JoanieW

Thanks for posting and Congrats on the weight loss!! Any advise pre and post surgery? What to eat? How to eat? Any suggestions??

Most of what to eat and when is decided by your physician. I had Dr. Watkins, and he required one week of liquids preop and 800 calories, but I think for a higher BMI it was two weeks on liquids before the surgery. Liquids are anything you can sip through a straw. So, you could mix Soup in a blender. One thing I liked was to whip up a Protein smoothie with cottage cheese. It took away some of the sweetness and was very good. I think some other doctors want you on just liquids. You also need to be around 60-65 gm of protein a day and 60 oz of fluids. The first week after my surgery, I was on one week of liquids (sip through a straw type) and two weeks of mushies which is any food that is mushy, i.e. scrambled eggs, cottage cheese, mashed potatoes, etc.

I don't know that I have any advice for preop surgery other than to follow your doctor's recommendations. Postop diet is a little hard, because mushies go through you pretty fast, as do liquids, so you need to eat a little more often. Keep in mind, you will get hungry, but are easily satisfied on less. I now understand why this is called a tool. You still have to watch what you eat, because you can put a lot of ice cream and potato chips in that little stomach. But it's not the same hunger as before, and it's a lot more manageable and easily satisfied. I think the best part of this is that once I have lost all the weight, It will be easier to keep it off.

Postop, I didn't have any pain or gas, and I think that was thanks to Dr. Watkins. There must be something he does differently, but I'm not sure. I hope that's what you wanted to know. Let me know of any other questions you might have.

So I guess you decided on the plication?

Want to stay in touch with anyone who has had this procedure. Welcome any comments from those who have "gone before me". Keep posting please!!!

Hi Lguidry,

I'm sorry to be late in posting, but I haven't been on here for a few days. I am doing great. I'm down 27 pounds since my preop diet. My surgery was on Aug.6. I think my weight loss has slowed down a little because I came off of one of my blood pressure pills, and it was a diuretic. But just being able to come off my BP meds is great news! I'll be taken off the other one soon, and it's a diuretic as well. I've gone from 210 to 183 in two months, just 33 more to go. I feel good and no more joint pain. Let me know if there are any specific questions you have.

Hi Joanie,

Thanks for the support! I was concerned about how this would work for pre-op workup then having surgery and being so far away in case of problems/questions.

When did you have your procedure and how are you doing since? I've been researching lap-bands but this is a new procedure to me.

Karen

Hi Karen. I had my surgery on Aug. 6, and I'm doing very well. I've lost 24 pounds including the one week preop diet I was on. Unfortunately, I didn't lose any last week. You will sometimes hit a stall. If you click on Dr. Watkins' name in one of his posts, you can read everything he has written regarding the plication. That will give you a lot of information.

Joanie

I am considering gastric plication. I've had 2 nissan fundiplications in the past. One broke down after 2 years when I had a really bad stomach virus. I had really bad nausea post-op and we think I weakened the sutures from the start. The 2nd was very sucessful. No reflux, not able to vomit no matter what!

I guess I have a couple of questions.

Does anyone know if BCBS of NC covers this procedure?

Can I have it done after having the Nissen fundiplication?

How does it work using an out-of-state surgeon? Do I have to go to the other state (really interested in Dr. Watkins from all I've read).

Does anyone in NC do this procedure? And, do they have any/much experience with the procedure? I really do not want to be a guinia pig!

I appreciate this forum so much!

Welcome, KKD. I'm sorry, I don't know of any doctors in NC that do this procedure; however, I did travel to Cincy from GA to get my plication done with Dr. Wakins. My surgery was on Fri., and we left the next day and drove home seven hours. Dr. Watkins and his staff have stayed in touch, and I was able to have my barium swallow (required as a followup by Dr. W.) here, so I haven't had to go back.

I'm sure Dr. W. will be along and answer your questions about the fundoplication. If you choose to go to Cincy, you will be in good hands.

HEY CONGRATS on the weight loss that is fantastic news I know what you mean about feeling full on a lot less. How much further do you have to go? Have you adopted any sort of exercise regimen or is the weight loss purely down to lower food intake down to your good food choices and that feeling of satiety with the help of your procedure?

Regards

LetmeGimmee

Thanks, Letme. I wanted to lose 60 pounds, so I have 36 more to go. Hopefully that will be even less when I weigh myself on Sat. I'm ashamed to say, I haven't been doing very much exercise. I walk in the morning sometimes, but I could do a lot better. I just hate to exercise.

