| Obesity | | | | two nights in the intensive care unit for close |
| Obesity is a major health problem approaching an | | | | monitoring of their cardiopulmonary status |
| epidemic proportions. An NIH consensus conference | | | | Complications from bariatric surgery: |
| on the surgical treatment of obesity recommended | | | | The risk of formation of gallstones. |
| consideration of surgery in patients with a BMI of | | | | Inflammatory hepatitis. |
| greater than 40 kg/m2 without medical complications | | | | Occult cirrhosis |
| or a BMI of greater than 35 kg/m2 if severe co | | | | Dumping Syndrome, (stomach contents move too |
| morbidity were present. Obesity accelerates the | | | | rapidly through the small intestine includes nausea, |
| progression of coronary arteriosclerosis in young men | | | | weakness, sweating, faintness, and sometimes |
| (age range 15 to 34 yr). Obesity increases the risk of | | | | diarrhea after eating) |
| developing: | | | | Constipation / Diarrhea |
| Hypertension, | | | | Vitamin B12 Deficiency |
| Hyperlipidemia, | | | | Nutritional deficiencies |
| Type 2 diabetes, | | | | Anemia (due to reduced absorption of Iron in the |
| Coronary artery disease, | | | | stomach) |
| Cerebrovascular disease, | | | | Metabolic bone disease (due to less calcium |
| Osteoarthritis, | | | | absorption in the small intestine) |
| Sleep apnea, | | | | Abdominal Pain |
| Endometrial, breast, Prostate, and colon Cancers. | | | | Vomiting |
| Severe obesity is a chronic condition that is difficult | | | | Incisional Hernia / Abdominal Hernia |
| to treat through diet and exercise alone. | | | | Bleeding (including splenic injury) |
| Gastrointestinal surgery for obesity, also called | | | | Gastrointestinal leaks(inadvertent injury to the GI |
| Bariatric surgery, is an option for persons who are | | | | tract) |
| severely obese and cannot lose weight by traditional | | | | Wearing away of the band and breakdown of the |
| means or who suffer from serious obesity-related | | | | staple line. |
| health problems. | | | | In very less cases post operative infection or death |
| Bariatric surgery | | | | from complications may occur. |
| Bariatric is derived from the Greek term bars, | | | | REVISION OPERATIONS |
| meaning weight. Bariatric surgery creates an anatomic | | | | Early technical complications and inadequate weight |
| barrier preventing over-consumption and accumulation | | | | loss, well-known sequelae of this procedure, |
| of excess calories either by restricting the gastric | | | | necessitated reoperation . The incidence of major |
| reservoir or by inducing malabsorption. Bariatric | | | | postoperative complications following revisional |
| surgery alters the digestive process and is classified | | | | bariatric procedures is substantially higher compared |
| into two categories: | | | | to primary operations. |
| Restrictive | | | | Patients who have gastric bypass occasionally require |
| Malabsorptive. | | | | revision, either for inadequate weight loss or for |
| Nearly all morbidly obese patients with satisfactory | | | | complications. The incidence of major postoperative |
| postoperative weight loss, experience substantial | | | | complications following revision Bariatric procedures is |
| improvement in the quality of their lives. At present, | | | | substantially higher compared to primary operations. |
| Roux en Y Gastric Bypass (RYGB) may be the only | | | | Early morbidity rates range from 15% to 50%. The |
| Bariatric operation that has produced durable | | | | mortality rate reported after revision operations |
| long-term weight loss at an acceptable level of risk. | | | | ranges as high as 10%, undoing any Bariatric |
| Indications: | | | | operation without conversion to another |
| Body mass index (BMI) above 40 | | | | weight-reduction procedure is invariably associated |
| Significant obesity comorbidity (e.g., hypertension, | | | | with the patient's promptly regaining the lost weight. |
| diabetes, sleep apnea, pickwickian syndrome, | | | | Indications for reoperation includes |
| incapacitating osteoarthritis) | | | | Dilated gastrojejunal anastomosis |
| Obesity-related physical problems that interfere with | | | | Inadequate weight loss without demonstrable |
| employment, walking, or family function may be a | | | | enlargement of the anastomosis |
| candidate. | | | | Staple line breakdown |
| Procedure of Bariatric Surgery: | | | | Anastomotic obstruction |
| 1.Restrictive procedures | | | | Anastomotic leak |
| Promote weight loss by closing off parts of the | | | | Enlarged proximal gastric pouch . |
| stomach to make it smaller, thus restricting the | | | | Reoperation consisted of : |
| amount of food the stomach can hold. Restrictive | | | | Completely redoing the initial RGB |
| procedures do not interfere with the normal digestive | | | | Redoing the anastomosis alone |
| process. | | | | Staple line revision |
