Bariatric or Weight Loss Surgery
What is Bariatric surgery?
Weight loss surgery is also known as Bariatric surgery. Surgery on
the stomach and/or intestines to help a person with extreme obesity
lose weight is called Bariatric Surgery. Bariatric surgery is an option
for people who have a body mass index (BMI) above 40. Surgery is also
an option for people with a BMI between 35 and 40 who have health
problems like type 2 diabetes or heart disease. There are two main types of bariatric surgery:
1 Adjustable Gastric Banding
2 Gastric Bypass.
How is bariatric surgery or weight loss surgery done?
Adjustable Gastric Banding
In adjustable gastric banding, insertion of a band restricts the
size of the opening from the esophagus to the stomach. The size of the
opening to the stomach determines the amount of food that can be eaten.
The size of the opening can be controlled by the surgeon by inflating
or deflating the band through a port that is implanted beneath the skin
on the abdomen. The band can be removed at any time.
Gastric Bypass
In contrast to gastric banding, gastric bypass (sometimes referred
to as roux-en-Y gastric bypass) is a permanent reduction in the size of
the stomach. The proximal portion of the stomach is used to create an
egg-sized pouch that is connected to the intestine in a location that
bypasses about 2 feet of normal intestine. The amount of food that can
be eaten is limited by the size of the pouch and the size of the
opening between the pouch and the intestine.
How do I decide whether I should go for weight loss surgery?
You should consider opting for surgery if:
- BMI (Body Mass Index) above 40 or between 30 to 40 in the presence
of other associated diseases that may improve with weight loss (high
blood pressure, diabetes, sleep apnea, and painful joint condition
arthritis proven by x-ray)
- Age between 18 and 55 years
- Obese for more than five years
- Failure of dietary or weight-loss drug therapy for more than one year
- Absence of glandular diseases such as hypothyroidism
- Comprehension of the procedure and compliance by the patient
- No dependency on alcohol or drugs
- Acceptable operative risk
- Not have depression or other major emotional disorder
Are there any medical benefits of weight loss surgery?
There are host of medical benefits too of weight loss surgery which include:
- Normal Blood Pressure-
About 60 percent of patients with high blood pressure are able to stop
all medications and have a normal blood pressure, usually within two to
three months after surgery.
- Normal Cholesterol-
More than 70 percent of patients will develop normal cholesterol levels within two to three months.
- Diabetes More than 80 percent of Type-2 diabetics obtain
excellent results, usually within a few weeks after surgery. There is
no medical treatment for diabetes that can achieve as complete and
profound an effect as surgery.
- Asthma
According to IFSO, successful bariatric surgery reduces the number and severity of asthma attacks.
- Respiratory Insufficiency
Improvement of exercise tolerance and breathing ability usually occurs
within the first few months after surgery. Often, patients who have
barely been able to walk find that they are able to participate in
family activities, and even sports.
- Sleep Apnea Syndrome
Dramatic relief of sleep apnea occurs as patients lose weight. Many
report that within a year of surgery, their symptoms were completely
gone, and they had even stopped snoring completely-and their spouses
agree. Sleep apnea is cured in about 75 percent of patients after
surgery.
- Gastro-Esophageal Reflux Disease
Relief of symptoms of reflux usually occurs within a few weeks of surgery for many patients.
- Gallbladder Disease
When gallbladder disease is present at the time of the surgery, it is
"cured" by removing the gallbladder during the operation.
- Stress Urinary Incontinence
This condition responds dramatically to weight loss and usually significant improvement in the control occurs.
- Low Back Pain, Degenerative Disk Disease, & Degenerative Joint Disease
Patients usually experience considerable relief of pain and disability
from degenerative arthritis and disc disease and from pain in the
weight-bearing joints.
Are there any investigations to be carried before the surgery?
Certain basic tests are done prior to surgery which include
- Complete Blood Count (CBC)
- Liver function test
- Kidney function test
- Lipid profile
- Thyroid Function Test
- Old age patients also need to get a chest X-ray and an electrocardiogram.
- Due to the high incidence of obstructive sleep apnea, most patients
require a polysomnography study. Other tests, such as pulmonary
function testing, echocardiogram, GI evaluation, cardiology evaluation,
or psychiatric evaluation, can also be done if indicated depending upon
the patient's condition.