Dr. Watkins: Thank you for your very clear and thorough answer. You are a very rare, and caring, doctor to actually spend time explaining things to people in an online chat room, I am very impressed with this generosity, as you have answered all my questions and I am totally ready to get all my arrangements done and make my GPS appointment at your clinic!!!

Rain, you won't be disappointed. He's a wonderful doctor.

Well, it's been two weeks now and I am down 15 lbs. Clothes are fitting better and my face seems thinner. This is amazing. I haven't been able to lose weight for several years and now it is finally coming off! Started with a BMI of 32.9, so I want to lose a total of 60 lbs. I'm on my way!

Congratulations on your weight loss! With a BMI of 32.9, that's amazing. It looks like you're living up to your name. :-)

Letmeeatcake (love your name), I suggest you click on Dr. Watkins name in his last post and read all his posts. I think you will find a lot of your questions have already been answered by him, and you can trust what he says. Let me know if you have any others about my personal experience, and I will be happy to answer them.

None that I am aware of. aNYONE KNOW OF tgvp surgeons in or around the UK. Good to know you have had yours repaired. HOW are you doing with the weight loss and in general, i always think a large part of the journey is as psychological as it is physical.

Best Wishes:biggrin0::thumbup1:

I have had great weight loss. As of last Sat. and including my one week preop diet, I have lost 24 pounds. You are right, the journey is both psychological and physical. I now understand why this is just a tool. You still have to watch what you eat to get the weight off. You don't want to be eating chips, ice cream, and Cookies. The good part is that I am satisfied on a lot less, and I think I can keep the weight off a lot easier than in the past. Thank you for the well wishes.

Hi

It's November 8th, thanks for the welcome. I was hoping someone would point me in the right direction re. reflux and hiatal hernias. It appears the surgeonwho is operating is prefers not to carry out the TGVP if the hernia is larger than 2cm and due to my reflux? I thought that weight loss would help with hernia's? Anyway he is going to do an endoscopy but if I insist on proceeding will have me sign some sort of liability waiver re. potential for hernia/reflux problems continuing or worsening. I'd love appreciate any insight upon this, then at least I can go ahead and decide better informed.

Thanks Again Regards

I don't know what size my hernia was, but it was fixed during surgery. I don't see why a large hernia couldn't be fixed, as well. Are there any doctors closer to you where you can get a second opinion?

i'm awaiting plication surgery in PRAGUE

Hi Letme. Welcome to our little corner of the world. When is your surgery?

Thanks Joanie!

It's more like 6.5 weeks, but that's okay. I feel better now - sounds like we started about the same bmi! Hope we have an awesome 2011 : )

Mari

Mari, I know we will. And a much healthier one too. My starting BMI was 36. I'm now down to 31.9.

Hello!

6 weeks = 22 lb loss...

Which is okay for me - I have about 35 more to goal :thumbup:

Seems less than others.. No excuses here lol, but I have not been working out just walking the dog nightly... My bf tells me that by not being on a structured work out session, I am not doing the GPS justice :001_wub:

I told him when I am ready, I will... :biggrin2: I am doing very well with my eating and Protein intake though.

Ck - you are doing outstanding and I love your blog!

Hi MW. A loss of 22 pounds in six weeks is amazing. The more you have to lose, the faster it comes off. I have 34 more to goal. Keep up the good work!

Having a real hard time deciding between the two procedures. I really want to make the right choice and I'm not sure what that is? My BMI is 39.5. I'm very interested in knowing what and how others are doing with the plication procedure?? Is the weight loss as significant as with VSG??:001_smile: Need help please! Also, I'm considering Dr. Corvala (Hospital Angeles, TJ, Dr. Ortiz(Obesity Control Center, TJ) and Dr.Jose Rodriguez, INT in TJ MX and Star Medica in Juarez) and possibly Dr. Aceves. Who's the best at which procedure??

Hi Iguidry. I can only speak for myself as to why I chose the plication over the VSG. It was hard for me to live with the fact that I would be losing 85% of my stomach. I was also afraid of having a leak. Once I started researching the plication, I made my decision right away without hesitation. It has the same EWL as VSG and it's safer.

You have to write down what's important to you, maybe do a pros and cons list. Plication pros for me were: Safer, great weight loss, less time on a liquid diet, faster healing. Cons: Cannot eat large meals. Oh wait a minute. I guess that could be a pro also. VSG pros: Great weight loss. Cons: The whole pro/con thing with not being able to eat large meals and staples. There is also the debate on grhelin, but Dr. Watkins cleared that up in his latest post.