| As a result of this surgery, most persons lose the | | | | Intraoperative dilatation of the anastomosis |
| ability to eat large amounts of food at one time. | | | | . |
| After an operation, the person usually can eat only | | | | Intractable marginal ulcer |
| ¾ to 1 cup of food without discomfort or | | | | Major postoperative complications are: |
| nausea. Also, food has to be well chewed. | | | | RGB failure |
| Restrictive operations for obesity include the | | | | RGB revision for early technical failure |
| following: | | | | Inadequate weight loss is associated with a high |
| Adjustable gastric banding | | | | incidence of major complicationssubsequently, |
| Vertical banded gastroplasty | | | | negligible weight loss. |
| Both the methods are used to create a small | | | | Intractable marginal ulcer. |
| stomach pouch. | | | | Severe metabolic complications |
| 2. Malabsorptive Procedure | | | | Therefore repair of RGB for technical failure or |
| The most common gastrointestinal surgeries for | | | | complications is not recommended. |
| weight loss, combine stomach restriction with a partial | | | | Gastric bypass patients with anatomically intact |
| bypass of the small intestine. A direct connection | | | | operations and unsatisfactory weight loss have |
| from the stomach to the lower segment of the small | | | | probably "outeaten" the operation.Gastric |
| intestine is created, bypassing portions of the | | | | bypass patients with unsatisfactory weight loss are |
| digestive tract that absorb calories and nutrients. | | | | best converted to a more malabsorptive modification |
| Biliopancreatic diversion (BPD): | | | | of Roux-en-Y gastric bypass, or in some cases |
| In this more complicated malabsorptive operation, | | | | biliopancreatic diversion. Unfortunately, some patients |
| portions of the stomach are removed. The small | | | | who are converted to a malabsorptive procedure |
| pouch that remains is connected directly to the final | | | | suffer severe metabolic complications. |
| segment of the small intestine, completely bypassing | | | | The more extensive the bypass, the greater the risk |
| the duodenum and the jejunum. Although this | | | | for complications and nutritional deficiencies. Persons |
| procedure successfully promotes weight loss, it is | | | | with extensive bypasses of the normal digestive |
| used less frequently than other types of surgery | | | | process require close monitoring and life-long use of |
| because of the high risk for nutritional deficiencies. A | | | | special foods, supplements, and medications |
| variation of BPD includes a "duodenal | | | | Why to undergo gastric bypass surgery in India |
| switch," which leaves a larger portion of the | | | | Revision Gastric bypass surgery in India has seen a |
| stomach intact, including the pyloric valve that | | | | phenomenal growth during recent past. Most patients |
| regulates the release of stomach contents into the | | | | from countries like USA and UK travel to India for |
| small intestine. It also keeps a small part of the | | | | treatment. |
| duodenum in the digestive pathway. | | | | Few main reasons: |
| Roux-en-Y gastric bypass | | | | India offers wide range of cheapest pricing options |
| Roux-en-Y gastric bypass (RGB) is an accepted | | | | of treatment. |
| operation for the control of body weight in morbidly | | | | While planning a treatment in India, one does not |
| obese patients. This operation is the most common | | | | require waiting in patient queues or registering for a |
| and successful malabsorptive surgery. First, a small | | | | waiting list. |
| stomach pouch is created to restrict food intake. | | | | Moreover the doctors and the medical facilities in |
| Next, a Y-shaped section of the small intestine is | | | | India are comparable to the best in the world. |
| attached to the pouch to allow food to bypass the | | | | Another main reason for choosing India for revision |
| lower stomach, the duodenum, and the first portion | | | | gastric bypass surgery is comfort of communication; |
| of the jejunum. This bypass reduces the amount of | | | | one does not face a problem as most people speak |
| calories and nutrients the body absorbs | | | | English. |
| Operative Consideration : | | | | Above all, India always offers a good holiday, which |
| Severely obese patients tolerate general anesthesia | | | | can help in fast health recovery. Another important |
| remarkably well. However, Endotracheal intubation | | | | reason why more and more people from overseas |
| may be difficult. | | | | are considering India for health treatments is the |
| Patients may require admission to the intensive care | | | | advancement and the medical and technical |
| unit postoperatively. | | | | superiority of the medical fraternity in India. Hence |
| Patients with sleep apnea, congestive heart failure, | | | | India is the most ideal destination for Medical tourism. |
| and severe asthmatic bronchitis should spend one or | | | | |