Bariatric Surgery in Bangalore

Best Bariatric Surgeon in Bangalore
Best Bariatric Surgeon in Bangalore

Obesity Worldwide

Obesity is considered one of today’s most life-threatening conditions worldwide classified as the 2nd most common cause of preventable death. Not to mention, the co-morbidities associated with obesity which make this problem even more dangerous. The number of people suffering from obesity has been increasing over time. Studies showed that over the past 10 years the world-wide prevalence of obesity reached 35%(1).  Even though Obesity can be caused by genetic predisposition, the rise in obesity number we are seeing is strongly associated with increased in caloric intake in addition to the decrease in physical activities (2).

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Definition of Obesity

Obesity is defined as the abnormal or excessive fat accumulation in body which leads to impairment in systems function and putting the patient’s health at risk. Body mass index (BMI) is an index of weight-for-height that is commonly used to classify overweight and obesity in adults.

BMI Scale

  1. Normal:                                                             18.5 – 24.9
  2. Overweight:                                                     24.9 – 29.9
  3. Grade l obese:                                                  30    – 34.9
  4. Grade ll Obese (severe obesity):               35    – 40
  5. Grade lll Obese (Morbid obesity):            40+
  6. Super Obese:                                                    50+
  7. Super Super Obese:                                      60+

What Comorbidities are associated with obesity?

A comorbidity is a condition which develops in association with another disease and resolves with the treatment of that disease. Comorbidities associated with obesity are:

  1. Obstructive Sleep Apnea (OSA): sleep apnea is the most common comorbidity of obesity caused by deposition of fat in the neck and upper airway. It is interesting that 70-85% of cases can be cured with bariatric surgery.
  2. GERD: caused by increased intra-abdominal pressure
  3. Hypertension: 62% of cases cured with bariatric surgery
  4. Diabetes Mellitus Type 2: 77% of cases cured with bariatric surgery
  5. Heart failure
  6. Hyperlipidaemia
  7.  Osteoarthritis
  8. Disc Prolapse
  9. PCOs
  10. Depression

Obesity in Bangalore

In Bangalore in specific, studies showed that 4 in 10 people are obese with incidence of 43%, ranked number 2 for obesity in India. This surprising percentage was linked to the urbanization and life style changes in the area over the previous few decades.

Furthermore, Certain studies showed evidence of genetic markers in a significant number of the Indian population which puts them at risk of obesity, especially around the waist area.

Obesity Treatment Options

To avoid the life-threatening conditions associated with obesity, Substantial weight loss is the definitive treatment. Diet programs can show effectiveness, but it depends on how much weight the patient needs to lose. Once a patient reaches Morbid Obesity; the medical (conservative) failure rate is about 100%. Bariatric surgery in Bangalore is the most effective and sustainable method of weight loss with a failure rate of 10%

Bariatric Surgery in Bangalore for definite treatment of obesity

A huge number of studies showed that bariatric surgery is found to be the most effective tool in losing weight and maintain that loss, thereby improving overall health, life quality, and life expectancy. In one study, bariatric surgery was shown to reduce the relative risk of death in morbidly obese individuals by 89% (3). Studies also showed that patients who went through with bariatric surgery lived longer and had fewer hospital admissions due to problems related to obesity.  Furthermore, bariatric surgery in Bangalore has been shown to be extremely effective in improving and possibly resolving co-morbidities associated with obesity.  Failed bariatric surgery is defined as weight loss < 25 Kg.

Indications of Bariatric Surgery

  1. Grade lll (Morbid obesity)
  2. Grade ll obesity associated with co-morbidities
  3. Severe comorbidities
  4. Social and psychological effects on the patient 

Bariatric surgery evolution

Obesity was noticed to be remarkably increasing in the 18th century with the technology burst. First procedure used to control obesity was Jaw wiring which limited food intake, but later was complicated by infections and failure rates.  In 1954, surgeons and researchers noticed that surgeries which were complicated by nutrient malabsorption and intestinal shortening resulted in sustained weight loss (4), and from here the idea of bariatric surgery took place.

What is bariatric surgery?

Bariatric surgery is an invasive procedure which makes changes to your digestive system that aims for weight loss either through limiting the amount of food the stomach can accommodate, causing malabsorption of nutrients, or both. (5)

Types of Bariatric Surgeries performed in Bangalore

 There are multiple types of bariatric surgeries; Restrictive surgery, malabsorptive surgery, and combined.  Each has its advantaged, disadvantages, indications, and contraindication.