My BMI was 36, and I have lost 24 pounds. My BMI is now 31.9.

By the way, I don't know anything about the other doctors you mentioned, but I think Dr. Watkins is amazing and has great followup care.

6 weeks=24 pounds

I had surgery with Dr. Brad Watkins only 8 days ago! I lost 10 lbs 1 week prior and another 10 lbs this week. It's unbelievable to be down 20 lbs in 2 weeks! I've been over 220 lbs. for 10 years! (started this journey at 245) My clothes are already getting too big!- ps. I am not starving myself... I am on "soft foods" and today's menu included: breakfast- mushed boiled egg (yes I did put a little mayo in - usually on do this at Easter- but wow, it tasted great; Protein drink, Soup (lunch); Protein water; salmon with some noodles, overly cooked little-green Beans (still afraid to eat veggies)- will increase vegetable intake after the 3rd week-

Welcome aboard COGSP and congrats on your weight loss! It's funny that you are from Castle Rock. We just moved to GA from Colorado Springs. I really do miss CO.

Ghrelin is reduced by pressure on the gastric wall. You do not have to remove stomach to reduce ghrelin. Ghrelin is a feedback hormone meaning when the gastric wall is stretched, ghrelin levels are reduced. The reason ghrelin levels are lower in sleeve gastrectomy patients is due to the smaller size stomach, not from removing stomach tissue. The sleeve that remains still produces ghrelin and levels are reduced by pressure.

In gastric bypass, for example, ghrelin levels go to very low levels and the entire stomach is still there. All of the ghrelin producing tissue is still there but the levels are very low due to pressure. No ghrelin level studies have been done in plication, but plication patients describe the same appetite reduction as sleeve gastrectomy patients.

There is certainly more data about sleeve gastrectomy, but the plication patients lose weight in the same manner and describe the same appetite reduction. Another important thing to remember about ghrelin is that it is a small part of a very complex appetite mechanism that we understand very poorly and superficially. The only reason ghrelin gets so much press is that the molecular structure of the hormone is know - it has been discovered. We know there are a lot of things floating around in the blood stream that affect appetite that haven't been discovered. All of these hormones are reduced by pressure in the stomach wall, not by resecting stomach tissue.

Whereas we don't currently have morbidity and mortality data on the plication, it will be less than sleeve gastrectomy because there is no cutting and no stapling involved. Regardless of the fact that the sleeve gastrectomy has been around longer, many patients do not want to have their stomachs cut and stapled and most of it discarded. The minimal invasiveness of the plication is really resonating with lots of people. Our experience with the plication is that patients are losing weight like the sleeve gastrectomy patients and they are losing weight like the European patients that have had plication. Plication x-rays (barium study) look just like the sleeve gastrectomy x-rays. It creates the same space and works the same way - by pressure with fewer calories.

Also, in terms of stomach being folded on itself, we have been doing this for many years with an operation called Nissen fundoplication, an operation done for severe reflux. It is comforting to know that through all of the many years fundoplication has been done, there hasn't been one documented case of a problem with stomach being folded on itself. Though the plication hasn't been around very long, folded stomach has been around a very long time without any issue so we don't anticipate any issue with plication as a weight loss operation.

The important truth to keep in mind is that ghrelin levels are reduced by pressure, not by resecting portions of the stomach. Any remaining stomach will produce ghrelin and those levels will respond to pressure, not volume of stomach tissue remaining in the body. Another example is that the Lap Band will reduce ghrelin levels and 100% of the stomach remains. The levels are reduced because the stomach pouch above the band is much smaller and stretching that small portion of gastric wall above the band is creating the reduction in ghrelin levels.

Brad Watkins MD

Thank you, Dr. Watkins. I knew you would come through for us. I feel a lot better about my decision!

Anyone seen ANY research yet on the M&M (morbidity and mortality) numbers for plication? Also, I'd be interested in seeing EWL (excess weight loss) figures.

