Weight loss surgery, also known as bariatric surgery in medical terminology, refers to a group of gastrointestinal surgical procedures carried out on patients suffering from chronic morbid obesity (i.e., at least 100 lbs overweight, or a body mass index, BMI, of 40 or greater, for more than 5 years). It is used to facilitate weight loss and avoid the risk to life-threatening diseases associated with morbid obesity, such as type II diabetes, heart disease, sleep apnea, degenerative arthritis, etc.

Weight loss surgery is normally resorted to as a last measure when an all other conventional weight loss methods, such as diet control, exercise and weight loss medications, have failed in treating the person for morbid obesity. It may be pointed out that weight loss surgery is distinct from liposuction in that the latter is more of a cosmetic procedure rather than a medical procedure.

What does weight loss surgery involve?

According to The American Society for Bariatric Surgery, there are basically two approaches to weight loss surgery:

1. Restrictive procedures, which help reduce the capacity for food intake in a single meal but do not interfere with the normal absorption (digestion) of food.

2. Malabsorptive procedures, which help reduce absorption of calories from food by altering the process of digestion.

Restrictive procedures are mainly of two types:

1. Lap band surgery, which involves placing laproscopically a silicone gastric band around the top of the stomach in order to create a very small stomach pouch. As a result, the person starts feeling full with just a small portion of food. Food will then slowly empty from the smaller pouch into the lower part of the stomach and into the rest of the digestive tract.

2. Gastric bypass surgery, which involves stapling of the smaller, upper part of the stomach to separate it from the rest of the stomach and rerouting the small intestine to connect it to the smaller stomach pouch.

Lap band surgery is a relatively simple and less risky procedure compared to gastric bypass surgery. It requires just 1 to 3 days of hospital stay as opposed to 5 to 8 days in the latter case. Moreover, there is no malabsorption of vitamins and minerals after lap band surgery, which is not always the case with gastric bypass surgery. However, the expected weight loss over a period of 18 months is lesser (50 to 60% of the excess weight) compared to gastric bypass surgery (70 to75%). Both the procedures are reversible, but lap band surgery is much more easily reversible.

There is a third type of restrictive procedure too, called sleeve gastrectomy, that is less commonly used. In this the surgeon removes approximately 60% of the stomach laparoscopically so that the stomach takes the shape of a tube or “sleeve”.

Malabsorptive procedures are rarely used these days due to the problems of malnutrition and nutritional deficiencies caused by them.

Any risks?

In addition to general risks associated with any kind of major surgery, weight loss surgery can pose its own complications. Discomforting symptoms such as nausea, vomiting, weakness, hernia, gallstones and nutritional deficiencies can crop up after weight loss surgery.

Is it for you?

Though the ultimate answer to the question whether you qualify as a candidate for weight loss surgery or not rests entirely with your bariatric surgeon, here are some pointers that can help you in your decision-making process. If you have been more than 100 lbs overweight for more than 5 years, if your body has failed to respond to the conventional weight loss methods, and if you are not suffering from any major disorder that makes surgery difficult, you can seriously consider weight loss surgery as a feasible option. Consult your doctor for detailed information in order to weigh the risks against benefits of weight loss surgery.

Finally, remember that even if you keep realistic goals in mind, the real success of weight loss surgery is strongly dependent on your making long-term changes in your diet and lifestyle.

On Successful completion of 2-Years of Surgical Weight Loss technique , Department of Gastroenterology , SPS Apollo Hospitals, Ludhiana has launched “Weight Loss Support Group” also called “Bariartic Support Group” involving Doctors, Anesthetists, Psychologists, Dieticians, Physiotherapists, Bariartic Nurses and most importantly Post-Operative patients to discuss issues, share successes and trade helpful hints with one another as well as with those considering surgery..Having weight loss surgery does not by itself guarantee successful weight loss said Dr. Arindam Ghosh, noted Laparoscopic Surgeon  - surgery is only one of many tools that will help you achieve your goals. Key factors to success include: following the diet, exercise, proper use of nutritional supplements, and the ongoing support of those who share this experience with you. We have launched this support group to  provide a sense of community, and provide information and encouragement during this life-altering time.
We require people to attend our support group prior to having the surgery so that that can get the perspective of those who have gone before you. We encourage you to come to the support groups prepared to ask questions.

