Florine Roche
Daijiworld Media Network - Mangalore
Mangalore, Jul 9: What do famous personalities like Diego Maradona, Nitin Gadkari, Adnan Sami, Ashok Kheni and singer S P Balasubrahmaniam have in common? They all were extremely obese and suffered from many obesity related diseases not long ago. However, they underwent bariatric surgery to improve their health by losing weight and are enjoying a new phase of life.
Given a chance to be thin or obese most people would choose the former because obesity is more than a matter of appearance. Obesity, which is now considered as a disease like any other in US and many Eurpoean countries, has devastating effects on the physical and emotional health of people suffering from it. Apart from excess weight these people also suffer from obesity related diseases like diabetes, blood pressure, joint pain, restricted mobility etc. For most obese people it is a lifelong ‘battle’ because they have to be constantly at war with their bodies – a battle they often find difficult to sustain.
But now there is a hope for obese people to lose weight in the form of Bariatric Surgery also known as weight loss surgery. Until recently people from the coastal districts of Karnataka who wanted to consult or undergo this surgery had to go to Bangalore or other bigger cities as Mangalore did not have this facility. But now Bariatric surgeries are performed in Mangalore and people need not go in search of far off places to undergo this surgery.
Dr N Devidas Shetty who has been conducting laproscopic surgeries in Mangalore since the last 15 years, has undergone training in Bariatric and other advanced laproscopic surgery in AIIMS and offers his services in Mangalore. He is the first and only laproscopic surgeon in Mangalore who is trained in bariatric surgery.
Dr Devidas Shetty graduated from Karnataka Medical College, Hubli in 1984 and completed his masters from Mysore Medical College in 1989. He went abroad in 1994 and completed his FRCS in 1997. He worked in various hospitals all over England till his return to India in 2000.
In a free-wheeling chat with daijiworld.com he delineates what bariatric surgery is all about dispelling many misgivings and doubts in the process.
Q. Since there is not much awareness about bariatric surgery will you explain what this procedure is?
A. It is a surgery conducted on people with extreme and excessive obesity to help them lose weight especially when diet and exercise fail to have any impact. Since overeating is the primary cause of obesity in 80% patients this surgery helps restrict the food intake and decrease absorption of food in the stomach and intestines. This reduction in the amount of nutrients and calories absorbed results in patients losing weight and reduce the health hazards of obesity-related diseases.
Q. Why Bariatric surgery is called weight loss surgery?
A. We have to understand that bariatric surgery is done on those suffering from obesity and have failed to lose weight through diet, exercise or other aggressive medical weight loss programmes. Since weight loss is guaranteed in bariatric surgery over a period of time, it is also called weight loss surgery.
Q. There is a feeling that Bariatric surgery is a magic wand to lose weight?
A. It is in fact a misconception because those who treat it as an easy way out fail to realize that it is a disease like any other diseases and needs treatment. In fact surgery is only a tool for the patients to lose weight and not a solution. It involves lifestyle adjustments like behavioral change, diet and physical activity to sustain the benefits accrued by the surgery.
Q. Are there any other benefits of bariatric surgery other than weight loss?
A. This surgery is recognized as the best approach for obese people to lose weight and also surmount many other diseases that accompany obesity like Type II Diabetes, Sleep Apnea, high blood pressure, Joint pains and many such diseases associated with morbid obesity.
Q. Do all obese people qualify for bariatric surgery?
A. There are certain criteria which a patient should meet in order to qualify for bariatric and therefore not all obese people become eligible for bariatric surgery. We determine the patient’s eligibility by taking into consideration the body mass index (BMI) rather than using total weight as a consideration.
So a patient who has failed to reduce weight in an earlier attempt through medically supervised programme or a patient with a BMI greater than 40 or between 35 and 40 with major obesity related health problems are candidates for bariatric surgery.
Q. Is there an upper or lower age limit for patients willing to undergo this surgery?
A. Anybody in the age group of 14 to 65 is eligible to undergo this surgery with a BMI above 40 or BMI of 35 to 40 with obesity related problems. However, women who go through the surgery should postpone their pregnancy for a period of 18 months after the surgery.
