Obesity Surgery


Obesity doctor: A weight loss and Diabetes Surgery centre, helps to reduce the excess weight after all initial modalities fails. Centre is having most experienced and super-specialist laparoscopic Gastrointestinal surgeon along with team of physician, diabetologists, intensivist, dietician and specialized physiotherapist to take care of all & high-risk obese person. This centre is equipped with all latest facilities to deliver world class treatment.





Know About Obesity


Killer of your health

  •   Obesity is a chronic illness in which person accumulates excess fat, which can jeopardize health. Obesity is the result of an increase in the size or percentage of fat cells in the body. When a person gains weight, these fat cells first grow in size and then in number.
  •   Since obesity is a chronic illness, its symptoms (called co-morbidities)) develops gradually. In its early stages, obesity can make it hard to walk and cause back pain, fatigue, skin conditions & shortness of breath. If left untreated, obesity has a tendency to worsen. When obesity crosses the line into morbid obesity, it can lead to life threatening illness such as type 2 diabetes, high blood pressure, certain forms of cancer, high cholesterol and sleep apnea. The only way to prevent further development of the symptoms is to achieve lasting weight loss.

  1. Health Risk: Morbid obesity is a metabolic disease associated with numerous medical problems, some of which are virtually unknown in the absence of obesity. Almost all organs of body are ill-effected by untreated obesity. Diabetes, heart disease, high blood pressure, certain types of cancer, sleep apnea and joint pain are most commonly suffered diseases.
    1. Joint related disorders: The most frequent problem is the combination of arthritis and degenerative joint disease, present in at least 50% of morbidly obese person.
    2. Respiratory disorders: Obstructive Sleep Apnea Obstructive Sleep apnea is a sleep disorder characterized by pauses in breathing during sleep. Each episode lasts long enough that one or more breaths are missed, and such episodes occur repeatedly throughout sleep. Common problems related with obstructive sleep apnea are loud snoring, restless night sleep leading to have day-time sleepiness and in severe form it affects heart in form in congestive heart failure. Sleep apnea is diagnosed with an overnight sleep test called a polysomnogram (sleep study) that shows blood oxygen desaturation (fall of oxygen in blood) of 3–4% or greater.
    3. Metabolic disorders: In obese patients, Insulin (hormone that regulate blood sugar level) functions are ineffective and in long term lead to development of so called “metabolic syndrome”. Metabolic syndrome encompasses 3 of the following components: the presence of visceral obesity (waist circumference of more than 40 inches in males and more than 35 inches in females), hypertension (HTN) with a blood pressure greater than 130/85mmHg, fasting blood glucose greater than 100 mg/dL, elevated triglycerides of 150 or greater, and a low high-density lipoprotein (HDL) of less than 40 in males and 50 in females.
    4. Cardiac disorders: Cardiac problems are also very common in obese person. Obesity itself is a dominant risk factor for coronary artery disease and associated metabolic disorders make heart to more vulnerable for coronary artery disease and sudden cardiac death.
    5. Risk of Cancer: Obese patients have higher chance to develop cancer of esophagus, colon, breast, endomatrium, prostate & kidney.
    6. Gastrointestinal disorders: Gastro-esophageal reflux is an abnormal reflux of stomach acid to the esophagus due to high intra-abdominal pressure in obese person and manifest as burning sensation in chest and upper part of abdomen. Stone in Gall bladder (Cholelithiasis) are frequently associated with obesity.
    7. Liver disorders: Untreated obese person have tendency to accumulated extra fat in to Liver, medically condition is known as Non-alcoholic-fatty-liver-disease (NAFLD). This disease has been convincingly shown to have a progressive course, potentially leading to cirrhosis, liver cancer or liver failure. The rise in NAFLD has paralleled increases in obesity and diabetes. Prevalence of Non-alcoholic-fatty-liver-disease (NAFLD) in morbidly obese is 93% and in type 2 diabetics is about 62%.
    8. Infertility
      1. Female infertility: Up to 4-7% obese female have polycystic-ovary-syndrome (PCOS) and those with PCOS not only suffer from infertility as a result of anovulation; but also have an increased risk for recurrent miscarriages and complications during pregnancy.
      2. Male infertility: Like obese female, obese male also suffers from infertility and it’s largely due to reduced sperm concentrations and DNA fragmentation in semen and to some extends by poor sperm motility and morphology.
      3. Effect on pregnancy: Obesity significantly increases the risk for maternal complications during pregnancy. Obesity is associated with increased risk for early and recurrent miscarriage. Obese person are also prone to have hypertensive disorders, diabetes, infection, thrombo-embolism, altered mood during the course of pregnancy and complications during labor and delivery.
  2. Mortality (Early death): Obesity is proven risk factor for early death from number of diseases increase as BMI increases. This risk is more in person who remains overweight for longer period of time.
  3. Lower quality of life

