Bariatric Surgery

Bariatric Treatment in Pune

Obesity

Obesity is not a simple condition of eating too much. It is now recognised that obesity is a serious, chronic disease. Obesity was widely perceived as a symbol of wealth and fertility at other times in history, and still is in some parts of the world. In 2013, the American Medical Association classified obesity as a disease which leads to many comorbidities like diabetes, high BP (hypertension), cholesterol, infertility, PCOS (PCOD), arthritis, sleep apnea etc. Obesity is a leading preventable cause of death worldwide, with a change in lifestyle there is increasing prevalence in adults and children, and authorities view it as one of the most serious public health problems of the 21st century.

Causes of Obesity

Here’s a very simple explanation of how you put on weight and will lose weight with surgery. Your body needs the energy to function and your energy source is the food that you eat. A normal weight person successfully balances their energy intake (food eaten) with their energy requirements (daily activity). In other words, they burn up all the energy provided by the food they eat and stay slim. At an individual level, change in lifestyle i.e. combination of excessive food energy intake and a lack of physical activity is thought to explain most cases of obesity. A limited number of cases are due primarily to genetics, medical reasons, or psychiatric illness. In contrast, increasing rates of obesity at a societal level are felt to be due to an easily accessible and palatable diet, increased reliance on cars, and mechanised manufacturing.

Consequences of Obesity or Why Treat Obesity

The costs linked with treating obesity and its related health conditions are enormous. Putting the costs aside, the main concern regarding obesity is the impact it has on health. Almost all body systems are affected by obesity. Being overweight can also shorten your life. On average obese people are likely to die 10 years earlier than those who are not overweight, preventing many from reaching retirement age. The heavier you are and the longer you have been overweight the greater the risk
If you are obese, severely obese, or morbidly obese, you may have Major health risks.

• – Shorter Life Expectancy
• – Diabetes (type 2)
• – High Blood Pressure
• – High Cholesterol
• – Joint problems (e.g., arthritis)
• – Obstructive Sleep Apnoea
• – Heart disease
• – Gallbladder problems
• – Certain types of cancer (breast, uterine, colon)
• – Digestive disorders (e.g., gastroesophageal reflux disease, or GORD)
• – Breathing difficulties (e.g., sleep apnea, asthma)
• – Psychological problems such as depression
• – Problems with fertility and pregnancy (Polycystic Overy Disease PCOD)
• – Incontinence

What is obesity or bariatric surgery?

Bariatric surgery, also known as weight loss surgery, refers to the operations designed to reduce weight (bariatric come from the Greek meaning pressure or weight). Operations may restrict the amount you are able to eat (restrictive operations such as the gastric band sleeve gastrectomy) or both restrict the amount you can eat and reduce the amount you can absorb (gastric bypass, mini gastric bypass or duodenal switch). The term does not include procedures for surgical removal of body fat such as liposuction or abdominoplasty (tummy tuck).

Why do Bariatric Surgery?

There can therefore be many benefits to health with weight loss, particularly after obesity surgery. Scientific research demonstrated that obesity surgery can reduce health problems considerably, as shown in the table below:

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One study, conducted in Sweden, demonstrated quite clearly the differences in health between a group of obese patients who underwent surgery and those that did not.

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Types of Bariatric surgery

We at Obesity Care offer a wide range of surgical procedures such as gastric banding, Roux-en-Y bypass (gastric bypass), sleeve gastrectomy and Gastric Balloon. All operations are performed laparoscopically (keyhole surgery), which will help you to get up and around and back to normal as soon as possible after surgery. One of the mainstays of our service is the multidisciplinary team. Each team member has his or her own role and all together we ensure you are fully informed about weight loss surgery and that your operation is performed in the safest possible environment. Your safety is our first priority.

How surgery works?

Obesity surgery works by helping to reduce the number of calories that are available in your body. There are two ways this can be achieved surgically:
• Restriction – by reducing the size of the stomach, only small meals can be eaten and the appetite is satisfied
• Malabsorption – by bypassing part of the small intestine, less calories from food are absorbed by the body

What is laparoscopic gastric banding?

  • An inflatable silicone band that is placed around the top part of the stomach to create a pouch
  • Inserted using keyhole (laparoscopic) surgery, this only leaves a few small scars.
  • The laparoscopic gastric band restricts the amount of food that can be eaten.
  • Attached to the gastric band is a port which is placed just under the skin. The port can be accessed with a needle to inflate or deflate the gastric band after surgery.

Advantages

  • You can expect to lose roughly 50-60 percent of your excess weight.
  • The amount of food that can be consumed at a meal is restricted.
  • The band can potentially be removed in the future. The aim however, is to leave in place for life as removal will result in weight regain.

Sleeve Gastrectomy

In this procedure, the surgeon creates a narrow tube-like stomach and removes the remainder. Hence, the capacity of the new stomach is much smaller than the original. It is usual to offer this operation as a first stage procedure to super obese patients – a second stage procedure is then offered after the patient has lost some of the excess weight to make this type of surgery safer. In a small number of patients, a sleeve gastrectomy may be the only operation that is required. It should be noted, however, that long-term data of weight loss following sleeve gastrectomy is not yet available.

