleeve Gastrectomy by creating restriction without the use of an implant and without gastric resection and staple.
Reducing stomach capacity to promote mechanical restriction to food intake is one of the traditionally accepted mechanisms used in bariatric procedures to promote weight loss. There are at least two surgical procedures that appear to rely on this principle in current clinical practice, Adjustable Gastric Banding and Vertical Sleeve Gastrectomy. AGB (Adjustable Gastric Band) achieves around 50 percent EWL (excess weight loss), but unsatisfactory weight loss occurs in more than 20 percent of patientswith failure rate requiring surgical revision in up to 25 percent of patients.
LGCP (the Gastric Wrap) is notably similar to a VSG in that it generates a gastric tube and eliminates the greater curvature, but does so without gastric resection. Initial clinical reports by Talebpour and Amoli and Sales demonstrate satisfactory weight loss up to three years. The present series, compared to findings reported in some series involving AGB, has the lowest early complication rates among all bariatric procedures.
LGCP (the Gastric Wrap) seems to be feasible, safe, and effective in the short term as a promising bariatric procedure on this initial series.”
A Note on BMI (Body Mass Index) and co-morbidities
Your BMI will help Dr Cierny to assess your suitability for surgery, but there are several other factors which influence his decision.
- You may be a yo-yo dieter, going through the “thinner” phase of your yo-yo effect now, but you can show your BMI has been substantially higher in the past.
- The way in which your excess weight is distributed around your body may make your obesity of greater risk to your overall health, that is why it is often useful for Dr Cierny to see photographs of you
- Your racial origin may make you more likely to develop some of the serious co-morbidities related to obesity at a lower BMI than others. There is research which suggests individuals of Asian origin are more likely to develop weight- related illnesses at a lower BMI.
- Co-morbidities. Our list of co-morbidities is not exhaustive, and some co-morbidities, such as Diabetes Mellitus (Type II Diabetes), can have more serious implications than others. There is a strong body of evidence for the link between sustained weight loss, achieved by Bariatric surgery, and improvements in Type II Diabetes
High Risk Patients
The risks involved in surgery for some patients are greater than for others. Statistically “higher risk” patients fall into one or more of the following categories:
- Age over 50 – As with most operative procedures, people older than 50 are known to be at higher risk during surgery
- BMI over 50 – those patients whose Body Mass Index is over 50 tend to be more at risk of peri-operative and post-operative complications
- Male Patients – Men are more likely than women to suffer from certain conditions that can increase surgical risk. These include diabetes, hypertension and metabolic syndrome (also known as syndrome X or insulin resistance syndrome), a condition characterized by a group of risk factors including hypertension, high triglyceride levels, low HDL levels and high blood sugar levels after fasting.
- High Blood Pressure (Hypertension) – People with high blood pressure (hypertension) often suffer from heart disease and/or chronic blood vessel inflammation, both of which increase the odds of serious surgery-related complications.
- Heart or circulatory problems or a history of ischemic heart disease, or disease of the heart valves
- History of Pulmonary embolism (blood clots in the lungs) – People who have previously had a blood clot in their lungs (pulmonary embolism) or legs, or who are genetically at risk for developing blood clots are at elevated surgical risk. All patients, regardless of their risk for clotting, are prescribed blood-thinning medications during the course of their stay in the clinic.
- A history of breathing problems, pulmonary and bronchial disease, asthma or chronic bronchopulmonal obstructive syndrome. People who have suffered from these problems are more likely to encounter difficulties during or after surgery and present a higher risk for anaesthesia
- A history of hiatal hernia, gastro-oesophagal reflux disease, stomach ulcers or a history of chronic diseases of the digestive tract (e.g.Chron’s disease, Barrett’s oesophagus)
- A previous open major abdominal surgery in the upper abdomen might also signal a higher probability of adhesions which would prolong the procedure and make the operation technically more difficult.
If you fall into one or more of the higher risk groups Dr Cierny may well ask for additional medical reports/tests to be made available to him prior to making his decision on your approval for surgery.
Patients who are in High Risk categories usually require additional tests, treatments and medication at the hospital, either before or after their surgery to ensure maximum care and safety. This will generate additional costs for the hospital. If you are regarded as a high risk patient because you can be placed into one or more of the categories listed above, your medical questionnaire will be carefully evaluated by the team at the hospital (together with any further medical information you are asked to provide) and we will let you know into which Risk Band Dr Cierny and the team have placed you when providing your quotation. Extra charges for High Risk patients will either be £200.00 (Risk Band I), £390 (Risk Band II) or £760 (Risk Band III – the most vulnerable patients)