Pls. clarify surgery name and qualified Drs

jg62 · August 19, 2010

First I'd like to say thank you to all the posters who have been so kind and open to share their experiences. It's been such a great help to new researchers like me.

But as much help as it has been, I admit that it has also added to my confusion...

I've read about a relatively new surgery which DOES NOT involve cutting the stomach, but instead folding. Claims to have the least complications in comparison to other weight loss surgeries yet yields great weight loss results. This is the surgery that I am VERY INTERESTED in having but the problem is, I do not know what the procedure is called?! This is due to so many procedures being described the SAME WAY but are being called so many different names (i.e. Super Sleeve, Gastric Plication Sleeve (GPS), Total Gastric Vertical Plication Sleeve Surgery (TGVPS), Gastric Imbrication, VSG etc.) I know I am not the first person to question this but I guess with all my research, i haven't found a definite answer? I thought the key word was "PLICATION" but my confusion continues when I see a poster referring to the success of their "PLICATION" surgery and then another poster commenting that they too have had the same success with the same surgery but they refer to it as the "super sleeve" or some other name? Are they actually talking about the same surgery? In addition, I'm confused as to which Doctor's are currently performing this procedure (the one I describe at the beginning of my post) - I was told by Medical Tourism Corporation that Dr. Corvala in Mexico, is the only Doctor. I have since learned that Dr. Watkins is also performing the same said procedure (at least I "think" it's the same procedure!). Both doctor's websites confirm this. But what confuses me is again, other posters stating that they have had the procedure done by other doctors (i.e. Dr. Jose Rodriguez, Dr. Cottam and another Dr. in Mexico whose name I cannot recall) yet when I visit the websites of these doctors, they do not list "plication" as one of the procedures they offer?

So to make a long story short (and I do apologize for the length of my very first post!), can ANYONE help me sort out all this information?

Thank you in advance

JoanieW · August 19, 2010

First I'd like to say thank you to all the posters who have been so kind and open to share their experiences. It's been such a great help to new researchers like me.
But as much help as it has been, I admit that it has also added to my confusion...

I've read about a relatively new surgery which DOES NOT involve cutting the stomach, but instead folding. Claims to have the least complications in comparison to other weight loss surgeries yet yields great weight loss results. This is the surgery that I am VERY INTERESTED in having but the problem is, I do not know what the procedure is called?! This is due to so many procedures being described the SAME WAY but are being called so many different names (i.e. Super Sleeve, Gastric Plication Sleeve (GPS), Total Gastric Vertical Plication Sleeve Surgery (TGVPS), Gastric Imbrication, VSG etc.) I know I am not the first person to question this but I guess with all my research, i haven't found a definite answer? I thought the key word was "PLICATION" but my confusion continues when I see a poster referring to the success of their "PLICATION" surgery and then another poster commenting that they too have had the same success with the same surgery but they refer to it as the "super sleeve" or some other name? Are they actually talking about the same surgery? In addition, I'm confused as to which Doctor's are currently performing this procedure (the one I describe at the beginning of my post) - I was told by Medical Tourism Corporation that Dr. Corvala in Mexico, is the only Doctor. I have since learned that Dr. Watkins is also performing the same said procedure (at least I "think" it's the same procedure!). Both doctor's websites confirm this. But what confuses me is again, other posters stating that they have had the procedure done by other doctors (i.e. Dr. Jose Rodriguez, Dr. Cottam and another Dr. in Mexico whose name I cannot recall) yet when I visit the websites of these doctors, they do not list "plication" as one of the procedures they offer?

So to make a long story short (and I do apologize for the length of my very first post!), can ANYONE help me sort out all this information?

Thank you in advance :sad0:

Welcome to the board JG. I'm going to try and make this short so as not to confuse you anymore. I think it was Dr. Rodriquez that started calling the plication a super sleeve, but I don't know why. Here is what I know about the super sleeve:

>>>>>>>What is super sleeve?

Laparoscopic sleeve gastrectomy is not so simple as any other gastrectomy. There are some important technical details, unknown to inexperienced surgeons. Gastric tube size influences both the degree of weight loss and weight stability. A large sleeve predisposes to gastric dilatation and weight regain. Inexperienced surgeons tend to create large tubes ( or to leave back large remnants of the gastric fundus. A standardised technique with a gastric capacity less than 100 mL (A) is mandatory in order to get the patient achieve a durable weight loss. The sleeve should be "super" which means a small gastric sleeve diameter and a higher degree of restriction. In our hands, with the gastric capacity been restricted to 60-80 gr and Ghrelin (the appetite hormone) totally suppressed, the resultant weight loss is predictable and comparable to this achieved with gastric by-pass (60-70% EWL), without any serious complication or side effects (e.g. Vitamin mal-absorption). We introduced super sleeve in our bariatric program, as the most effective and safe bariatric solution even for the super-obese patients.>>>>>

These surgeries you mentioned are all the same surgeries where the stomach is folded in on itself and not removed: (Gastric Plication Sleeve (GPS), Total Gastric Vertical Plication Sleeve Surgery (TGVPS), Gastric Imbrication).