I would be stunned if plication can approach the sleeve for EWL, since the ghrelin is still present (although it may not be as prevalent without fundus stretching; then again, the plication may also trigger essentially permanent ghrelin secretion; who knows?) and the ghrelin reduction of VSG is posited to be one of the primary mechanisms for EWL from VSG aside from the purely restrictive aspects. I'm sure that initial weight loss in plication is good, but then again it's also good in all WLS -- banding, DS, and so on. It's the long term maintenance that I'm concerned about; that's what drew me to VSG over, say, lap-band (aside from the foreign body issues): VSG has, hands-down, the best 5 year EWL maintenance statistics around. Very interested to see how plication will stack up, but I know that that data is simply not available. Calling plication a "super sleeve" without this kind of data seems to me to be at best misleading, and at worst downright deceptive. But, time will tell; hopefully all the plication patients thrive and do well.

The only place I can see plication touching VSG is on the M&M figures, since there's no resection. But even that is hypothetical, as there are a lot of unanswered questions (what are the effects of all that "bundled" tissue long term? can the staples come undone? are there vascularization effects? &c &c)

There have been some studies done on the GPS. One of them was for about three years, and you can find it at bariatrictimes.com. From that study, the EWL was comparable to VSG. There was another two-year study in Brazil. But you're right. We don't have enough data. I just knew that I couldn't do the VSG but I had to do something. This was a viable alternative for me. I had my surgery on Aug. 6, and I am down 21 pounds since my one week postop diet. I do get hungry, but not like I used to. It's not that all consuming hunger I used to get where I couldn't stop eating. I eat a very small amount, and I'm satisfied. I think your question about what happens to the bundled long term tissue is a good one and is a concern of mine. Since Dr. Watkins posts here from time to time, I hope he sees this and will give us his opinion. At the end, I have posted a copy of what Dr. Brad Watkins has had to say about the surgery. By the way, there are no staples, just sutures.

#12 (permalink)

07-14-2010, 02:53 PM

DrWatkins

Registered User

Join Date: Jun 2010

Posts: 25

Gender: Male

City: Cincinnati

State: OH

Re: Calling all (TGVP) people!!! new procedure

Gastric plication and gastric imbrication are describing the same operation. The ROSE procedure is an endoscopic stitching for gastric bypass patients that have regained weight due to stretching or dilation of the connection between the gastric pouch and the small intestine.

As opposed to the sleeve gastrectomy whereby the stomach is made into a tube using staples (and the stomach is removed), the plication (or imbrication) creates a sleeve by folding the stomach in on itself and then stitching to keep it folded in on itself. Your entire stomach is still there, it's just folded in on itself with stitches to keep it there. No staples. No cutting. No stomach removal.

I have not seen ghrelin studies on gastric plication but plication patients do describe profound appetite reduction and they get full on small amounts of food so it appears to be a very good weight loss tool. Ghrelin reduction comes mainly from pressure, stretching the wall of the stomach, which occurs when the stomach volume is smaller. Ghrelin appears to be a small part of a very complex appetite mechanism of which we only have the most superficial understanding.

In my mind the only downside to the plication is that we just don't have that long-term data with hundreds of thousands of patients over ten to twenty years like we have with the bypass or the band. There is two year data out of Brazil that shows plication weight loss in the 60% excess weight loss at 2 years which compares favorably to other successful weight loss operations.

We performed our 5th plication this morning. Three were band patients that converted to plication and two were primary plication patients (plication done as the original operation). To date, I have been very pleased with the satiety the plication causes and the associated weight loss. We call it the GPS (Gastric Plication Surgery).

GPS is very different from the VBG (vertical banded gastroplasty) from years ago. VBG was simply stapling a small pouch in the upper part of the stomach. GPS (plication) creates a small tube out of the entire length of the stomach.

Hope that helps

Brad Watkins MD

Gastric Plication Surgeon

Cincinnati, OH

Hi everyone

I'm so happy that we have now more and more members here in this forum.

I've lost 15 kilos so far or about 33 Ib but without exercising. I'm just trying to walk more,but I'm little worried about my weight I always have that feeling that my body is going to resist weight loss ,since the third week , I've been losing 1 kilogram each week.Is this enough?Is this normal?. I'm so worried ,but I've noticed that those who had the procedure 6 or 7 weeks ago had lost the same weight..........I also have a question... Has anyone noticed that this procedure is different from other procedure coz I found that we can eat like normal people,but people who had other procedures suffer when eating certain food and even vomit.My friends who know that I had surgery wonder how I can eat everything........I'm so worried ....Is this normal or there is something wrong with my surgery .....I'm going to see my surgeon 10 days ago but I realy need support and encouragment.

N.B:I'm from Egypt and this surgery isn't well known here .I'm even the only one who had it in my city.