    Obesity affects social, psychological and financial aspect of person. Obese individuals are routinely discriminated against in terms of employment. Severely obese individuals are thought of by much of the public as being lazy and lacking self-discipline. Psychologic diseases such as depression therefore have an extraordinarily high incidence in this population compared with the general public. Poor self-image is almost universal among these individuals as well.



To better understand how weight loss surgery works, it is important to understand how your gastrointestinal tract functions. As the food you consume moves through the gastrointestinal tract, various digestive juices and enzymes are introduced at specific stages that allow absorption of nutrients.

  •   Esophagus is a long muscular tube, which moves food from the mouth to the stomach.
  •   Stomach: Here the food is mixed with an acid that is produced to assist in digestion. The pylorus is a small round muscle located at the outlet of the stomach and the entrance to the duodenum (the first section of the small intestine). It closes the stomach outlet while food is being digested into a smaller, more easily absorbed form. When food is properly digested, the pylorus opens and allows the contents of the stomach into the duodenum.
  •   Small intestine is about 4.5 to 6 meters long and is where the majority of the absorption of the nutrients from food takes place. The small intestine is made up of three sections: the duodenum, the jejunum and the ileum.
  •   Duodenum is the first section of the small intestine and is where the food is mixed with bile produced by the liver and with other juices from the pancreas. This is where much of the iron and calcium is absorbed.
  •   Jejunum is the middle part of the small intestine extending from the duodenum to the ileum; it is responsible for digestion.
  •   Ileum is the site for absorption of fat-soluble vitamins A, D, E and K and other nutrients.
  •   Large intestine is the site where excess fluids are absorbed and a firm stool is formed.

Hospital stay

For most of patients, usual hospital stay is between 3-5 days. You are advised to stand up and move as soon as possible after surgery. This will build you confidence in your recovery along with it will minimize the risk of blood clotting in your legs.

Depending upon your medical state, you may be admitted to intensive care ward for strict observation of your heart and lung.

You will be discharged when:

  •   You can swallow enough liquids to prevent dehydration
  •   You don't have fever
  •   You have sufficient pain control with medicine

Complication & Side effect of obesity surgery

There are risks that go with any type of medical procedure and surgery is no longer an exception. Success of surgery depends upon 3 factors: type of disease/surgery, experience of surgeon and overall health of patients. The risks of each procedure need to be considered in the light of potential reductions in mortality, morbidity or co-morbidity, quality of life and productivity.

  •   The most common complications of Gastro-intestinal (bariatric) surgery include anastomotic and staple-line leaks (3.1%), wound infections (2.3%), pulmonary events (2.2%) and haemorrhage (1.7%). Morbidity rates are lower after laparoscopic procedures, which constitute a steadily increasing proportion of bariatric operations. (Nguyen NT et al. Use and outcomes of laparoscopic versus open gastric bypass at academic medical centers.J Am Coll Surg2007;205: 248“255).
  •   Early post-operative morbidity and mortality are related to the complexity of the surgery. The US Bariatric Outcomes Longitudinal Database (BOLD) reviewed over 57 000 consecutive procedures and reported one or more complication at 1-year rates of 4.6, 10.8, 14.9 and 25.7% following laparoscopic adjustable gastric band, sleeve gastrectomy, Roux-en-Y gastric bypass and bilio-pancreatic diversion, respectively. (DeMaria EJ. Baseline data from American Society for Metabolic and Bariatric Surgery-designated Bariatric Surgery Centers of Excellence using the Bariatric Out-comes Longitudinal Database.Surg Obes Relat Dis2010;6: 347“355)
  •   The 30-day mortality associated with Gastro-intestinal (bariatric) surgery is estimated at 0.1“0.3%, a rate lower / similar to that for laparoscopic cholecystectomy & described as ˜low™. Thirty-day post-surgical mortality is 0.1% for laparoscopic adjustable gastric band, 0.5% for Roux-en-Y gastric bypass and 1.1 for bilio-pancreatic diversion. (Buchwald H et al. Trends in mortality in bariatric surgery: a systematic review and meta-analysis. Surgery 2007;142: 621“632).
  •   Long-term concerns, especially with Roux-en-Y gastric bypass and bilio-pancreatic diversion, include vitamin and mineral deficiencies, osteoporosis and, rarely, Wernicke™s encephalopathy and severe hypoglycaemia from insulin hypersecretion.