According to Dr. Rajan Damathia, Consultant General Surgeon, Ludhiana is now being considered one of the emerging Weight Loss Surgery destinations in India. Many patients are  put off by the high prices in Europe and the US and are traveling to India to get the same treatment at vastly reduced cost of 60% or more. The slogan thus is, “First World treatment’ at Third World prices” In addition to the cost savings the benefits of this surgery  are huge;  immediately following surgery, most patients lose weight rapidly and continue to do so until 18 to 24 months after the procedure.
Weight reduction surgery has been reported to improve many conditions including sleep apnea, diabetes, high blood pressure, and high cholesterol. In one study, the blood sugar levels of most obese patients with diabetes returned to normal after surgery. According to Dr. Ghosh, For an experience surgeon to perform the operation will cost at least $17,000 upwards to $30,000 to get the operation carried out in the US.But lots of people are getting their surgery done in India for much cheaper. Ludhiana will start giving competition to facilities elsewhere in the country by being even more economical. According to Dr. S.P. Singh , COO, “We have offered an all-inclusive deal in Ludhiana for fraction of an amount as compared to the USA or else where in India. The price normally will include pick-up at the airport, hospital,  physician fees, and pre-op workup etc So, all that is needed is to add the cost of a flight” he adds “In our hospital, once the door is closed you could be in a hospital in America.

STATISTICAL ASPECT

Obesity is emerging as a health epidemic around the world. According to the Centers for Disease Control and Prevention, obesity is rapidly spreading across all regions and demographic groups. An estimated 97 million adults in the United States  are overweight or obese. That figure represents more than 50% of the American adult population. Of this group, 11 million adults suffer from severe obesity. In India 3% (>3 Crore) of Indians are obese and almost 1% suffer from severe obesity,  of these 17 per cent of men and 15 per cent women  are obese and the numbers are growing by leaps with changing lifestyles and eating habits. The Obese individuals have a 50-100% increased risk of death as compared to normal weight individuals, This substantial increase in health risks has made obesity the second leading cause of preventable death in the USA, Canada and other European countries .

Recently Mr. Jaswinder Gill , a 53 year male from Tronto, underwent a successful stomach bypass surgery . His weight was 175 Kgms and BMI 57. The operation will reduce his extra weight by 80% in 1 Year and afterwards he is going to maintain his slim body for life. The operation was performed by Dr. Arindam Ghosh, Dr. Rajan Damathia and their team.

Dr. Arindam Ghosh-+ 91 92 16830032, + 91 92 9814117997

Obesity

Obesity is a major health problem approaching an epidemic proportions. An NIH consensus conference on the surgical treatment of obesity recommended consideration of surgery in patients with a BMI of greater than 40 kg/m2 without medical complications or a BMI of greater than 35 kg/m2 if severe co morbidity were present. Obesity accelerates the progression of coronary arteriosclerosis in young men (age range 15 to 34 yr). Obesity increases the risk of developing:

Hypertension,

Hyperlipidemia,

Type 2 diabetes,

Coronary artery disease,

Cerebrovascular disease,

Osteoarthritis,

Sleep apnea,

Endometrial, breast, Prostate, and colon Cancers.

Severe obesity is a chronic condition that is difficult to treat through diet and exercise alone. Gastrointestinal surgery for obesity, also called Bariatric surgery, is an option for persons who are severely obese and cannot lose weight by traditional means or who suffer from serious obesity-related health problems.

Bariatric surgery

Bariatric is derived from the Greek term bars, meaning weight. Bariatric surgery creates an anatomic barrier preventing over-consumption and accumulation of excess calories either by restricting the gastric reservoir or by inducing malabsorption. Bariatric surgery alters the digestive process and is classified into two categories:

Restrictive

Malabsorptive.

Nearly all morbidly obese patients with satisfactory postoperative weight loss, experience substantial improvement in the quality of their lives. At present, Roux en Y Gastric Bypass (RYGB) may be the only Bariatric operation that has produced durable long-term weight loss at an acceptable level of risk.

Indications:

Body mass index (BMI) above 40

Significant obesity comorbidity (e.g., hypertension, diabetes, sleep apnea, pickwickian syndrome, incapacitating osteoarthritis)

Obesity-related physical problems that interfere with employment, walking, or family function may be a candidate.

