Calling all (TGVP) people!!! new procedure

[DrWatkins 13]

Dr. Watkins,

I asked Dr. Corvala at the time of surgery about sutures cutting through the stomach tissue and he said that it was just people not knowing.

But as of late, I have heard that the stomach tissue is like butter or melon and that the sutures would cut like fishing line through the tissue. Is this really the case?

I don't think it is, and I think it is just people that don't know what they are talking about spouting. But could this be a result? I would just like your medical input.

I for me can tell you that this surgery has been what I was looking for. Had the surgery 2 weeks ago in Tijuana with Dr. Corvala and his team. I am down 18lbs, and am on mushy/soft food. I can tell when I am full (something I didn't have before) and am not hungry all the time. I get hungry every 3-4 hours and I have about 150-250 calories. I am eating between 600-900 cal per day.

Thank you for your wealth of information.

CK

Even though we don't have long-term information on the plication, we have placed the exact same sutures on the stomach for many years so we certainly know how they behave over the long-term. Based on our extensive past experience, I believe strongly that our sutures will hold strongly over a lifetime. I also believe that like any other weight loss operation on the stomach that a small percentage of patients will have dilation years later with weight regain. In that instance, we could place more stitches laparoscopically (tiny incisions) or you could band the top of the sleeve or you could have any other weight loss operation for that matter - plication doesn't burn any bridges - you still have your stomach.

It's worth mentioning that I've already seen quite a variation of the stitches being used and that does make a difference. In my opinion, the best way to do the plication is to perform two layers of running 2-O Ethibond suture and then place interrupted stitches to reinforce the outer layer. You don't need to reinforce the inner layer because it will remain beneath the outer layer. I've seen surgeons having trouble with Prolene suture coming undone so I would not recommend this. Prolene doesn't hold it's knots as well and does not cause any reaction from tissue. I've read reports of Prolene stitches coming undone and the patients therefore report zero restriction shortly after the surgery and it has to be redone. Ethibond is a third generation silk suture and it is intentionally designed to cause a reaction with the tissue that creates a little scar tissue at the stitch which makes the bond stronger than simply the stitch. On the outer layer, if you do this as a running (continuous) suture and then reinforce it with interrupted stitches, the plication looks really perfect and is quicker to do (less anesthesia time). Then, the interrupted stitches are easy and quick and you've got redundancy which should make the possibility of it coming undone as near zero as we can get in human healthcare.

Brad Watkins MD

[NotSoLittleMermaid 14]

Thank you so much Dr. Watkins, as always, you are giving great info and helping everyone. Details are SO important..

[Cknorte 7]

Thank you so much Dr. Watkins for responding.

I really think this surgery is awesome. I feel great, have had no adverse effects to food. I am actually pretty much back to normal, with the exception I eat like a bird (or skinny person). I don't feel deprived of anything, and I am not hungry at all.

My energy has rebounded.

Thank you to all the medical minds that came together to create this surgery!!!!

[Mw9955 2]

Hello all, I had a hard night last night. I don't know if I slept wrong, but my top incision at my bra line split open and bled! I am one week post op. The strips are still in place but the gauze was completely covered in blood. Is this normal?

Oh also, my left shoulder was killing me yesterday! I read it could be the co2 gasses dissipating, but my boyfriend thinks it may be a sign of infection...

Mari

Edited August 10, 2010 by Mw9955

[jennyomtc 0]

I'm sooo nervous, im having surgery on Aug 28 in Mexico with Dr Corvala....Im excited yet nervous...I don't want to wake up with untolerable pain or vomiting....I have never had general anes only local....reading this thread makes me feel better...Does anyone know of anymore sites that have plication threads/forums????.:thumbup:

[Cknorte 7]

You will love Dr. Corvala and the staff at Angeles Hospital.

Best of luck. I didn't wake up with any pain or vomiting....my first night was a bit rough, I did have pain and was a little uncomfortable. They gave me pain and nausea meds. I was up and about the next day....felt 1000 times better after my first shower....