Restrictive Bariatric Surgery

  1. VBGT (Vertical Banded Gastroplasty)

– In this procedure the upper stomach near the oesophagus is stapled vertically to create a small pouch along the inner curve of the stomach. The outlet from the pouch to the rest of the stomach is restricted by a band made of special material. The band delays the emptying of food from the pouch, causing a feeling of fullness. (6)

-This type of surgery is not done anymore due to its high failure rate related to dehiscence and dilation of gastric pouch. For Bariatric Surgery in Bangalore

  • LAGB (Laparoscopic Adjustable Gastric Band)
  • It is a Laparoscopic procedure which involves placing a silicone band with an inflatable balloon around the upper part of your stomach to create a small pouch to hold food. The band limits the amount of food you can eat by making you feel full after eating small amounts of food.
  •   This procedure is reversible and adjustable through a subcutaneous port that can be injected with saline to inflate the balloon more if the patient is not losing enough weight. The saline can be suctioned to deflate the balloon if the patient is experiencing too much vomiting. For Bariatric Surgery in Bangalore

Combined Bariatric Procedures (Restrictive + Malabsorptive)

  1. Fobi (Banded Gastric Bypass)
  2. consists of a less than 30 cc pouch of the proximal stomach on the lesser curvature, a silastic ring around the stomach that functions as a stoma. A gastroenterostomy to a Roux-y limb of the jejunum completes the operation. A gastrostomy tube is placed to decompress the distal stomach perioperatively. The gastrostomy site has a silastic ring marker to facilitate percutaneous radiological evaluation of the distal stomach if the need arises. (7)
  3. This procedure fails due to dilation of the pouch
  4. Patients need vitamin supplementation for life
  • BPD DS (Biliopancreatic Diversion / Duodenal switch) (8)

First, a sleeve gastrectomy is performed. For this, a large portion of the stomach is removed with a stapling instrument, leaving you a narrow tube, or sleeve, from the top to near the bottom of the stomach. With less stomach to fill, you will feel full more quickly and eat less food and fewer calories. 

The second part of the procedure reroutes food away from the upper part of the small intestine, which is the natural path of digestion. This cuts back on how many calories and nutrients your body can absorb. The small intestine is divided, and connection is made near the end of the small intestine.  For Bariatric Surgery in Bangalore

The third part of the BPD/DS procedure changes the normal way that bile and digestive juices break down food. This cuts back on how many calories you absorb, causing still more weight loss. One end of the small intestine is connected to the duodenum, near the bottom of the stomach.

Sleeve gastric surgery in Bangalore

This Surgery is a laparoscopic procedure known as “Banana Stomach”. It is done by removing almost 85% of the stomach, shaping the remaining stomach into a sleeve “banana like”. It can be used as a bridging procedure preceding gastric bypass to achieve initial weight loss before the definitive procedure. Like any procedure, this procedure has its advantages and disadvantages.  The main advantage of this procedure is that it avoids altering the anatomy of the stomach. in Addition, estimate weight loss in 80%. A re-sleeve surgery can be done if the original one did not show satisfactory results. On the other side, this procedure has many advantages including; short-term results, stenosis, and nutritional complications. This procedure is indicated in  patients who are not suitable for a bypass surgery. For Bariatric Surgery in Bangalore

Gastric bypass surgery in Bangalore 

The Roux-en-Y gastric bypass abbreviated as (RYGB) is the most common procedure done for weight-loss in the united states of America. It is a combined restrictive and malabsorptive procedure which work by both restricting food intake and decreasing its absorption. A small gastric pouch limits the intake of food. Most of the stomach and upper intestine is excluded which aims in decreasing food absorption. The food goes directly from the small stomach pouch to the distal part of the small intestine. Laparoscopically, the surgeon uses staples to separate the upper stomach from the lower part there fore creating a pouch, after this the jejunum; which is part of the distal small intestine is connected to this pouch allowing food to bypass the in-between structures.

Like any procedure, Gastric Bypass has advantages and disadvantages. The advantages are summarized by the bullet-point below:

  • Most of health issues associated with obesity were resolved after a successful bypass surgery being the most effective procedure for weight loss. For Bariatric Surgery in Bangalore
  • Weight lost was sustained even up to 15 years post-surgery.

Disadvantages of the procedure include:

  • Poor absorption of important nutrient due to removing part of the small intestine. After this procedure the patient may face low levels of calcium, vitamin B12, and iron leading to anaemia and metabolic bone disease. Lifelong vitamins supplementation will solve this problem.
  • Dumping syndrome which we will discuss further late on this article.

