Calling all (TGVP) people!!! new procedure

ellenmarie60 · July 29, 2010

I had those problem a bit, it was like it would stick in my chest im 1 week out and its gone : >

DrWatkins · July 29, 2010

There was a question about a measuring catheter used during plication surgery. This is likely referring to the "EndoFlip" which is a commercial measuring catheter used for multiple purposes.

My opinion is that this is unecessary for plication surgery. The idea is not to make the stomach tube too tight or too loose. This can be accomplished using a surgical bougie (pronounced "BOO - gee"), which is a long soft rubber tube that comes in different sizes. Surgeons have not agreed on the perfect size bougie yet but the sizes surgeons use are around 32Fr ("French" - a diameter sizing system).

What I like to do is to perform an EGD (esophago-gastro-duodenoscopy - a scope of the stomach) in the operating room just prior to the surgery to make sure the stomach is normal and healthy and there are no polyps or ulcers, etc. Also, the scope is 32Fr so I simply leave it in place and use it as the measuring device and then I can examine the gastric tube I have made at the end of the procedure. This also eliminates blind intubation of the esophagus and stomach and avoids multiple tubes being passed into the esophagus and stomach and this will reduce the chance of any injury due to blind intubations.

We have done 7 cases now with this technique so my opinion is that no additional costly measuring devices are needed. The beauty of plication is that you are just using stitches which are relatively inexpensive and that is why the cost of the surgery is so much less. You certainly don't want to add additional expense unless it adds a marked advantage.

Brad Watkins MD

DrWatkins · July 29, 2010

Another common topic of discussion is the hiatal hernia.

What I have learned from doing weight loss surgery for over 8 years now is that all overweight people have a hiatal hernia. The hiatus is the opening in the diaphragm breathing muscle for the esophagus swallowing tube. This is supposed to be the size of a quarter (coin); we often find it to be the size of a lemon and this needs to be repaired. The repair is easy as you simply stitch the muscular opening down to the appropriate size.

What I have learned is that you don't often see these hiatal hernias at the initial surgery because they contain ("extra padding tissue that is yellow in color"). To be thorough you have to go looking for them and if you go looking for them (hiatal hernias) you will find them and they need to be fixed.

Hiatal hernias cause heartburn (GERD, acid reflux, etc). When you do any opertion that restricts the volume of food as most weight loss surgeries do, the plication being no exception, you must repair the hiatal hernia even if it is small. If this is ignored (not repaired) the patient will have severe heartburn after the procedure which causes frustration, additional medications and interferes with successful weight loss.

I am a radical proponent of fixing hiatal hernias. Many surgeons don't agree with me and only fix large hiatal hernias which are evident on visual examination. Most surgeons that have experience with weight loss operations for more than a couple of years have learned the importance of fixing hiatal hernias (in every surgery).

Therefore, a routine part of my plication surgery is to repair the hiatal hernia. It is right there in the same are where we are working, it is easy to repair and creates happy patients after surgery.

The best time to do perfect surgery is the first time.

Brad Watkins MD

NotSoLittleMermaid · July 29, 2010

Hi Everyone,

I am curious to find out if many can wear a bikini eventually without tell tale signs of surgery and incisions. I have only seen 1 YouTube video and the girl did have scarring.

1) How long did it last?

2) On pale skinned people, is it permanent?

3) Anything else I should know?

That probably seems like it should be the least of my worries, but I feel like I am sort of in between surgery and no surgery. Since I've started reading this forum, I have really cut back my portions and actually started to see the scale slowly reverse! (Ok like a few pounds - but for me, I have been steadily gaining every week for the last year.)

In first week or so I was ravenously hungry and couldn't wait to have the surgery. I have had to go about 3-4 times a day when I am empty and hungry but it has lessened. (BMI 32 about 60lbs to lose.) Obesity runs in my family and my little sisters who really diet and workout hard daily are still chunky. I probably will end up having it because I feel this weight loss is temporary and I am 34 and the struggle will only get worse. All I want is to feel fuller longer, and be able to eat healthy & small portions of food I really like. Verses all low carb or no bread ever, etc. So far, I've cut back portions and still eat most of what I like. Yes, there are times when I am hungry. Usually, when I think about food or whether or not I am hungry, I physically GET hungry. So that is why I feel my recent success is only temporary. (In the middle of this long paragraph I weighed myself and realized a gained a pound since yesterday, despite drinking lot of Water..: ) typical. So I probably will lean towards surgery. 1 pound gained in a day from having salad, tacos and a tiny peice of cake & small margarta!)

I feel like I should move toward a decision within the next few days/weeks because the surgery I want is Plication cheaper for the next month. I am self pay. I also think if I am going to do it, get it over with, so I can get through post op and have a better quality of life ASAP.