I hope you have an awesome surgery and recovery.....

[Cknorte 7]

Hello all, I had a hard night last night. I don't know if I slept wrong, but my top incision at my bra line split open and bled! I am one week post op. The strips are still in place but the gauze was completely covered in blood. Is this normal?

Oh also, my left shoulder was killing me yesterday! I read it could be the co2 gasses dissipating, but my boyfriend thinks it may be a sign of infection...

Mari

Mari,

My left side incision kept on opening night after night, since I sleep on that side, I actually ended up rubbing off the steri strips. I ended up after the strips came off putting on one of those advanced healing bandaids on, and they did the trick, stayed on for a few days and then I let it air dry.

The one between my boobs heals and scabs...but since my bra and rubs on it, especially the sports bra, I keep on tearing the scab. I'm about to put another one of those bandaids to the test....

Keep it clean, and put some neosporin on it, that should do the trick for a while.....

[JoanieW 13]

I'm sooo nervous, im having surgery on Aug 28 in Mexico with Dr Corvala....Im excited yet nervous...I don't want to wake up with untolerable pain or vomiting....I have never had general anes only local....reading this thread makes me feel better...Does anyone know of anymore sites that have plication threads/forums????.:thumbup1:

Hi Jenny. I had my surgery last Fri. and did not wake up with intolerable pain or vomiting. In fact, I have taken no pain meds since surgery and have not vomited once. Everyone is nervous about surgery, but usually the anticipatory anxiety is 100 times worse than the actual event. You'll do fine!

[DrWatkins 13]

Left shoulder pain after surgery is a common symptom and a common question.

Basically, left shoulder pain is a referred pain from the diaphgragm (breathing muscle between the chest and abdominal cavity).

If the diaphragm has inflammation the brain feels this in the left shoulder. The reason for this is called referred pain.

If the brain can see something, it learns pain signals very quickly and easily and can localize it precisely. If you were blindfolded and someone stuck a pin in your finger, you could pinpoint the exact finger and location because your brain has learned these pathways. If something hurts inside the abdominal cavity this is a different story. The brain "feels" the pain where it thinks it is coming from.

The reason the brain thinks that diaphgram pain is coming from the left shoulder is because of the phrenic nerve anatomy. The phrenic nerve is the nerve to the diaphragm and it doesn't enter the spinal cord down low where the diaphragm is, it enters the spinal cord up high at C4 (fourth cervical vertebrae in the neck). This is a great design because you could break your back and spinal cord nearly along the entire length and still not require a ventilator. Now, Christopher Reeves (Superman), broke his neck above C4 when he fell off the horse so he had to have a ventilator - his diaphragm was paralyzed.

Therefore, when the diaphragm is the source of pain, the signals are carried to the brain up the phrenic nerve to C4, the same location the shoulder nerves enter the spinal cord and the brain says, "Hmmm, the shoulder area is sending pain signals, the shoulder must be hurting." This is referred pain. It feels truly that the shoulder is hurting but the source is the diaphragm. This is very common in all laparoscopic surgery. It is also common in spleen injury, with blood under the left diaphragm, patients have left shoulder pain (Kehr's sign).

The main reason to explain this is that you don't have to stand on your head or do funny positional things to "get rid of the gas". We use carbon dioxide gas which is the most diffusable gas there is so the body gets rid of it very quickly and easily. Left shoulder pain is not due to "gas left inside"; it is related to diaphragm inflammation from surgery. When you exhale, CO2 comes out of your bloodstream into the lungs and out. Think of carbon dioxide (CO2) like Casper the ghost - it could go through walls easily, it is very diffusable.

I hope this adds clarity to an interesting phenomenon associated with laparoscopic surgery.

Brad Watkins MD

[Pookie718 0]

Thank you Dr. Watkins for explaining this so well! I had quite a bit of pain in the left shoulder after my gastric sleeve plication surgery, and it was explained away as "probably due to my IV line". Now we all know what is really happening. For me, my shoulder pain outweighed anything else from the procedure.

