Department of Bariatric Surgery.
The Department of Bariatric Surgery at Columbia Asia Hospitals perform all types of weight loss surgeries, tailored to meet individual patient needs and provides support after surgery. The team includes a bariatric surgeon, endocrinologist, cardiologist, bariatric nutritionist, psychologist, physiotherapist and a trained anesthetist to provide comprehensive care. The center is equipped with state-of-the-art technology and adequate facilities for peri-operative management and care. The focus of the hospital is to provide care to all patients in a comfortable and safe environment, while maintaining the much needed privacy.
The department provides treatment of diseases associated with Obesity and for Morbid Obesity. A personalized treatment plan for each individual is prepared in consultation with the multi-disciplinary team of specialists. The Department of Bariatric Surgery at Columbia Asia Hospitals perform the following procedures:
- Gastric Banding
- Laparoscopic Sleeve Gastrectomy
- Gastric bypass
The hospital has highly skilled bariatric surgeons, multi-specialties like endocrinology, psychiatry, cardiology, support personnel and excellent infrastructure to provide comprehensive care for obese patients
- The hospital has highly skilled bariatric surgeons, multi-specialties like endocrinology, psychiatry, cardiology, support personnel and excellent infrastructure to provide comprehensive care for obese patients
- The operation theatre is well equipped for obesity surgery
- Back up services like 64 slice CT, 1.5 T MRI, Endoscopy, Fluroscopy, Laboratory service and round the clock ICU/ monitoring is available
- Bariatric support group to help patients and families
What is Obesity?
Obesity is a medical condition in which excess body fat has accumulated to the extent that it may have an adverse effect on health, leading to reduced life expectancy and/or increased health problems. An increase of 20% or more above the “ideal body weight” is the point at which excess weight becomes a health risk. India is now facing an epidemic of obesity with about 5% of its population having morbid obesity (NFHS 2007). Asian-Indian populations have a higher total and central fat for a given body weight when compared to matched caucasian population. Indians are genetically susceptible to obesity especially around the waist.
What Causes Obesity?
Obesity is most commonly caused by a combination of excessive food intake, lack of physical activity and genetic susceptibility although a few cases are primarily due to hereditary causes, endocrine disorders, medications or psychiatric disorders
How do I know whether I am obese?
Body Mass Index (BMI) is a tool to measure the extent of obesity, where weight and height are used in a formula. BMI is your weight (in kilograms) over your height squared (in centimeters)
Classification of Obesity
- Overweight (pre-obese) if BMI is between 25 - 29.9
- Class I Obesity if BMI is between 30 - 34.9
- Class II Obesity if BMI is between 35 - 39.9
- Class III Obesity if BMI is =/>40 Overweight and Class I Obesity can usually be treated with diet modification, exercise and behavioural changes and do not require surgery. Class II and III obesity require bariatric surgery.
Who are the ideal candidates for a Bariatric Surgery
- Patient with BMI > 35 or > 32 .5 with co-morbid conditions
- If your multiple attempts of weight reduction by diet and exercises have failed
- If you have no treatable underlying endocrine disorder or any major psychiatric illness
- Most importantly, a patient must be committed to post-operative diet and lifestyle modifications
Types of Bariatric Surgery
All types of bariatric surgeries are done under general anaesthesia. These are minimally invasive surgeries which require a short stay in the hospital, recovery after surgery is faster and resumption of routine activities is also possible earlier. Since such procedures are as the name implies minimally invasive (key hole), there is usually less blood loss and damage to tissues, hospital stay is shorter (about 2-5 days) and no post-operative ICU stay or bed rest.
A soft band is placed on the upper stomach, which reduces the amount of food consumed at one time and provides a feeling of fullness for a longer time. Hence there is weight loss.
Laparoscopic Sleeve Gastrectomy
About two-thirds of the left side of the stomach is removed laparoscopically and makes the stomach look like a tube with a capacity of 60 cc to 150 cc. The part of the stomach that produces Ghrelin hormone, which stimulates appetite and promotes fat deposition in the body is removed.