Procedure of Bariatric Surgery:

1.Restrictive procedures

Promote weight loss by closing off parts of the stomach to make it smaller, thus restricting the amount of food the stomach can hold. Restrictive procedures do not interfere with the normal digestive process.

As a result of this surgery, most persons lose the ability to eat large amounts of food at one time. After an operation, the person usually can eat only ¾ to 1 cup of food without discomfort or nausea. Also, food has to be well chewed.

Restrictive operations for obesity include the following:

Adjustable gastric banding

Vertical banded gastroplasty

Both the methods are used to create a small stomach pouch.

2. Malabsorptive Procedure

The most common gastrointestinal surgeries for weight loss, combine stomach restriction with a partial bypass of the small intestine. A direct connection from the stomach to the lower segment of the small intestine is created, bypassing portions of the digestive tract that absorb calories and nutrients.

Biliopancreatic diversion (BPD):

In this more complicated malabsorptive operation, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. Although this procedure successfully promotes weight loss, it is used less frequently than other types of surgery because of the high risk for nutritional deficiencies. A variation of BPD includes a “duodenal switch,” which leaves a larger portion of the stomach intact, including the pyloric valve that regulates the release of stomach contents into the small intestine. It also keeps a small part of the duodenum in the digestive pathway.

Roux-en-Y gastric bypass

Roux-en-Y gastric bypass (RGB) is an accepted operation for the control of body weight in morbidly obese patients. This operation is the most common and successful malabsorptive surgery. First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum, and the first portion of the jejunum. This bypass reduces the amount of calories and nutrients the body absorbs

Operative Consideration :

Severely obese patients tolerate general anesthesia remarkably well. However, Endotracheal intubation may be difficult.

Patients may require admission to the intensive care unit postoperatively.

Patients with sleep apnea, congestive heart failure, and severe asthmatic bronchitis should spend one or two nights in the intensive care unit for close monitoring of their cardiopulmonary status

Complications from bariatric surgery:

The risk of formation of gallstones.

Inflammatory hepatitis.

Occult cirrhosis

Dumping Syndrome, (stomach contents move too rapidly through the small intestine includes nausea, weakness, sweating, faintness, and sometimes diarrhea after eating)

Constipation / Diarrhea

Vitamin B12 Deficiency

Nutritional deficiencies

Anemia (due to reduced absorption of Iron in the stomach)

Metabolic bone disease (due to less calcium absorption in the small intestine)

Abdominal Pain

Vomiting

Incisional Hernia / Abdominal Hernia

Bleeding (including splenic injury)

Gastrointestinal leaks(inadvertent injury to the GI tract)

Wearing away of the band and breakdown of the staple line.

In very less cases post operative infection or death from complications may occur.

REVISION OPERATIONS

Early technical complications and inadequate weight loss, well-known sequelae of this procedure, necessitated reoperation . The incidence of major postoperative complications following revisional bariatric procedures is substantially higher compared to primary operations.

Patients who have gastric bypass occasionally require revision, either for inadequate weight loss or for complications. The incidence of major postoperative complications following revision Bariatric procedures is substantially higher compared to primary operations. Early morbidity rates range from 15% to 50%. The mortality rate reported after revision operations ranges as high as 10%, undoing any Bariatric operation without conversion to another weight-reduction procedure is invariably associated with the patient’s promptly regaining the lost weight.

Indications for reoperation includes

Dilated gastrojejunal anastomosis

Inadequate weight loss without demonstrable enlargement of the anastomosis

Staple line breakdown

Anastomotic obstruction

Anastomotic leak

Enlarged proximal gastric pouch .

Reoperation consisted of :

Completely redoing the initial RGB

Redoing the anastomosis alone

Staple line revision

Intraoperative dilatation of the anastomosis

.

Intractable marginal ulcer

Major postoperative complications are:

RGB failure

RGB revision for early technical failure

Inadequate weight loss is associated with a high incidence of major complications

subsequently, negligible weight loss.

Intractable marginal ulcer.

Severe metabolic complications

Therefore repair of RGB for technical failure or complications is not recommended.

Gastric bypass patients with anatomically intact operations and unsatisfactory weight loss have probably “outeaten” the operation.Gastric bypass patients with unsatisfactory weight loss are best converted to a more malabsorptive modification of Roux-en-Y gastric bypass, or in some cases biliopancreatic diversion. Unfortunately, some patients who are converted to a malabsorptive procedure suffer severe metabolic complications.