Penny

[jodidit 0]

I'm glad to see so many Sleeve Plication people out there.

I had the Sleeve Plication Revision done on 5-22-10 by Dr. Jose Rodriguez in Tijuana, Mexico (south of San Diego, CA). He also has a facility in Juarez, Mexico (south of El Paso, TX). His cost is $6200 through Beliteweight. I am every so grateful for Dr. Rod and his Surgical Team for giving me a second chance of keeping my weight down...and for Beliteweight for making this trip so easy.

[wannabeslim 0]

I'm confused about TGVP. Some are calling it plication, some imbrication. Is there a difference in the two terms, and if so, what is the difference?

The thought of it being reversible is of course attractive, but would there not be damage to the stomach after being pleated for a while? Have they successfully reversed TGVP and patients had no complications? I'm scheduled for VSG...of course just now seeing TGVP and my last minute nerves are jangling...what if I have selected the "wrong" procedure? I know what I'm doing is the right thing, but what if a better choice for me would be TGVP?

Any explanations will be greatly appreciated. What little I can find online is rather limited.

Pliication, Imbrication, is the same surgery, but I agree, I wish they would pick just one description.

I guess it hasn't been around long enough to be able to tell regarding reversibilty, but I have heard that probably for the first year or two it's probably reversable. Later there could be "sticking," (kinda like Velcro) which could cause scar tissue, but nobody knows for sure yet. Would love an expert opinion.

Congrats to all that have had it, I hear it's a great weight loss tool.

My daughter is getting ever closer to having the Plication surgery with Dr. Rodriguez:thumbup1: in Tijuana or Jaurez.

[wannabeslim 0]

Thank you Dr. Watkins for your easy to understand and very valuable posts, I hope you become a regular here. You are very much appreciated :-)

[DrWatkins 13]

Regarding the reversibility of the plication...

The simple answer is that, yes, the plication is reversible.

The more complicated answer is that it is not as simple as removing a hem and the fabric falls apart. The stomach is a wonderful living organ and we use third generation silk suture (Ethibond) that causes a little scar reaction so that the result is stronger than the suture alone.

Now, I don't imagine we will have people wanting to reverse the operation, but if someone did, the process would be to remove each stitch (laparoscopically) and that would take some time and there would be a risk for stomach perforation (small risk). If surgeons used Prolene suture (looks like fishing line), it would be easier to reverse but that is the problem. I've already seen reports of Prolene plications falling apart and the surgery has undone itself soon after the operation (not good).

Also, the imbrication and plication describes the same procedure where you stitch the stomach smaller with no stapling and no cutting. The good news is that your stomach is still there and you haven't burned any bridges - you could still have any other procedure down the road.

Hope that helps.

Brad Watkins, MD

[JoanieW 13]

Regarding the reversibility of the plication...

The simple answer is that, yes, the plication is reversible.

The more complicated answer is that it is not as simple as removing a hem and the fabric falls apart. The stomach is a wonderful living organ and we use third generation silk suture (Ethibond) that causes a little scar reaction so that the result is stronger than the suture alone.

Now, I don't imagine we will have people wanting to reverse the operation, but if someone did, the process would be to remove each stitch (laparoscopically) and that would take some time and there would be a risk for stomach perforation (small risk). If surgeons used Prolene suture (looks like fishing line), it would be easier to reverse but that is the problem. I've already seen reports of Prolene plications falling apart and the surgery has undone itself soon after the operation (not good).

Also, the imbrication and plication describes the same procedure where you stitch the stomach smaller with no stapling and no cutting. The good news is that your stomach is still there and you haven't burned any bridges - you could still have any other procedure down the road.

Hope that helps.

Brad Watkins, MD

Hi Dr. Watkins. Thanks for making things so clear and for actually responding.

I had a question posed to me today by a doctor, and he asked me won't the two sides that have been invaginated eventually stick together, making the surgery irreversible? Any comments on that? Thanks!!