Q. Is weight loss surgery the best option for all obese patients?
A. No. It is not a solution for all patients. We try to determine whether a patient qualifies for the surgery after a thorough evaluation and discussion with the patient. This is important because it is life-altering procedure and we want to make sure the patient is committed to modify his lifestyle and lead a better life after the surgery.
Q. Since this surgery is a serious life-altering procedure as you already mentioned, what are the risks involved?
A. All major surgeries come with an element of risk and these risks may differ from patient to patient. Though there are not many risks common complications some patients may experience excessive bleeding, infection etc. Since risks differ, it is better to know individual risk levels from your surgeon before undergoing the surgery.
Q. What is the amount of weight loss a patient may experience after the surgery and how fast the patient can expect the benefits.
A. Bariatric surgery results in a 40 to 50% excess weight loss within a year depending on the kind of procedure chosen by the patient. Patients who opt for adjustable gastric banding procedure usually lose weight faster than those opting for gastric bypass or sleeve gastrectomy procedure. Usually the weight loss after the surgery is about 60 to 70% over a period of three years. But the result depends on the kind of diet and regimen the patient follows and the lifestyle modifications he or she adheres to.
Q. What are the different procedures a patient can choose from?
A. There are three most commonly performed bariatrict surgeries: a. adjustable gastric banding, a malabsorption procedure b) Laproscopic Sleeve Gastrectomy or restrictive procedure to reduce intake of food and c) Surgery to restrict both food intake and facilitate mal-absorption.
Q. What is the process involved in gastric band procedure?
A. This is a restrictive procedure wherein a small pouch or belt is placed around the upper part of the stomach. Inside the belt is a balloon that can be filled which will restrict the intake of food. Since the balloon is filled it slows the passage of food from upper pouch to lower pouch. When the band gets filled patient feels full even with smaller amount of food. Here the patients need to be monitored for iron, calcium and vitamin D deficiency.
Q. What is the advantage of this procedure and risks if any?
A. In this procedure there is minimal stress on the body as the operation is done laproscopically and recovery is also quick. People can resume work within a week of the surgery. It does not involve cutting the stomach or rerouting the intestines. But weight loss in this procedure is slow and steady.
There may be leakage which can be corrected and there is a possibility of adjusting the band depending on the needs and weight loss goals of the patient.
Q. What is Sleeve Gastrectomy and how is it performed?
A. In Laproscopic Sleeve Gastrectomy (LSG) a portion of the patient’s stomach is cut and stapled so that the patient has a smaller stomach with reduced capacity. In this procedure about 75% of the stomach is removed leaving only a narrow gastric sleeve and hence the name. Here no intestines are removed or bypassed and there is no change in the anatomy of the patient. Complications are less in this surgery. There is no danger of decreased absorption of nutrients. In this surgery there will be significant weight loss and improvements in obesity related disorders like diabetes, sleep apnea, depression and joint pains.
The third type of surgery i.e. mal-absorption and restriction (which is not available in India) is an excellent procedure for patients suffering from uncontrolled diabetes with an addiction to sweets.
Q. What is the risk factor in this LSG procedure?
A. The risk in this is less than the risk associated with gastric bypass. The risk is in the form of leak from the sleeve which can cause infection or abscess. Correcting it may require another surgery or endoscopic intervention.
Q. How long the patient need to be hospitalized for the surgery?
A. It depends on the type of surgery the patient opts for. Patients are encouraged to be mobile within 5 to 6 hours of surgery to prevent clotting of the leg veins. Patients can be mobile within a day of the surgery and are usually discharged on the 2nd or 3rd day.
Q. How soon can the patients resume normal activities after the surgery?
A. After gastric banding surgery patient can return to normal working in a week’s time. In sleeve gastrectomy patient requires two to four weeks of time to recover.
Q. How long a patient has to be under physician’s supervision after the surgery?
A. A patient has to visit his surgeon within a week following the surgery. After that follow up is for lifetime starting from visiting to the surgeon a month after the surgery. Finally a yearly visit thereafter is a must.
Q. Is physical exercise a must after bariatric surgery?
A. Success after bariatric surgery involves healthier lifestyle transformation. Therefore, regular exercise and lifestyle modifications are extremely important for maintaining the weight loss effected after the surgery.