At the same time, I am very scared and have never had surgery before. I am worried I will get it and have regrets. Anyone been there? Thank you for all of your posts.

DrWatkins · July 29, 2010

We do the plication using all 5mm laparoscopic incisions (tiny). If a surgeon uses any 10mm instruments this would require 10mm scars so you should ask your surgeon about the size of the incisions. For example if you do stitching using simple surgical instruments this only requires 5mm incisions. There is a commercial device that some surgeons use (EndoStitch) that aids suturing but this is uncecessary if you are comfortable with laparoscopic stitching using standard laparoscopic instruments and it requires a 10mm incisions.

For Lap Bands we use a cosmetic approach by hiding the port scar in the umbilicus(belly button) and 2 addition 5mm incisions. This technique makes it very difficult to tell any surgery was done. The plication involves a total of five 5mm incisions.

For free weight loss classes, I have put a series of weight loss lectures on YouTube that would be helpful for anyone desiring to lose weight. If you search "Watkins Weight Loss Class" they will pop up out of order. To find them in order, you have to add the next number to the search (ie 1,2,3,4, etc)

Brad Watkins, MD

NotSoLittleMermaid · July 29, 2010

Hi Dr. Watkins, do you email or how can I email you privately? You are a wealth of info. Would like to find out more about your surgery options

NotSoLittleMermaid · July 29, 2010

Mine is Amy@REOGulfCoast.com

bird · July 29, 2010

I had those problem a bit, it was like it would stick in my chest im 1 week out and its gone : >

When did it go away? Did you feel ready to move on to mushy/puree on schedule? What are some things your eating now?

bird · July 31, 2010

Can anyone out there please tell me if it is normal to have severe back pain? I was expecting it after surgery, like the band. This is coming on day 5,6,7 and who knows how much longer. Please let me know if I'm the only one. Am I always going to feel like this? I felt awesome up to day 5.

Mountaingal · July 31, 2010

Hey JoanieW how did it go? Were you already on a liquid diet when you went up for the appt yesterday? How long from first contact with Dr Watkins to surgery date? Hope the trip and everything else went well for you. Keep us informed please.

JoanieW · July 31, 2010

I had my GPS done on 7/23, by Dr Watkins. I am now 5 days post op. The pocedure was recommended to me because I had the band for 3 years and never had great success. I was commited to the process and diet, but I could never get the "sweet spot".

So far I have had less pain then with the band. However, I don't remember it being so hard to get liquids in with the band recovery. Yesterday was a great day and I was able to get down almost 2 slim fast and about 2 bottles of Water. Today was bad, about 1 bottle of Water. I sip all the time. The pain in my chest is so tight because of the swelling it hurts to drink. I am hoping everyday will get better and I will not get dehydrated.

I did lose 12 pounds since the week prior to surgery. I am happy about that!

Hi Bird. I just came back from a consultation with Dr. Watkins. I'm scheduled for Aug.3. I think he's a very caring and dedicated professional, and I know I made the right choice. Welcome to the boards. Hope today is better for you.

JoanieW · July 31, 2010

Hey JoanieW how did it go? Were you already on a liquid diet when you went up for the appt yesterday? How long from first contact with Dr Watkins to surgery date? Hope the trip and everything else went well for you. Keep us informed please.

Hello MG. Thanks for asking about me. The consultation went great. I was really impressed by Dr. Watkins and his staff. They all adore him. I started my liquid diet on Friday. It's only been two days but seems like forever. I only have to do a week because my BMI is a little lower. Notice how I didn't say low, because it's not. When I first called the office, I went ahead and scheduled the consultation and the surgery at the same time, so it's only been about two weeks. I didn't want to wait any longer. What's your story?

JoanieW · July 31, 2010

hi everyone ! this is nicole and i am going to Mexico to have the sleeve done. hope all goes well! has anyone heard of dr Almanza in Tijuana mexico?

Welcome, Nikki. When is your surgery scheduled. Keep us posted on your progress. Joanie

JoanieW · July 31, 2010

Hi Bird. I just came back from a consultation with Dr. Watkins. I'm scheduled for Aug.3. I think he's a very caring and dedicated professional, and I know I made the right choice. Welcome to the boards. Hope today is better for you.

Oops! Wrong surgery date. It should be Aug. 6.

Mountaingal · July 31, 2010

Hi JW,

Thanks for asking about my story. Like you I am not very high BMI compared to some others but I am tired of dragging around that "bag of dog food" (as I think of it) every day. I have fought the battle for 30 yrs and as I get older It is winning. I know my knees would feel better and it would be so much better for my health to weigh less. I am trying to make the decision to do what is best for me regardless of what others might think or say, or the cost involved. I researched lap band and decided for several reasons it wasn't right for me. Like you I am 6 hrs from Dr Watkins. Did you drive up for your consultation? Feel free to pm me if you want to chat.