Overview
Bariatric Surgery (also called Weight Loss Surgery) is performed on obese patients for reduction of weight & also for relief from co-morbidities like diabetes, hypertension and obstructive sleep apnoea. This weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding); or through removal of a portion of the stomach (sleeve gastrectomy); or by resecting and re-routing the small intestines to a small stomach pouch (Roux en y gastric bypass/Minigastricbypasssurgery)
Types of Surgeries
Intra-Gastric Balloon Insertion is a non-surgical and reversible procedure in which a saline filled silicon balloon is endoscopically inserted into the stomach and kept in situ for a period of 6 months to a year. Balloon occupies most of the space in the stomach and leaves little room for food. On an average intra-gastric balloon surgery leads to about 30% excess weight loss. It also leads to improvement in other associated co-morbidities of obesity like type 2 diabetes, high blood pressure, high cholesterol etc.
Laparoscopic Gastric Banding is a reversible, surgical procedure for weight loss in which an adjustable gastric band made of silicon is applied on the outer surface of the stomach. This divides the stomach in a smaller upper pouch and a larger lower pouch. The band is connected to a tube that connects it to a port which is placed below the skin in the abdomen. Laparoscopic adjustable gastric banding works on the principle of food restriction and leads to a weight loss of about 45 to 50%. Laparoscopic gastric banding also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc.
Laparoscopic gastric banding was a popular procedure in India till about a decade ago. Over the years owing to less than satisfactory results, lap band surgery has gone out of favour with doctors and patients alike.
Laparoscopic Sleeve Gastrectomy is a surgical procedure for weight loss in which the stomach is divided longitudinally. This leads to the formation of a long narrow banana shaped stomach with a much smaller capacity for food intake. Laparoscopic sleeve gastrectomy surgery works mainly on the principle of food restriction. Gastric sleeve surgery also increases the rate at which the stomach empties and leads to an increase in the levels of certain gastro-intestinal hormones. These along with a reduction in “Ghrelin” which is the hunger inducing hormone lead to weight loss and other metabolic benefits post sleeve gastrectomy surgery.
Laparoscopic sleeve gastrectomy leads to about 65 to 75% excess weight loss over 12 to 18 months. Laparoscopic sleeve gastrectomy also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc.
Laparoscopic Sleeve Gastrectomy is one of the most popular procedures being performed in India presently.
Single Incision Laparoscopic Surgery is a step ahead of conventional laparoscopic surgery. Single incision laparoscopic surgery was used for bariatric surgery for the first time in 2008. Single incision sleeve gastrectomy is a “scarless” technique of performing sleeve gastrectomy. In this technique, a small 2 cm cut is made in the belly button and the entire surgery is performed through this tiny cut. There will be no other cuts/scars on your abdomen. Once it heals, there is practically no visible scar or tell-tale sign of surgery.
Although single incision weight loss surgery is a little more difficult to perform, it has great results in good hands. Single incision sleeve Gastrectomy is a surgical procedure for weight loss in which the stomach is divided longitudinally. This leads to the formation of a long narrow banana shaped stomach with a much smaller capacity for food intake. Single incision sleeve gastrectomy surgery works mainly on the principle of food restriction. Single incision sleeve gastrectomy also increases the rate at which the stomach empties and leads to an increase in the levels of certain gastro-intestinal hormones. These along with a reduction in “Ghrelin” which is the hunger inducing hormone lead to weight loss and other metabolic benefits post sleeve gastrectomy surgery.
Single incision sleeve gastrectomy leads to about 65 to 75% excess weight loss over 12 to 18 months. Single incision sleeve gastrectomy surgery also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc
Laparoscopic Roux-en y Gastric Bypass Surgery is one of the oldest and time-tested bariatric procedures with great weight loss results. It also leads to a significant improvement in all obesity related co-morbidities like type 2 diabetes, high blood pressure, high cholesterol etc.
Laparoscopic Roux-en y gastric bypass surgery is a weight loss procedure in which a small pouch of the stomach is created and the small intestine is re-routed to attach to this pouch. Rest of the stomach remains inside and is bypassed along-with the duodenum and first part of jejunum. A non-adjustable band can be applied over the stomach pouch to prevent it from dilating in future.
Laparoscopic Roux-en y gastric bypass surgery leads to about 65 to 75% excess weight loss over 12 to 18 months. Of course this can be made better if the patient puts in more effort in the form of diet and exercise. Roux-en y gastric bypass surgery also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc.
In a “Banded Gastric Bypass”, a non-adjustable band is applied over the stomach pouch to prevent it from dilating in future. This helps is better long-term weight maintenance and prevents weight regain.
Laparoscopic banded Roux-en y gastric bypass surgery leads to about 65 to 75% excess weight loss over 12 to 18 months. Of course this can be made better if the patient puts in more effort in the form of diet and exercise. Banded Roux-en y gastric bypass surgery also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc.
