Bariatric Surgery

Bariatric Surgery

Obesity the single most important growing menace affecting modern society today. Combination of factors including life style changes, changing eating habits, fast pace of life etc are in combination responsible for the same. Rather than dwelling on these factors let us see how the increased incidence of obesity can affect modern society and how this can be conquered.

What are the effects of obesity on human physiology?

A long string of disease has been directly linked to or has been well documented to be due to obesity Hypertension with its consequent problems Cardiac eventualities like heart attacks etc Cancers especially uterine, breast etc have a definite association with obesity Sleep disorders like sleep apnoea etc Knee pain, osteoarthritis of knee etc Heart burn and reflux diseases Infertility, hirsuitism (female facial hair growth) etc due to peripheral hormonal conversions Cosmetic and consequent psychological problems Inferiority complexes etc Inability of differentially abled people to look after themselves due to massive weights These and a whole lot more diseases occurring as a direct consequence or is closely related to obesity are known as the "co-morbidities"

How do you quantify obesity?

Obesity is best quantified by the index BODY MASS INDEX(BMI). BMI = Weight of the patient(in kilograms/height (in meter 2) A normal person should have a BMI between 18 and 25.Those with BMI between 25 and 30 qualify as overweight. People with BMI above 30 are considered obese . Those with BMI above 35 are considered morbidly obese and qualify for some form of bariatric surgery. Those patients with any 2 of the above mentioned "co morbidities" ( hypertension, diabetes, osteoarthritis etc) and with BMI above 30 also qualify for bariatric surgery because they are at more risk for the consequences of obesity.

What are the options for managing obesity?

Basically the huge amounts of overfeeding that has occurred over years has accumulated in various parts of the body as fat causing obesity. Obviously the best way of managing would be to reduce calorie intake and simultaneously indulge in calorie burning. Simply put this means dieting and exercising. However, practically, it has been proved that even with the most determined, with this exercise- diet regime, only 10 to 15 kg weight loss is attainable. More importantly the shed kilos tent to re accumulate with more vigor once exercising and dieting is stopped!

What is the permanent solution for obesity?

It has been scientifically documented that BARIATRIC SURGERY is the only permanent solution for massive weights, hoping to loose weights of over 20 to 150 or more kilo.

What exactly is bariatric surgery?

Contrary to popular misconception it does not involve surgical removal of fat from the body. Sucking out fat from the subcutaneous regions of the body is known as liposuction. It is not a weight reduction procedure. It is basically used for body contouring in cosmetically oriented people with isolated regions of excess body fat like huge thighs buttock etc. you cannot expect a weight loss of more than 10 kg at the most with this procedure. More over it is a painful procedure and has its own risks and complications. More importantly scientifically it has never been recommended as a mode of treatment for massive obesity. Bariatric surgery is the collective name for a string of procedures meant for obesity. Gastric sleeve resection, gastric banding and gastric bypass are the most commonly done procedures in our centre and perhaps all over the world. All these procedures have been made safer, simple and almost painless by advent of laparoscopy.

Sleeve gastrectomy

This procedure is fast becoming the most appropriate bariatric surgery for most Indians, because it is the most physiologic of procedures and needs no pills or tablet after surgery. Sleeve gastrectomy is a purely restrictive procedure where the amount of intake is reduced. Food that we eat passes down from the mouth through the gullet (oesophagus)into the stomach where it is' milled' before it passes down into the small intestine for absorption. Now this stomach is like a rubber bladder (roughly 1-1.5 liter in capacity) capable of expanding to accommodate more food. Voracious eaters have bigger stomach volumes due to serial massive distentions. As a consequence these people fail to feel the 'stomach fullness' on a full meal and tend to eat more. There is a hormone secreted by the upper part of the stomach (ghrelin), called the hunger hormone which stimulates appetite. Ghrelin secretion is very high in obese. In sleeve gastrectomy a long sleeve of stomach including the part that secretes ghrelin is removed. This reduces the stomach capacity to 80 to 100 mls (from 1.5-2 liters) ensuring reduced intake of food(as a consequence of reduced stomach capacity), a disinterest to food(as a consequence of reduced ghrelin secretion), and a reduced absorption(due to early transit of food through this newly fashioned stomach tube). Patients tend to lose weight at a rate of approximately 10-14 kg per month for the first 6 months and at decreasing rates for the next 18 months before the weight stabilizes. On an average they can expect to attain 80% of their excess body weight to be lost before stabilizing. (Eg: 150 kg reduces to approximately 80-90 kg in 2 years) Over this period the stomach gradually expands, enough to accommodate food necessary to maintain weight at the stabilized level. The procedure will need hospitalization for 2 to 4 days is done under general anesthesia and patient is ready for office activities in 5 to 7 days. Active exercising is encouraged a month after surgery. Diet will be liquid and semisolid for 20 to 30 days after surgery, after which normal diet in reduced increments, with more protein will be encouraged. (A professional dietician/nutritionist? doctor will guide the person through the transition and will be available over phone always). There will be plenty of pleasant, healthy options on the menu. Our patients till date have never complained about this. Review will be once a month for a couple of months and over the phone consultations after.

Gastric bypass

This procedure practically is massive obese (weights over 200 kg) especially meat eaters. Thankfully such people are rare in our obese population. Basically it involves short circuiting the small intestine as well (in addition to the stomach volume reduction) causing a degree of malabsorption and consequently greater weight loss. These patients need to be on lifelong vitamin and iron supplements. The hospitalization and recouping are basically similar to sleeve gastrectomy patients. Patients can expect massive weight losses of over 100 kg in this procedure over 6 to 12 months.

Gastric banding

This is the only reversible bariatric procedure. It involves a circumferential band at the upper stomach using a silastic inflatable band reducing the food intake. This band can be inflated or deflated or even removed depending on the patientís requirements. For example, if the patient were to become pregnant warranting increased food intake, the band could be deflated or even removed. The weight reduction though with this procedure is less. Patients tend to lose only 30 to 40 kg with this procedure. However it is an excellent procedure for the young female not so obese contemplating pregnancy.

Which procedure is best suited to me?

Each of these common procedures mentioned and other rarer bariatric surgeries have their positives. It would be most appropriate to discuss each procedure in detail with the doctor before deciding collectively on which is the ideal one for you.

What is metabolic surgery?

Analysis of huge volumes of patients all over the world who underwent bariatric surgery always showed one interesting positive offshoot. A high percentage (over 70%) of these of these patients shows resolution of their co morbidities like diabetes, hypertension, hyper cholesterolemia, infertility, sleep disorders, osteoarthritis etc. This encouraged bariatric surgeons to modify the procedures, tailoring them to cause more effective co morbidity resolution, and less weight loss so that it can be used for patients with lower BMI (25-30) also. Such procedures (bileopancreatic diversion, ileal transposition etc) collectively known as metabolic surgeries are slowly gaining prominence.

What is metabolic surgery?

Analysis of huge volumes of patients all over the world who underwent bariatric surgery always showed one interesting positive offshoot. A high percentage (over 70%) of these of these patients shows resolution of their co morbidities like diabetes, hypertension, hyper cholesterolemia, infertility, sleep disorders, osteoarthritis etc. This encouraged bariatric surgeons to modify the procedures, tailoring them to cause more effective co morbidity resolution, and less weight loss so that it can be used for patients with lower BMI (25-30) also. Such procedures (bileopancreatic diversion, ileal transposition etc) collectively known as metabolic surgeries are slowly gaining prominence.