Efficacy

The actual weight a patient will lose after the procedure is dependent on several factors. These include:

  •   Patient's age
  •   Weight before surgery
  •   Overall condition of patient's health
  •   Surgical procedure
  •   Ability to exercise
  •   Commitment to maintaining dietary guidelines and other follow-up care
  •   Motivation of patient and cooperation of their family, friends and associates

It is better to be slightly overweight and fit, than to be of normal weight but unfit.

Time period
  •   You will be awake after surgery with same weight. After end of first week you will be feeling the process of weight loss. Most of the eight will be lost in initial 6 months and then continues to lose till 18-24 months. With a band, it will be a steady progression of losing 0.5 - 1kg/week once your band is adjusted to the 'sweet spot'.

Resolution of obesity related co-morbidities
  •   If you have diabetes, you have more chance of it resolving completely with operations that achieve a greater weight loss or exclude some of the hormone release in the stomach. High blood pressure and sleep apnoea will almost certainly improve with a lesser degree of weight loss. The length of time and the severity of your obesity related illnesses will also determine how likely they are to resolve and will be something to discuss with a physician in a multidisciplinary team.

Weight regain
  •   Patients may lose weight upto 18-24 months. Although some patients continues to lose weight, but most of patients finds that weight is stabilized. At this point onward, there are chances of weight gain so patient should be careful in caloric intake and expenditure to prevent weight gain.

Diet

Regardless of the weight loss procedure, you will require permanent changes in your eating habits that must be adhered to for successful weight loss. Post-surgery dietary guidelines will vary by bariatric procedure.

  •   Take protein diet as first food and daily target is 60 gm/day.
  •   Take small and frequent meals, about 6 meals a day.
  •   Eat slowly, take 30 minute to eat your meals, Chew foods thoroughly and stop when you feel full.
  •   Do-not skip meals Eat at least three meals a day.
  •   Drink 6-8 glass (250 ml each) of caffeine free, calorie-free ad non-carbonated beverage a day is must. Do-not drink with meal, stop drinking 30 minute before and after your meal.
  •   Take your vitamins and minerals supplement daily as prescribed.

Exercise & Return to regular work

It is important following obesity surgery that you not only alter your eating habits, but also your level of physical activity. Patients are generally recommended to start exercising slowly. As weight loss is achieved, physical activities will gradually become easier.

  •   Walk for 5-10 minute after every few hours.
  •   Start brisk walk after 1 week & increase to 30 min/day after 1 week and then maintain it. This will help to reduce risk of deep vein thrombosis (DVT). Contact to doctor if you develops severe chest pain, sudden onset of shortness of breath or persistent pain in your calf.
  •   Do incentive spirometries exercise for 5 min very 2 hourly for next 1 month. Start this exercise 15 minute after drinking liquids, and then do coughing exercise. Fluids help to liquefy secretions in your lungs.
  •   Driving can be started 15 days after surgery.
  •   Avoid strenuous exercise (weight lifting) for 1 month after surgery.

Contraceptive & Pregnancy
  •   The period between surgery and weight stabilisation is considered as a period of starvation, its usually between 12-18 month. It is not advisable to become pregnant during period.

Regular check-up & long term follow-up
  •   In most cases the surgery is a tool to limit what happens internally but you are still in control of what you put into your mouth. If you have previously attended a slimming club for 6 months or more and lost more than 10kg doing so, you are probably more likely to do well with surgery than if you haven't.
  •   Your weight loss surgeon will advise you weight loss surgery on the timing and frequency of necessary follow-up visits as part of their post-operative care program. Follow-up will be unique to your individual procedure and circumstances.

OBESITY AWARENESS

Tell people that biology and the environment cause obesity and they are offered the one thing we have to avoid: an excuse. As it is, people who see more fat people around them may themselves be more likely to gain weight.


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Shalby Hospitals,
Opposite Karnavati Club,
SG Road, Ahmedabad-380015,
Gujarat, India.

+91 88660 20505

contact@dravinashtank.in



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