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Bariatric & Weightloss Surgery

Overview

Obesity & weight gain are two of the most challenging healthcare issues we battle today, and it has almost reached epidemic proportions, especially in the developed and developing world. Diet and lifestyle are the fundamental causes of obesity wherein our diet is increasingly unhealthy, and our lifestyles are increasingly sedentary. These two factors make it almost impossible for people to break the obesity cycle and emerge out of obesity on their own. This often leads to a case of disappointment and giving up, because of the repeated failures one encounters in their fight against obesity.

Thus, a surgical intervention to reduce the size of the stomach to overcome obesity – bariatric surgery – is now an increasingly viable treatment for obesity. The procedure is taken as the last resort wherein all the conventional techniques for treating obesity have failed. And bariatric surgeries have been known to have successfully reduced various forms of obesity with a high percentage of success.

In a bariatric surgery, the doctors employ a gastric band or use a gastric bypass which reduces the size of the stomach and thereby resulting in decline of appetite. This leads to a certain weight loss in the long run. Surgical procedure encompasses those procedures that seek to reduce weight and obesity by means of surgically reducing the stomach.

Gleneagles Global Hospital, Lakdi-ka-pul is one of the nation’s foremost healthcare facility with a state-of-the-art bariatric care specialty. The Department of Bariatric Surgery at Gleneagles Global Hospital takes care of all weight-loss procedures – including bariatric surgeries to help people who are severely overweight and have failed to secure the right results with traditional weight loss methods.

The department is known for providing best bariatric surgery and care for the most challenging and complex obesity disorders. As the recognized leader in bariatric surgery, the institute takes a multidisciplinary approach and partners with patients for the best and long-term results.

The weight loss program covers pre-surgical education, nutrition and lifestyle counselling, as well as post-surgical support making it comprehensive and result-oriented. At every stage of the program, patients are treated with compassion and respect in a comfortable and reassuring atmosphere. The institute is committed to helping each patient attain and maintain a healthy weight. It is a centre of excellence for various minimal access bariatric surgeries.

The need for a surgical intervention for weight loss is two-fold – firstly when all other conservative measures for weight loss have failed and the patient is unable to achieve necessary reduction in weight by diet & exercise, and secondly when the proportion of weight is exceedingly high, leading to risks such as heart disease, type 2 diabetes, orthopedic problems, risk of cancers and others.

A BMI of 40 is the benchmark for qualifying a patient for a bariatric procedure. Anyone with a higher than 40 BMI definitely needs a surgical intervention to reduce weight – in a manner than is consistent, beneficial and long lasting.

Bariatric procedures achieve weight loss in a structured, scientific and progressive manner. Drastic weight loss in a short span of time by going on a crash diet or heavy exercise may not have the right results in the long term. Additionally, it may have side effects, relapse and other complications which are certainly avoided with a bariatric procedure.

Also, the doctors will undertake a through diagnostic profile as well as a lifestyle profile of the patient before qualifying them for the surgery. Bariatric procedures are not advised for patients with a heavy smoking history and unwillingness to give up the same, pregnant women, patients with psychiatric conditions, etc., are also disallowed from the procedure.

Gastric Balloon

A gastric balloon procedure involves inserting silicon balloons into the stomach of the patient that reduces the overall volume available for food. This results in the patient feeling satiated and full – with considerably smaller portions of good, thus reducing the overall food intake. Subsequently, this leads to weight loss and also helps the patient with type 2 diabetes, heart disease and joint-related problems.

The insertion of the gastric balloon is considered to be relatively safer when compared to a gastric banding or bypass procedure and has a good prognosis. The balloons are inserted while they are still deflated and then inflated once they have been implanted in the stomach. Patients with a BMI of 40 and above can opt to undergo a gastric balloon procedure while those with a slightly lower BMI may also choose for this procedure should they suffer from co-morbidities such as – type 2 diabetes, hypertension or sleep apnoea.

Biliopancreatic Diversion with Duodenal Switch

The Biliopancreatic Diversion with Duodenal Switch is a two-part bariatric procedure wherein the surgeon would first create a tubular pouch in the stomach by removing a part of the stomach – as in case of a gastric sleeve and secondly, a bypass is made in the large intestine. This procedure helps reduce the amount of food intake and thereby assists weight loss over a period of time.

However, in some of the other procedures the affect of the reduced stomach wanes over a period of time and thereby the patient by return to normal consumption of food over a period of time. Thus, in case of BD/DS, this is addressed by bypassing a large part of the small intestine, also the food consumed does not mix with the pancreatic and/bile enzymes until it is considerably down in the lower intestine leading to much lower quantities of absorption of nutrients into the blood stream.