The more extensive the bypass, the greater the risk for complications and nutritional deficiencies. Persons with extensive bypasses of the normal digestive process require close monitoring and life-long use of special foods, supplements, and medications

Why to undergo gastric bypass surgery in India

Revision Gastric bypass surgery in India has seen a phenomenal growth during recent past. Most patients from countries like USA and UK travel to India for treatment.

Few main reasons:

India offers wide range of cheapest pricing options of treatment.

While planning a treatment in India, one does not require waiting in patient queues or registering for a waiting list.

Moreover the doctors and the medical facilities in India are comparable to the best in the world.

Another main reason for choosing India for revision gastric bypass surgery is comfort of communication; one does not face a problem as most people speak English.

Above all, India always offers a good holiday, which can help in fast health recovery. Another important reason why more and more people from overseas are considering India for health treatments is the advancement and the medical and technical superiority of the medical fraternity in India. Hence India is the most ideal destination for Medical tourism.

Benefits, Risks and Costs of Gastric Bypass Surgery in India.

What is Gastric Bypass Surgery?

Gastric bypass operations combine the creation of a small stomach pouch to restrict food intake and construction of bypasses of the duodenum and other segments of the small intestine to cause malabsorption (decreased ability to absorb nutrients from food).

 

Who is Gastric Bypass Surgery for?

Generally, gastric bypass surgery is reserved for people, who are unable to achieve or maintain a healthy weight through diet and exercise, are severely overweight, and who have health problems as a result. Gastric bypass may be considered if:

§                  Patient’s body mass index (BMI) is 40 or higher (extreme obesity).

§                  Patient’s BMI is 35 to 39.9 (obesity), and patient have serious weight-related health problems such as diabetes, high blood pressure, sleep apnea and hyper-cholestreamia.

Gastric bypass surgery doesn’t replace the need for following a healthy diet and regular physical activity program. In fact, the success of the surgery depends in part on patient’s commitment to following the guidelines given to patient about diet and exercise. As one considers weight-loss surgery, make sure that you make every effort to exercise , change patient’s eating habits and adjust any other lifestyle factors that have contributed to patient’s excess weight.

How is Gastric Bypass Surgery done?

In gastric bypass the surgeon creates a small pouch at the top of patient’s stomach and adds a bypass around a segment of small intestine.

The surgeon staples patient’s stomach across the top, sealing it off from the rest of stomach. The resulting pouch is about the size of a walnut and can hold about an ounce of food. The pouch is physically separated from the rest of the stomach. Then, the surgeon cuts the small intestine and sews part of it directly onto the pouch. This redirects the food, bypassing most of patient’s stomach and the first section of small intestine, the duodenum. Food enters directly into the second section of small intestine, the jejunum, limiting patient’s ability to absorb calories. Even though food never enters the lower part of patient’s stomach, the stomach stays healthy and continues to secrete digestive juices to mix with food in patient’s small intestine.

Some surgeons perform this operation by using a laparoscope — a small, tubular instrument with a camera attached — through short incisions in the abdomen (laparoscopic gastric bypass). The tiny camera on the tip of the scope allows the surgeon to see inside patient’s abdomen.

What are the benefits of Gastric Bypass Surgery?

In addition to dramatic weight loss, gastric bypass surgery may improve or resolve the following conditions associated with obesity:

§                  Type 2 diabetes

§                  High blood cholesterol

§                  High blood pressure

§                  Obstructive sleep apnea

§                  Gastroesophageal reflux disease (GERD)

The improvements observed in type 2 diabetes, high blood pressure and high blood cholesterol may significantly decrease the risk of cardiovascular events in individuals who have undergone gastric bypass surgery compared with those treated through other means. Gastric bypass surgery has also shown to improve mobility and quality of life for people who are severely overweight.

Risks Associated With Gastric Bypass Surgery:

. People who undergo this procedure are at risk for:

• Pouch stretching (stomach gets bigger overtime, stretching back to its normal size before surgery).
• Band erosion (the band closing off part of the stomach disintegrates).
• Breakdown of staple lines (band and staples fall apart, reversing procedure).
• Nutritional deficiencies causing health problems.