Sarah, I think your weight loss is awesome. It's been a month, and I am down 20 pounds. I'm losing slower than most, but maybe it's because I only need to lose 60 pounds. I have 40 to go. Somedays, I can barely eat anything and other days I can eat more. I think you're doing great!

Well, I made it home safe and sound. The travel went well. I tried some chicken broth once I got home and must have eaten too much. I guess it will take time to recognize the signs my body is telling me. So I ended up on the floor whimpering in pain. Wow, the stomach and left shoulder pain was intense! It took about 15 minutes for it to calm down but boy was that scary. Did any of you have difficulty getting comfortable at night sleeping? I find myself waking up about every half hour and trying to change position. Can't tolerate my left side yet as it feels like there is pulling. I am so looking forward to being a month post op. That seems to be when most of you felt really great again. I'm five days post op now.... Each day is a little better. Say, I was wondering if Dr. Watkins patients have to give themselves anticoagulant shots until day 7? That is dr corvala's protocol and I was just curious. Anyone?

Hi Lisa. I am one of Dr. Watkins' patients, and I didn't have to give myself a shot at all. I know they gave me an anticoagulation shot during surgery. Is it just you or do all Dr. Corvala's patients have to do that? I wish you weren't so miserable. It will pass soon enough. If you haven't already read it, Dr. Watkins addressed the problem with shoulder pain in one of these threads.

CK, congrats on the 33 pounds you've lost!

Hi all,

Well I had my surgery with Dr. Corvala in TJ Mexico on Wednesday. This procedure is not a walk in the park. I have really felt lousy and have vomited several times. I am supposed to fly home tomorrow and I hope I will be up to it. Dr. Corvala and his staff have been great. I guess I thought it wouldn't be so uncomfortable. No real pain, just discomfort is the problem. I've been walking then sleeping, walking and sleeping. I just want those of you who are coming up to the surgery to be prepared. This is major surgery and there are no two ways about it. I'm not sure yet that I am glad I did this... Probably in a week I'll feel differently. I'll post again.

Hi Itsa. I am so sorry you are having a lousy time with your surgery. I guess I was one of the lucky ones. I had no problems, other than fatigue. Even so, I did have the same feeling of wishing I hadn't done it, but that will pass. I'm very happy now and am down 20 pounds. Looking forward to hearing from you, so keep us posted. Let us know if you have any questions.

I am excited Joanie! Dr. Watkins and their staff has been really great and caring.

They are great! Dr. Watkins has called to check on me, and Cookie, his nurse, checks in with me once a week still to see how I'm doing. I had to have a barium swallow just to check and make sure my new tummy is working properly. He placed the order for it. I could have gone back to Cincy and had it done there, but you don't have to. One of my incisions got a little red, and I told him that it just looked irritated because it was around my waistline. But he had me send a picture of it to him anyway, and he said all is well. I'm really glad I chose him.

I am two weeks out today. I feel really good and I have lost a total of 32 pounds including my week preop. I was able to eat 2 oz of salmon today and it felt really good and I was very full after I ate. I miss bread and chocolate but I know that down the road I will be able to add a little back in. I can't believe it has only been two weeks it seems like I am further out. I would have this surgery again in a heart beat.

Wow! Kamie that amount of weight loss in three weeks is incredible. Keep up the good work!

Hi, I was reading some forums on obisityhelp.com and there are some people that had the regular sleeve and they are sure putting down the Plication Surgery.

One thing they are saying and I would love to find out if it is true or not, they are saying that the stomach is like a melon and that after a few years the stomach will slide through the stitches.

Has anyone heard of this?

Lisa~

Lisa, you probably saw that Dr. Watkins has addressed this in the previous post. I don't understand why they are putting down the plication surgery like they are. All sorts of rumors are going around over there. I tried to explain what I new about plication, but they promptly told me that I was wrong, so I haven't gone back. Maybe a copy and paste of Dr. Watkins' reply would help. It's just common sense that why would doctors do this procedure and risk their reputations if the stomach was like a melon and the sutures were just going to pull through. In that same light, why wouldn't staples come through.

Also, my mother had half her stomach removed in the 70s because of a HUGE ulcer that covered half of it. I don't know if they used staples then, but her surgery has done fine since then, and she is at a normal weight. She still eats very small portions. I remember the surgeons putting her on a liquid diet afterwords and telling her to only eat five or six small meals a day.