What are the short and long term effects of the weight loss or bariatric surgery?
Results depend on a variety of factors and vary with each patient.
Most gastric bypass patients experience fairly rapid weight loss in the
first three to six months after surgery. Weight loss slows, but
generally continues up to 12 to 18 months after surgery, averaging 70
to 75 percent of excess body weight.
With the Lap-Band, weight loss is generally slower and more gradual
compared to the gastric bypass. Typically, patients lose up to 55
percent of their excess body weight within 18 months following lap band
surgery.
Regardless
of the procedure, it requires a team approach to solving a patient's
weight problem. This includes a comprehensive evaluation, as well as
psychological and emotional support before and after surgery for the
greatest chance of weight loss success.
The operation
itself is not the whole answer. A multidisciplinary approach—surgeon,
internist, dietician and psychiatrist—is needed to help the patient
lose and keep weight off. The goal is not only weight loss, but the
reversal of serious medical conditions.
How long does the surgery take and what is the Post Operative Care following Bariatric Surgery?
Bariatric surgery generally takes 2-2 ½ hrs.
The
patient recovers in the recovery room from the effects of anaesthesia,
after 2-3 hr. Once fully recovered the patient will be wheeled to their
bed or room in the hospital. Patients may have a nasogastric tube (NG),
an IV and a Foley catheter in their bladder. The NG is usually removed
1-2 days later, after an x-ray of the new pouch has been taken. After
2-3 days the patient can begin drinking water and about 60ml of a
dietary supplement such as Boost, Horlicks or other similar food
supplements. The patient will remain on liquids for the first 2 weeks
after surgery, drinking the supplement for meals. The other liquids
patients may have are decaffeinated coffee or tea, skimmed milk, broth
(kanji), water, diluted fruit juice (1/3 juice mixed with 2/3 water)
and sugar-free ice candies. The patient must avoid at all costs
sweetened and/or carbonated beverages and adding sugar in their
liquids. Average hospital stay is from 5 to 7 days depending on the
physique of the patient. Patients must be able to drink adequate
amounts of fluid before they can be discharged home.
What precautions are to be taken after the surgery?
In the first six months after surgery, eating too much or too fast may
cause either vomiting or an intense pain under your breastbone. Instead
of eating regular-sized meals three times a day, you'll be required to
eat four to six very small meals: about 2 ounces (60 ml) each. Most
people, however, quickly learn how much they can eat at one meal. And
over time, the amount you can eat increases.
What are the risks associated with the weight loss surgery?
Weight loss surgery has many of the same risks associated with any
other major abdominal operation. Life-threatening complications or
death are rare, occurring in fewer than 1% of patients. Such
significant side effects as wound problems, difficulty in swallowing
food, infections, and extreme nausea can occur in 5-10% of patients.
Will I have a lot of pain?
Every attempt is made to
control pain after surgery to make it possible for you to move about
quickly and become active. This helps avoid problems and speeds
recovery. Often several drugs are used together to help manage your
post-surgery pain. While you are still in the hospital, a Patient
Controlled Analgesia (PCA), which allows you to give yourself an
intravenous dose of pain medicine on demand, will be used to initially
control your pain. When you are ready to go home, you will be given a
prescription for pain medicine.
How long do I have to stay in the hospital?
As long as it
takes to be self-sufficient. Although it can vary, the hospital stay
(including the day of surgery) can be 1-2 days for a laparoscopic band,
3-4 days for a laparoscopic gastric bypass.
How soon will I be able to walk?
Almost immediately after, the doctor will require you to get up and
move about. Patients are asked to walk or stand at the bedside on the
night of surgery, take several walks down the halls the next day and
thereafter. Walking is the most effective means to decrease your risk
of having a pulmonary embolus. On leaving the hospital, you may be able
to care for all your personal needs, but will need help with shopping,
lifting and with transportation.
What is the cost of Bariatric Surgery in India?
Cost
of Bariatric surgery in India is less than one third as compared to
that in US. The cost varies between USD 5000- USD 7500 depending on the
the patient's condition and co morbidities and also the kind of
facility you choose.
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