The VSG and super sleeve are basically the same. A large portion of the stomach is removed.

The only surgeons I know of that are doing this surgery are Dr. Watkins, Dr. Cottam, and a Dr. at the University of Florida in Jacksonville. Not sure of his name. In Mexico, there is Dr. Corvala and Dr. Rodriquez that I know of. All of this is rapidly changing. There is a doctor here in GA who just did his first plication but not sure who that is.

Not to confuse you anymore, but there is another one called the POSE procedure being done in Louisianna (and I'm sure there are other locations). This one is done through the mouth, so no incisions are made. The plication and VSG are done through five laparoscopic incisions.

Does this help?

nwgal · August 19, 2010

Hi JG,

The 'Super Sleeve' is just another name for the gastric plication procedure. My surgeons in Tijuana, Drs. Osuna and Lopez do the super sleeve in addition to the VSG, and so does Dr. Rodriguez, although this is a very new procedure. It was mentioned when I scheduled my VSG, but I didn't want anything so untested.

Best of luck!

DrWatkins · August 19, 2010

Indeed all the names mentioned are in essence the same procedure. Since this procedure is not associated with a manufacturing company like the gastric band, different surgeons are applying different names to it and that is confusing indeed.

Regardless of what surgeons call it, the thing to make sure is that the stomach is being imbricated (folded in on itself in multiple layers) and then stitched (sutured, plicated) so that the end result is a smaller stomach capacity. I think adding the superlative, "super", to it is confusing and seems to imply that the resulting sleeve is really small. Even with stapled sleeve gastrectomy (a different procedure), there is no agreement as to the size of bougie (sizing tube) used to calibrate the volume of the sleeve. The cool thing is that patients lose weight really well across a wide range of bougie sizes. Like all other weight loss operations, they work best when patients are making good food choices (not eating ice cream everyday, etc) and are burning calories (walking, etc) since all weight loss comes from caloric deficit (burning more than consuming).

To my knowledge, in addition to our Cincinnati and Chicago clinics, plication procedures are offered in Salt Lake City (Dr. Cottam) and Tampa, Florida (I don't know the name). Dr. Ponce in Atlanta has contacted me and is interested in doing the procedure. When I spoke with him last he was planning on offering this but wasn't offering it to the public yet.

Cleveland clinic was part of a clinical trial but the trial is closed and I don't know if they offer it outside the trial.

Several weeks ago, I flew to Salt Lake City to watch Dr. Cottam do a plication procedure and we had great discussions comparing our experience with plication procedures. We have developed a clinical advisory board so that we may pool our experience in a single database and have an outside (non-biased) surgeon review our results and make sure these procedures have the same oversight as a formal clinical trial. This kind of oversight is common to new devices and sponsored by industry, however, plication has no device and therefore no industry involvement so Dr. Cottam and I are footing the bill for this. To my knowledge, no other surgeon has ever created an advisory board for a new procedure like this before. Suffice it to say, Dr. Cottam and I are extremely interested in doing this properly and learning from each other.

I don't see that we are going to see any major surprises with the procedure over the years. The main thing I imagine is that, like all other weight loss operations, the plication might dilate to the point that it is not as effective of a weight loss tool. If this happens, one could place more stitches, band the sleeve or any other weight loss operation since the stomach is still there and no bridges have been burned. The best way to prevent dilation is to not drink carbonated beverages and not eat to the point of regurgitation every day for months. Dilations are chronic, they do not happen after a single event.

I hope this adds some clarity to a new procedure. I like the plication a lot and I think it will be a really big deal as more people learn about it. I also imagine that it will someday be covered by insurance but that might be ten years away because they like to see lots of data.

Brad Watkins, MD

Cknorte · August 19, 2010

Hi JG,

In Mexico, I know Dr. Corvala is doing it and was one of the first to do it in Mexico. Since then others have started performing the surgery. I had the surgery done by Dr. Corvala in Tijuana on July 15th.

In the US, Dr. Cottam in Utah and Dr. Watkins in Cleavland are performing the surgery that I know of. Dr. Watkins posts on this site and he has shared some invaluable information.

It is unfortunate that the surgery is called by so many names, but yes, all the names you mentioned refer to the same surgery....even though the "super sleeve" really is a true VSG not a fold over...even though some Dr.'s are using the name for the foldover.

If you go one or two threads down, you can read what Dr. Watkins has shared with us. He also has a few youtube videos with weight loss lessons, Dr. Cottam has a video of the surgery on you tube as well.

If you want to know more about my experience you can go to my blog or PM me....I'll gladly share.....

JoanieW · August 19, 2010

Dr. Watkins. Thanks for caring enough to take the time to start an advisory board. You're the best!

jg62 · August 20, 2010

This forum has been a wealth of information! Thank you for those who have helped me clarify my burning questions!

A special thank you to Dr. Watkins for taking the time to provide your expertise on not only my posted question but to many others here as well.

CKnorte - would you mind if I messaged you privately? I've learned so much from your documented experience and I have some specific questions for you if have time to provide me with some insight.

Thank you!