- Preservation of the stomach function
- It does not require disconnecting or reconnecting the intestines
- It is a technically simpler procedure than gastric bypass or duodenal switch (rarely done)
- The stomach is reduced in volume but tends to function normally so most of the food can be consumed, albeit in small quantities
- Eliminates the portion of the stomach that produces hunger hormone – Ghrelin
- No dumping syndrome because the pylorus is preserved
- Minimises the chance of an ulcer occurring
- By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anaemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated
Size of the stomach is reduced and a part of small intestine is bypassed so that digestion process is altered and less food is consumed and absorbed.
Mini Gastric Bypass Procedure
The Mini-Gastric Bypass (MGB) is a type of obesity surgery which is simple, successful and an inexpensive technique in weight loss surgery. It is a hybrid procedure that has the advantages of a restrictive procedure (like Laparoscopic Sleeve Gastrectomy) and also the advantages of a mal-absorptive procedure (like Roux-en-y Gastric Bypass). It involves creating a long narrow tube of stomach along its right border and then joining it to a loop of small intestine about 180 cms from the starting point of the jejunum. The MGB is a viable and effective alternative to the Roux en-Y procedure due to the simple jejunal loop creation, thus reducing the morbidity and mal-absorption seen with a proper gastric bypass. MGB is fast becoming popular because of low risk of complications and good sustained weight loss. It has the effectiveness of sleeve and Roux-en-y gastric bypass without their complications or reflux problem.
In the MGB restriction of stomach, volume is achieved by surgically altering the stomach to make its size and capacity smaller as in sleeve gastrectomy. Mal-absorption is accomplished by looping and attaching the small intestine to the stomach tube bypassing about 150-180 cm of intestine as in Roux-en-Y gastric bypass.
- Single stage permanent procedure
- No resection or removal of parts stomach or intestine
- No implants like a balloon or band
- No reflux or acidity problem
- Hunger is reduced
- Sustained long term weight loss
- Easily reversible and revisable if necessary
- No prolonged hospital stay
- No major mal-absorption complications
What preparations are required before undergoing obesity surgery?
Before surgery the patient will undergo a complete health check. In addition, the medical and diet history will be taken into account to rule out:
- Alcohol or drug abuse
- Endocrine or hormonal cause for obesity
- Serious psychological problems or mental illness
Seven days prior to surgery, the patient will be kept on a very low calorie, high protein liquid diet. This is done to reduce the swelling of the left lobe of the liver and also serves as a test for the patients’commitment and readiness for the surgery and post-operative diet regimen.
Blood thinning medication is given to the patient to prevent blood clotting in the legs during surgery
Possible Immediate Risks of Bariatric Surgery:
Although Bariatric Surgery is very safe and success rate of Bariatric Surgery at Columbia Asia Hospitals is near 100% with over 1500 bariatric surgeries conducted by our medical experts across our hospitals in India. However, in some rare cases below mentioned complications may occur
- Anaesthesia complications
- Bleeding from staple line
- Injury to adjacent organs during surgery
- Leak from staple line
- Pulmonary embolism
- Wound infection
- Vomiting after surgery
Duration of stay during treatment of Bariatric Surgery:
Pre-operative evaluation takes 1-2 days in the hospital
Hospital stay is usually 4-5 days
Patient should be able to take enough fluids and nutrients orally before discharge
What results can I expect after Bariatric Surgery?
- Loss of 60-70% excess weight by the end of 1-2 years
- Improvement in associated diseases like diabetes
- Greater capacity for physical activity
Health Benefits of Bariatric Surgery:
- In Type 2 diabetics, sugar levels are known to come down after bariatric surgery and in some cases the medications are no longer needed Relief of sleep apnea is seen and hence better of quality of sleep
- Hypertension improves and in some patients medication is no longer required
- Cholesterol level comes down drastically and patients can lower or stop lipid lowering medicines
- Improvement in diabetes, hypertension and cholesterol levels has a direct effect on reducing the risk of heart diseases
- Post-surgery patients are known to have fewer and less severe asthmatic attacks. There is increased efficiency of breathing and exercise tolerance
- Those with Gastro Esophageal Reflux Disease (GERD) show relief of all symptoms of reflux within a few days
- Stress incontinence responds dramatically to weight loss
- Post-surgery, patients get tremendous relief from low back ache and joint diseases
- Women with polycystic ovarian syndrome show a return to normal regular menstrual cycles after weight loss surgery. Further level of fertility also show improvement