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bariatric

Bariatric Surgery

If you are someone for whom non-surgical procedures have failed to provide sustained weight loss, you can be evaluated for, and if appropriate, undergo lifesaving weight loss surgery. This surgery is known as Bariatric Surgery (also known as Weight Loss Surgery or Obesity Surgery).

Bariatric surgery is a major operation and should be considered only after non surgical weight-loss methods have failed. If you’re considering weight-loss surgery, you must make a serious, lifelong commitment to lifestyle changes

Important Considerations For Obesity Surgery:

  • Weight loss surgery is not cosmetic surgery but is done to decrease the health risks associated with obesity
  • The decision to elect surgical treatment requires an assessment of the risk and benefit to you and the meticulous performance of the appropriate weight loss surgery
  • Patient must understand every aspect of the weight loss surgery
  • Long term success of the surgery depends on the commitment of the patient to follow advise regarding the food habit, supplementary drugs, life style modification
  • Problems may arise after surgery that may require prolong hospitalization and re-operation

Indications:

If you have a BMI (Body Mass Index) of 37.5 or more, or a BMI of 32.5 or more with illness related to excess weight, and have not been able to sustain weight loss through diet and exercise, you probably are a candidate for weight-loss surgery.

If you do not meet these guidelines, or we find that you are not eligible for surgery for health reasons, don’t despair. Through our intensive non-surgical weight management program, we can help you lose weight by helping you change your eating habits, modify your behaviour and increase your physical activity.

Many obesity related health conditions may be improved or resolved completely following a gastric bypass surgery. These include Type II Diabetes Mellitus, High Blood Pressure/Heart Disease, Osteoarthritis of weight bearing joints, Obstructive Sleep Apnoea, Gastroesophageal Reflux Disease, Infertility in women, Stress Urinary Incontinence, etc. The lifestyle of these morbidly obese patients improves significantly, especially in social/economic opportunities and physical functioning and appearance.

Risks:

Risks are usually categorised as immediate risks which include bleeding, Deep Vein Thrombosis, injury to neighbouring organs (like oesophagus and spleen), shoulder pain and delayed risks, such as Pneumonia, Abdominal Infections and Pulmonary Embolism. These risks are common to all abdominal laparoscopic general surgeries. The risks associated specifically with bariatric surgery are chest pain, abdominal hernia, constipation or diarrhea, stoma obstruction, stretching of the stomach and reoperation for various reasons.

Procedures

  1. Laparoscopic Gastric Banding

    The GaBP Ring Autolock™ is a prefabricated, calibrated and sterilised silicone coated implantable device that is designed specifically to control the reservoir capacity in gastric bypass, gastroplasty and sleeve gastrectomy operations. The progressive weight regain after the Sleeve Gastrectomy has been well documented in most cases to be due to the dilatation of the sleeve with increase in the gastric reservoir and the ability of increased caloric intake. Banding the proximal pouch of the Sleeve operation at the time of the initial operation creates a proximal pouch within the sleeve. This proximal pouch becomes the reservoir that eventually will continue to provide the restrictive satiety effect of the sleeve. Banding the pouch in the gastroplasty operations increased both the weight loss and weight loss maintenance.

  2. Gastric Bypass

    Roux-en-Y Gastric Bypass (RNYGB) has a physical and hormonal effect. Physically it restricts food intake; portions sizes after the RNYGB are much reduced with an early feeling of fullness. Over-eating causes abdominal discomfort and vomiting. While the majority of the reduction in a patient’s calorie intake is attributable to the restriction, initially there is also an element of mal-absorption of fat similar to the duodenal switch. Long-term mal-absorption is probably not important as the patient’s body adapts to the bypass. Nevertheless patients do need regular dietetic review and should be tested for anaemia annually after surgery.

    RNYGB also reduces a patient’s appetite. The mechanism by which this occurs is not fully understood, but is related to a change in the normal gut hormonal patterns. Bypassing the first part of a patient’s small intestine affects the production of hormones which control appetite. After RNYGB most patients feel far less hungry, often forgetting to eat. Bypass surgery also affects the hormones that control blood sugar and consequently many diabetic patients become non-diabetic immediately after surgery.

    Furthermore, banding the pouch in the gastric bypass has also been documented to enhance weight loss and weight loss maintenance. Adding a GaBP Ring to Roux-en-Y Gastric Bypass leads to significant improvement in excess weight loss.

    The Mini Gastric Bypass (MGB) is a surgical procedure that can be performed by a minimally invasive surgical method. The procedure reduces food intake and reduces the absorption of nutrients from the food. Absorption of nutrients is limited because part of the intestines is bypassed and not used. A stomach sleeve is created and separated from the rest of the stomach which is retained in the body (like the RNYGB). The volume of the stomach sleeve after MGB is between 70-90 ml. The small intestine is anastomosed in continuity without disconnecting it (like in RNYGB) to the newly created stomach sleeve.

    MGB is very successful (50-70% of excess weight loss) as a primary weight loss procedure especially in type II DM. it can be used on patients who failed restrictive procedures like balloon, banding and sleeve gastrectomies. It is suitable for those who are sweet eaters and patients with heartburn. The procedure has lower complication rate in comparison to RNYGB and is completely reversible surgery if done as a first procedure and also convertible to RNYGB or LSG at a later stage if required. After MGB, lifelong vitamin and mineral supplementation may not be required like in RNYGB.

  3. Sleeve Gastrectomy

    The vertical sleeve gastrectomy, or sleeve gastrectomy, is a type of restrictive weight loss surgery. Vertical gastrectomy surgery causes weight loss by restricting the amount of food that a person can consumed before feeling full.

    The conventional vertical gastrectomy surgery isolates a small section of the stomach for processing food, limiting the size of meals to approximately 90 – 100 ml after surgery. The surgery is typically performed on patients who are too heavy to have other types of weight loss surgeries with the expectation that a second surgery will be performed once weight has been lost or on individuals who do not suffer from severe co morbidities and are young.

  4. Revisional Gastric Bypass

    Revisional Bariatric Surgery is performed to alter or repair one of the many types of weight loss surgery for the treatment of morbid obesity. The two currently popular procedures, Roux-en-Y gastric bypass and Laparoscopic Adjustable Gastric Banding Surgery, while successful, also require occasional revision. In fact the revision rate for the Gastric Banding Surgery is more than 10% during the first two years for either device-related problems or unsatisfactory weight loss. Likewise, the revision rate for gastric bypass is roughly 5-10% after 5 years for either troublesome complications, (e.g., ulcer, etc.) or for unsatisfactory weight loss. If you have had poor weight loss/weight regain or complications of the original procedure, e.g., ulcers for RNYGB or slippage of the band, you may qualify for revisional bariatric surgery.

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