Laparoscopic mini gastric bypass surgery(MGB) or single anastomosis gastric bypass (SAGB)
Laparoscopic Mini Gastric Bypass Surgery (MGB/SAGB) is becoming one of the most popular weight loss bariatric procedure in India. Laparoscopic mini gastric bypass surgery is a technically easier procedure to perform and has good results for super-obese patients.
Morbid obesity or clinically severe obesity has emerged as one of the fastest growing epidemics of this century. People who have attempted to lose weight, know how difficult it is to not only lose and then maintain the weight loss. We regularly see patients who put in a lot of efforts to lose weight. They go to every weight loss clinic, celebrity dieticians, gyms, yoga gurus and weight loss retreats on foreign locations. Unfortunately, most often, they meet with disappointment and yo-yo between weight loss and weight gain. This entire process turns out to be extremely disheartening and demotivating for them.
Bariatric surgery is the only way at the moment that can lead to sustained weight loss in patients with clinically severe obesity.
Laparoscopic Sleeve Gastrectomy with Duodenojejunal Bypass is a novel bariatric procedure. It has good weight loss results and it also leads to a significant improvement in all obesity related co-morbidities like type 2 diabetes, high blood pressure, high cholesterol etc.
Laparoscopic sleeve gastrectomy with duodenojejunal bypass is a procedure in which a sleeve of the stomach is created and a loop of the part of intestine called jejunum is attached to the first part of duodenum. First part of duodenum and jejunum are bypassed in this surgery. This surgery was first popularised in Japan and one of the advantages of this surgery is that no part of the stomach is bypassed. Countries like Japan and Korea have a very high prevalence of stomach cancer and it is important that even after bariatric surgery, stomach must remain accessible for upper GI endoscopy.
Laparoscopic sleeve gastrectomy with duodenojejunal bypass leads to about 70 to 75% excess weight loss over 12 to 18 months. Ofcourse this can be made better if the patient puts in more effort in the form of diet and exercise. Laparoscopic sleeve gastrectomy with duodenojejunal bypass also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc.
Laparoscopic Duodenal Switch Surgery is a highly mal-absorptive bariatric procedure. Though it has one of the best weight loss outcomes and leads to significant improvement in obesity related co-morbidities like type 2 diabetes, high blood pressure, high cholesterol etc, it is not performed routinely in India.
Laparoscopic duodenal switch surgery is a procedure in which a sleeve of the stomach is created and a part of the small intestine called ileum is attached to the first part of duodenum. Almost the entire small intestine is bypassed in this surgery barring the last one to one and half meters. This surgery was first popularised in Europe. The flipside to such high degree of mal-absorption is a very high chance of nutritional deficiencies and liver related issues. This surgery is not commonly performed in India.
Laparoscopic duodenal switch surgery leads to about 80 to 85% excess weight loss over 12 to 18 months. Laparoscopic duodenal switch surgery also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc.
Laparoscopic sleeve gastrectomy with duodeno-ileostomy (SADI) is a highly mal-absorptive bariatric procedure. Though it has one of the best weight loss outcomes and leads to significant improvement in obesity related co-morbidities like type 2 diabetes, high blood pressure, high cholesterol etc, it is not performed routinely in India. However, it may selectively be considered as a revision option for super-super obese patients who have undergone a sleeve gastrectomy as a first stage procedure.
Laparoscopic sleeve gastrectomy with duodeno-ileostomy (SADI) is a procedure in which a sleeve of the stomach is created and a loop of the small intestine called ileum is attached to the first part of duodenum. Almost the entire small intestine is bypassed in this surgery barring the last one to one and half meters. This surgery was first popularised in Europe. The flipside to such high degree of mal-absorption is a very high chance of nutritional deficiencies and liver related issues. This surgery is not commonly performed in India. Laparoscopic sleeve gastrectomy with duodeno-ileostomy (SADI) leads to about 70 to 80% excess weight loss over 12 to 18 months. Laparoscopic sleeve gastrectomy with duodeno-ileostomy (SADI) also leads to a significant improvement in associated co-morbidities like type 2 diabetes, high blood pressure, high cholesterol, gout, obstructive sleep apnoea, joint diseases etc. Laparoscopic sleeve gastrectomy with duodeno-ileostomy surgery is very demanding nutritionally. Patients need to be on very high doses of nutritional supplements as well as protein intake. After laparoscopic sleeve gastrectomy with duodeno-ileostomy surgery, the daily protein requirement is about 80 to 100 grams. Most Indian patients find it difficult to cope up with this and hence this surgery is not very popular in India. But yes, it may be considered as a second stage option for super-obese patients who underwent a sleeve gastrectomy and need further weight loss.
Our Team of Bariatric Surgeon