Cost for Gastric Bypass Surgery:

Gastric bypass surgery is one very popular form of Obesity surgery which putting things simply causes weight loss by making the stomach smaller. The cost of gastric bypass surgery is not cheap by any means. For an experience surgeon to perform the operation will cost at least $25,000 upwards to $35,000 to get the operation carried out in the US.

But lots of people are getting their surgery done in India for much cheaper. For example, a patient can get an all-inclusive deal in India for quarter of an amount as compared to the USA. Indian hospitals have very well trained surgeons, as good as the US surgeons if not better. The price normally includes pick-up at the airport, hospital, band, physician fees, and pre-op workup. So, all that is needed is to add the cost of a flight.

How Well It Works

Most people who have gastric bypass surgery quickly begin to lose weight and continue to lose weight for up to 12 months. Most patients loose about 75% of the excess weight within the first year itself.

 Why go to India for Gastric Bypass Surgery?

Gastric bypass surgery in India has seen a phenomenal growth during recent past. Most patients from countries like USA and UK travel to developing countries such as India for treatment, few main reasons; India offers wide range of cheapest pricing options of treatment. While planning a treatment in India, one does not require waiting in patient queues or registering for a waiting list. Moreover the doctors and the medical facilities are comparable to anyone in the world. Another main reason for choosing India is comfort of language; one does not pose a problem as most people speak English.  Above all India always offers a good holiday, which can help in fast recoveries. Here are few more reasons why more and more people from overseas are considering India for health treatments such as The Growth of Obesity Surgery in India which shows that now medical tourism is behind the growth of cosmetic surgery in India. Medical tourism is where residents of one country in order to reduce the costs of their medical treatment at home, goes for a cheaper alternative treatments abroad (and take a free holiday with the savings) and one of such countries offering these alternative is India.
India combines world-class healthcare with prices costing a fraction of those in the US or Europe.

To know more about affordable and low cost gastric bypass surgery in India-please visit the Website => www.forurhealthcare.com

As the famous song says, “Oklahoma is OK!” — and for us residents of the state, that’s the honest truth. From the farmlands to the ranches, from the Panhandle to the Arkansas border, “the land we belong to” is indeed grand. But another truth exists: the truth about obesity in Oklahoma. Almost 63% of the population of Oklahoma is overweight, with one in four Oklahomans (25%) qualifying as obese. That’s one out of every four of us! Oklahoma City is particularly plagued by obesity – our state capital was even named one of the most unfit cities n the nation by a major magazine only a couple of years ago.

Obesity is no joke. It kills people, and the ones it doesn’t kill right away usual suffer from co-morbidities, which are serious medical conditions directly related to obesity, such as heart disease, sleep apnea, diabetes, and hypertension.

We can’t afford to ignore this threat to our public health any longer. Oklahoma must act against obesity.

Booming Sooners

What is obesity? It is the condition of exceeding a medically healthy weight, based on a person’s height and build. Healthy weight is calculated in terms of individual body mass index, or BMI (weight in pounds x 703 / [height in inches]2). The only way to a better BMI is to lose excess weight. And that’s not hard: simply reduce the body’s daily caloric intake below its daily caloric needs. For some of us, just pushing back the plate, or switching to unsweetened iced tea instead of soda, is all that’s necessary.

But willpower alone isn’t the cure for obesity. Obesity is a disease that requires medical treatment that incorporates a complete change in the patient’s lifestyle and eating habits. This type of therapy will succeed in reducing BMI to a safe level in most people – but not all. For those beyond this form of care, there’s another option: weight loss surgery.

About Weight Loss Surgery

Weight loss surgery is not complicated. The patient is placed under sedation, then the surgeon performs a bariatric procedure—generally laparoscopically—to alter the stomach and/or bowel and limit how much food they can hold. These alterations force the patient to consume fewer calories each day than his or her body burns, resulting in the loss of excess weight.

But surgery is not a magical cure. It only works as part of a total medical treatment plan. Post-operative patients who fail to follow the diet and lifestyle program prescribed to them may fail to lose weight or quickly regain any weight lost. In addition, there are significant risks associated with weight loss surgery, and patients should consult with their physician prior to making a decision.

The Battle Begins

Oklahoma’s war on obesity can end up OK if the farmer and the cowboy – and the rest of us – join forces to fight it. By treating this disease as a disease, we can make our state a happier, better, and more beautiful place to be.