Mini-gastric bypass in Bangalore

Mini gastric bypass surgery is a simple procedure with low risk of complication and convenient weight loss results.  One of the problems facing this procedure that in Bangalore it is not covered by insurance because it is still considered and experimental procedure.  You will also see many surgeons avoiding to perform this procedure regardless of how easy, fast, and simple it can be. The reason behind this avoidance is the fact that mini gastric bypass includes bypassing more part of the small intestine than the bypass surgery does. As a result, more long-term complications including anaemia and vitamins deficiencies will face the patients.  One of the important complications of this procedure in bile reflux gastritis. Usually in bypass procedures the bile flow is driven away from the stomach, but in the mini-gastric procedure this step is skipped which will lead to persistent pain in patients.

Mini-gastric bypass still needs to go under research to prove its applicability and go under some modifications to avoid some complication. Otherwise, being simple, easy, and fast procedure with short term stay in the hospital makes it a very convenient procedure to lose weight for both the surgeon and his patients. For Bariatric Surgery in Bangalore

Endoscopic balloon for weight loss in Bangalore 

This is considered the least invasive procedure for weight loss. As the name implies, A silicone balloon is endoscopically placed in the stomach. It’s a temporary procedure which extends for up to 6 months and then can be easily removed endoscopically. The idea behind the balloon is making the patient feel full too quickly. The balloon is inserted and filled with saline through a small filling tube. This procedure has its own indications which consists of being overweight with an BMI of at least 27 and being illegible for surgical procedures.

Patients who undergo endoscopic balloon insertion should follow a healthy plan consisting of healthy diet and exercise. If they stick to the healthy regimen, 1kg loss per week should be observed. Sustaining the weight loss also requires from the patient to stick to the life style he adapted when the balloon was in since the Idea of the balloon is to help the patient to adapt this life and put him on the starting point towards a healthy life style.

After 6 months, the balloon will be removed the same way it was inserted. It will be deflated by suctioning up the water after puncturing the balloon. Light sedation is used for this procedure. After removal of the balloon, patients will have to be on a fluid only diet for one week. Afterwards, the patient can gradually start eating normal food. For Bariatric Surgery in Bangalore

Disadvantages of this procedure include some side effects such as; nausea and vomiting during first days after the procedure. Anti-emetic drugs will help solve this problem.

Post-Gastrectomy Syndromes

  1. Dumping syndrome: In dumping syndrome, food and gastric juices from your stomach move to your small intestine in an uncontrolled and abnormally fast manner. (10) Due to postprandial vasomotor response, the patient will experience palpitations, sweating, and light-headedness. It is divided into early stage; which is 30 minutes after earing, and the late type with is more than 90 minutes after eating which develops because of low glucose levels.
  2. Blind Loop Syndrome: bacterial overgrowth in a bypassed segment of the intestine.  The patient presents with malabsorption symptoms.

Cost of Bariatric Surgery in Bangalore

– Cost of Lap Sleeve Gastrectomy in Bangalore – Cost Includes surgery, bed charges, consultants’ fees etc may variy from Rs. 250000.00 to Rs 600000.00 based on hospital and type of Room and Experience of the Surgeon

Cost of Gastric Bypass Surgery in Bangalore – Includes surgery, bed charges, consultants’ fees etc. may rang from Rs. 370000.00 to 1000000.00 Based on hospital and type of Room and Experience of the Surgeon

Best Bariatric Surgeon in Bangalore 

Bangalore is one of the most sought-after destination for medical treatments in India. Bariatric surgery is one of such treatments.

There are many clinics and hospitals offering bariatric surgery in Bangalore.

Best Bariatric Surgery Centre in Bangalore 

Summary

To sum up, every procedure has its own benefits and risks. Each procedure can be suitable for one patient and contraindicated in another, a good surgeon should make the right call which procedure suits the patient the most. No to mention, co-morbidities associated with obesity show different response with different procedures. For example, diabetes showed to improve more with LSG procedure that it did with Rouz-en-Y procedure. (9) Therefore, we should understand that Bariatric surgery requires a multi-disciplinary approach because an obese person often has some other health complications. It is not easy to take the patient into an operation room and change his normal anatomy. Both the surgeon and the patients should be ready for the different outcomes.

Resources

Best Bariatric Surgeon in Bangalore
Best Bariatric Surgeon in Bangalore

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