Bariatric surgery is being performed in the West since 1980’s. currently, it’s being widespread in Asia. The long-run results (>20 years) have proven that these surgeries are safe & effective. a major sustained weight loss i.e. 60-90% is proved with 70-96% improvement in obesity(fatness) associated diseases.
Bariatric surgical procedures cause weight loss by limiting the quantity of food the abdomen will hold, inflicting absorption of nutrients, or by a combination of each gastric restriction and malabsorption. Bariatric procedures conjointly often cause hormonal changes. Most weight loss surgeries these days are performed by minimally invasive techniques (laparoscopic surgery).
The most common bariatric surgery’s procedures are a gastric bypass, sleeve gastrectomy, also known gastric sleeve operation, mini gastric bypass
Bariatric surgeries result in long-run weight-loss success. Most studies demonstrate that more than 90 % of people previously suffering from severe obesity are successful in maintaining 60 % or more of their excess weight loss following bariatric surgery. Among those suffering from super severe obesity, quite 80 % are ready to maintain more than 60 % excess weight loss.
Who should undergo surgery ?
- Patients with BMI > 37.5 without any diseases.
- Persons with BMI > 32.5 with any 2 comorbid diseases. i.e; Diabetes, hypertension, infertility, joint pains, obstructive sleep apnea, hyperlipedemia, fatty liver, hyperuricemia, impaired sexual function.
- Persons with BMI > 27.5 with uncontrolled comorbidities even with best medical management for example – Person with uncontrolled blood sugar levels even with insulin & antidiabetic medications.
- Age between 18-65 years and well motivated person.
Who should not undergo surgery ?
- Patients with chronic alcoholism, substance abuse.
- Patients unfit for general anaesthesia, portal hypertension.
- Unmotivated persons, severe psychiatric illness.
How does Diabetes Mellitus get controlled after Bariatric & Metabolic Surgery ?
- Duodenal exclusion via surgery improves pancreatic function.
- As the food transit time is shortened i.e. food is delivered early into small intestine, GLP-1 hormonal levels rise & this controls sugar via pancreas.
- Surgical procedure reduces weight which reduces insulin resistance.
How is this surgery performed ?
This is performed laparoscopically under general anaesthesia. The patient has 3-5 small 1-2cm incisions on abdomen. Laparoscopic surgery also known as key hole surgery has an advantage of less pain, better cosmesis, early recovery & discharge.
Patient needs to do some preliminary investigations followed by a liquid diet regime for 3 days to 7 days. Hospitalization is for 3-5 days & patient can resume work within 10-15 days.
Is this same as liposuction ?
Liposuction refers to procedures where superficial abdominal fat is removed. Mainly done who require cosmesis. Weight loss expected is less.
Bariatric surgery is different from liposuction. It is a Gastro Intestinal Surgery which produces significant weight loss.
What are the side effects of surgery?
This surgery has risks as any other laparoscopic surgery. There is a small <1% Risk of anastomotic leak & bleeding. Modern anesthesia has made this procedure safe.
Few patients may have skin laxity or nutritional deficiencies if adequate protein intake & diet is not followed.
How much weight loss is expected ?
Weight loss is more with malabsorptive procedures whereas less in predominantly restrictive procedures. An 60-90 % of excess weight loss is expected over 1-1.5 years time period.
Will my co-morbid diseases get resolved ?
Improvement is seen in 96% of Diabetics, 80% of Hypertensive patients. Resolution is seen in 85-90% of patients with hyperlipidemia & hyperuricemia,joint pain .
Why asymptomatic obese patient should undergo bariatric surgery?
27% of obese patients will develop new onset Diabetes Mellitus as compared to 4% in normal patients over 10 years.
Quality of life improves with weight loss for example- increased mobility & work productivity
Is this Surgery covered under any Insurance or Government scheme ?
Central Government employees can avail the benefit of a free surgery under CGHS Scheme
Few of the patients do get insurance claims and the OSSI(Obesity Surgery Society of India )is trying to get his surgery covered under the insurance. Apart from that, there are few financial institutes who offer monetary help to the needy as a loan on EMI basis
Apart from this the Pune Municipal corporation offers a grant for patients staying in PMC limits