This procedure is known to result in about 60-70% weight loss with a reduction in fat of 70% or more. It is also helpful in mitigating risks from type 2 diabetes, heart conditions, hypertension and other lifestyle/obesity related conditions.

However, on the disadvantages side, the procedure may require a slightly longer hospitalization compared to other bariatric procedures and has a statistically higher mortality rate when compared to the other bariatric surgeries.

Adjustable Gastric Band

An adjustable gastric band is a partition created in the stomach by placing a band in the upper part of the abdomen. This reduces the intake and absorption of food into the body, and thereby leads to weight loss. This is a widely practiced and successful variant of bariatric surgery and helps fight not just obesity but also a slew of other gastroenterological and other conditions.

Gastric banding helps prevent, gastroenterological reflux disease, reduces the risk of heart disease & hypertension, alleviate type 2 diabetes and provides protection against strokes.

The procedure is advised for patients with a BMI of 40 and above, however, those with a slightly lower BMI but co-morbidities such as – type 2 diabetes, hypertension or sleep apnoea – may also under the procedure.

Like all surgical procedures, gastric banding does have a few risks. But the medical staff will take all precautions to mitigate every possible. Some of the inherent risks include – excessive bleeding, infections, blood clotting and breathing difficulties.

Sleeve Gastrectomy or Laparoscopic Sleeve Gastrectomy

A sleeve gastrectomy or laparoscopic sleeve gastrectomy is a common bariatric procedure that removes about 75% of the stomach. This procedure is performed via a small laparoscopic incision. The remainder of the stomach following the surgery, is the size of a banana, shaped like a tube. This results in an overall reduction in consumption of food and absorption of nutrients that subsequently causes weight loss.

In addition to reduced food intake and absorption of nutrients, the surgery also results in hormonal changes in the body that further accelerate the weight loss.

Apart from aiding weight-loss the procedure is also known to reduce the risk of hypertension, heart diseases, strokes, gastroenterological reflux disease and alleviate the symptoms of type 2 diabetes.

This bariatric procedure is helpful for patients with a higher than 40 BMI, although doctors will also advise patients with a lesser BMI also to undergo this procedure, should they have various other co-morbidities as well.

Like all surgical procedures, gastric banding does have a few risks. But the medical staff will take all precautions to mitigate every possible. Some of the inherent risks include – excessive bleeding, infections, blood clotting and breathing difficulties.

Gastric By-pass or Roux-en-Y

A gastric by-pass, also known as a Roux-en-Y bypass is a bariatric procedure wherein the size of the stomach is reduced by creating a bypass for the food to enter the small intestine. The altered food path changes the secretion of the gastrointestinal hormones, and consequently reduces appetite, improves metabolism rate and causes weight loss. It is one of the widely accepted and performed bariatric procedures that has a high rate of success.

The success of this procedure requires the patient to maintain a strict dietary pattern for a few weeks/months following the surgery before they can return to normalcy.

Patients with a higher than 40 BMI can opt for this procedure, while those with slightly lesser BMI also qualify for the surgery should they be suffering from other co-morbidities such as heart-disease, type 2 diabetes and sleep apnoea.

The changes in metabolism, and subsequent loss of weight are expected to have certain side-effects, including but not limited to – body pains, fatigue, dryness of the skin, hair loss and mood swings. Gastric by-pass surgery does have a few risks, like all other surgical procedures, these include – excessive bleeding, infections, blood clotting and breathing difficulties. However, the medical staff will take all precautions to mitigate every possible risk.

The expected weight-loss from this procedure is around 65% over a period of about 18 months from the date of the procedure. If the patient has the habit of smoking, the result may not be very encouraging, and it may also increase the risks following the surgery.

Gleneagles Global Hospital is one of the best hospitals for bariatric and weight loss surgery in Hyderabad.  With advanced use of technology and state-of-the-infrastructure we carefully determine the need and kind of bariatric procedure required. Headed by some of the best-known bariatric specialists and weight reduction specialists, we deliver cutting edge treatment and surgical procedures for effective weight loss. Dedicated staff, world class infrastructure and a team of highly skilled bariatric specialists make us the pre-eminent destination for qualitative bariatric care in India.

Dr Kona Lakshmi Kumari

MS, FICS

Sr. Consultant - Surgical Gastroenterology, Minimal Access GI Surgery & Bariatric Surgery

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