Bariatric Surgery

TYPES OF BARIATRIC SURGERY PERFORMED

• Laparoscopic Roux en Y Gastric Bypass
  • Reduction in the size of stomach, from football to golf ball
  • Bypass of the section of the small intestine (duodenum) is done to attach smaller stomach to middle of small intestine to absorb the most calories
  • As stomach is smaller and absorb fewer calories, patients eat less. Even, food does not travel through duodenum
• Laparoscopic Adjustable Gastric Banding
  • Upper part of stomach is wrapped with silicone band filled with saline to create small pouch and cause restriction
  • Patients eat less as the feeling of full is quite quick
  • By adding or removing saline from band after surgery, the size of restriction can be adjusted
• Vertical Sleeve Gastrectomy
  • Emerging procedure
  • A sleeve-shaped stomach is left behind after removing approximately 85% of the stomach
  • No published studies on long-term results

IMPACT ON OBESITY-RELATED DISEASES

• According to study, bariatric surgery resolves type 2 diabetes in 73% - 83% of patients
• According to study, bariatric surgery cuts down the risk of developing coronary heart disease in half
• According to studies, bariatric surgery resolves the condition of obstructive sleep apnea in more than 85% of patients

BARIATRIC SURGERY: RISKS VS. BENEFITS

• Death risk involved in bariatric surgery is about 0.1%
• As compared to the people who do not have surgery, morbidly obese individuals who have bariatric surgery have extended life
  • Improvement in patient's life expectancy by 89%
  • Reduction in patient's risk of dying by 30% - 40%
• Morbidly obese patients who have undergone surgery have remarkable reduction in their risk of dying from an obesity related disease, when compared to those who do not have surgery
  • Risk of death from diabetes down 92%, from cancer down 60% and from coronary artery disease down 56%

LONG-TERM EFFECTIVENESS OF BARIATRIC SURGERY

• It is quite common that a bariatric surgery patient experience maximum weight loss after 1-2 years of surgery after that maintain a substantial weight loss. For years, improvements in obesity-related conditions are also visible
• After 6 months of surgery, patients may lose 30% - 50% of their excess weight whereas additional 77% of their excess weight is lost as early as 12 months after surgery
• According to long-term studies, morbidly obese patients who had surgery maintain a greater weight loss and more favorable levels of diabetes, cholesterol and hypertension up to 10-14 years after surgery when compared to those who did not have surgery

ADOLESCENTS AND BARIATRIC SURGERY

• With the increase in obesity rates, adolescents (12-17 years old) who are receiving bariatric surgery are also increasing
• Bariatric surgery is the most common procedure performed on morbidly obese adolescents of more than 10 years and for this age group, doctors are gaining experience in surgery
• The long-term efficacy and impact of the surgery is a topic of ongoing research

FOLLOW-UP CARE

• Bariatric surgery is regarded as a tool to help morbidly obese patients in losing weight. It is effective only when used in conjunction with some changes in eating and exercise habits
• Keeping regular appointments with the doctors is also beneficial, as research shows that bariatric surgery patients who keep all doctor's appointments for at least 3 years after surgery lost an average of 24% more weight, as compared to those who skipped appointments
• According to a study, in comparison to patients who do not attend support groups, bariatric surgery patients who attend support groups maintain about 20% - 30% greater excess weight loss

Surgical treatment is recommended for patients who present with intermittent vomiting of blood or passing malena for a permanent cure for bleeding. In non-cirrhotic patients, the surgery is performed in the form of a splenorenal shunt or splenectomy with devascularisation in cirrhotic patients. The patients who bleed from a duodenal ulcer will be considered as emergency case and require under-running of the bleeder or a partial gastrectomy.

On-time surgery done properly without any delay can save many lives.


In both national and international front, Dr.Radhakrishna has presented his experience, including Asia-Pacific Hepato-biliary conference in Bangkok and Digestive Diseases Week at New Orleans, USA in 2010.