Advantages:

  • You can expect to lose roughly 50-60 percent of your excess weight.
  • The amount of food that can be consumed at a meal is restricted.
  • Food passes through the digestive tract in the usual order, allowing it to be absorbed fully by the body.
  • There is no re-routing of small intestines

Roux-en-Y Gastric Bypass (LRYGB)

In this procedure, the surgeon creates a small gastric pouch of approximately 30-60ml. The small bowel is then divided and the end brought up and attached to the gastric pouch. In this way, food passes into the pouch and straight down into the lower part of the small bowel. The rest of the stomach and the bypassed part of the small bowel are then re-attached further down. This ensures that the gastric and pancreatic juices enter the small bowel and digest the food. You will need to take tablets daily including a multivitamin and mineral, calcium and vitamin D, Iron, as well as have three monthly vitamin B12 injections.
Advantages:

  • Weight loss starts from the time of surgery and can be rapid within the first 6 months.
  • You can expect to lose roughly 70 – 80 percent of your excess weight at 2 years.
  • In most cases, further surgery is not required.
  • Patients report decreased hunger and appetite due to hormonal changes.
  • Has the highest and fastest remission rate for diabetes (type 2)

Mini-Gastric Bypass

The mini gastric bypass procedure was first developed by Dr. Robert Rutledge from the USA in 1997. A mini gastric bypass creates a long narrow tube of the stomach along its right border (the lesser curvature). A loop of the small gut is brought up and hooked to this tube at about 180 cms from the start of the intestine The MGB has been suggested as the latest alternative to the Roux-en-Y gastric bypass procedure due to the simplicity of its construction, and is becoming more and more popular because of low risk of complications and good sustained weight loss. It has been estimated that 15.4% of weight loss surgery in Asia is now performed via the MGB technique Mini Gastric Bypass (MGB) works by:

  • Restrictive – A Small stomach pouch is created restricting the amount of food you can eat.
  • Malabsorptive – A portion of the small intestine is bypassed. Since the small intestine is responsible for absorbing the calories from the food you eat, bypassing a portion of the small intestine results in fewer calories being absorbed, thus creating additional weight loss.
  • Hormonal – The hormone ghrelin has been nicknamed the “Hunger Hormone” by researchers because of its significant effect on appetite. Gastric Bypass results in a fall in ghrelin levels resulting in a reduced appetite.

Gastric Balloon (Intra Gastric Balloon)/ Stomach Balloon

What is a gastric or stomach balloon?
Gastric Balloon is a non-invasive procedure whereby weight loss can be achieved without surgery or operation. A soft, silicone balloon is introduced into the stomach with the help of gastroscope or endoscope. Once in the stomach, the balloon is filled with colored sterile saline, occupying a large part of the stomach, giving you a feeling of fullness. The Gastric Balloon is reversible procedure ie no permanent changes are made to your stomach or intestines (unlike sleeve gastrectomy or gastric bypass) and is effective in reducing hunger, controlling food intake, initiating behavioural change, and achieving target weight loss of 10 to 30kg. This procedure is now available in Pune, India and is performed by Dr. Girish Bapat.

How does the gastric balloon work?
Once the balloon is placed and filled with a saline, it will partially fill the stomach. This effect will help the person to feel less hungry, so that they may consume smaller portions of food and experience similar satisfaction to what they would have previously experienced after consuming a larger meal (early satiety).

How is the gastric balloon introduced?
Gastric Balloon is performed as a day procedure with local anaesthesia and sedation. Dr. Girish Bapat will introduce gastric balloon with the help of gastroscope or endoscope. The procedure usually takes 30 mins.

How long can the gastric balloon stay in the stomach
Gastric balloon stays in the stomach for a maximum of 6 months. If required, the balloon can be replaced after 6 months.

How much weight loss can I achieve with the gastric balloon?
For the best results, gastric balloon must be used in conjunction with healthy lifestyle ie healthy eating and exercise (our specialist dietician will assist you). With a gastric balloon, it is possible to achieve a target weight loss of 10- 30 kgs.

Possible side effects of a gastric balloon?
The gastric balloon can cause nausea or vomiting initially, however these symptoms settle down.

When and how will the gastric balloon be removed?
Gastric Balloon will be removed with the help of endoscopy. Gastric Balloon removal is again a day case procedure.

Cost of Gastric Balloon insertion in Pune, India.
Cost depends on numerous factors like existing medical conditions and type of balloon used. For further info. Please contact +919765555451.

Frequently Asked Questions

Which operation is right for me?

There is no straightforward answer to this question! It is likely that you will have your own ideas as to what is the right operation for you. Based on your personal circumstances and medical conditions such as diabetes, hypertension, our experienced team will be able to provide you with information to help you decide the best possible treatment plan. It will be a joint decision between you and the surgeon.

Am I a Right Candidate?

There are a number of widely accepted criteria which make a patient suitable for Bariatric or weight-loss Surgery: – Weight greater than 45 kgs above ideal body weight for sex and height – BMI > 38.5 (Asians) by itself or > 33.5 if there is associated illness such as diabetes, high BP or sleep apnea – Obesity related health problems – No psychiatric or drug dependency problems – Capacity to understand the risks associated with surgery There is considerable flexibility in these guidelines. Sometimes a lower BMI between 30-35 is accepted if comorbidities exist.

Cost of Bariatric Surgery

Cost depends on lots of factors such as
• Bed category
• Type of surgery
• Open or laparoscopic repair
• Choice of hospital
• Preexisting medical conditions such as diabetes, angina which may prolong your hospital stay or need critical monitoring. Following your first meeting with the doctor, we would be able to give you an approximate estimate.

Easy Finance: In association with Bajaj Finserve, we have made available easy finance options whereby you can pay the entire cost of surgery is eight monthly installments.

Follow up

We like to see you 10 days after the operation to check on your progress and wounds.

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