Gold standard for weight loss surgery that involves restricting the size of the stomach by creation of very small stomach pouch and bypassing the remaining major part of the stomach and the upper part of small intestine (duodenum) where absorption of the nutrients and calories take place.
Q1. What is a bariatric surgery?
A1. Bariatric surgery is commonly referred to as Weight loss surgery or Obesity surgery. Those people who wish to shed significant amount of weight surgically, go for Bariatric surgery, provided they meet the criteria laid for right candidate for the bariatric surgery.
Q2. What happens in Roux-en-Y Gastric Bypass surgery?
A2. Roux-en-Y Gastric Bypass surgery, most commonly performed bariatric surgery, works on the principle of
1. Restriction of the size of the stomach so that the person feels satiated early with less intake of food and hence less calories consumption at a time.
2. Bypassing that part of the intestine where the absorption of nutrients and calories take place.
In order to achieve the above, the stomach is divided into two parts, upper small pouch of the size of the walnut that can hold only 30 ml of food and the lower remaining big part of the stomach which would be bypassed, in this surgery. The surgeon separates these two parts of stomach by putting surgical staples in between.
Similarly, the small intestine is also divided into two parts, the upper, duodenum which remains attached to the stomach like before and will be bypassed too and the Jejunum, lower part of the small intestine, which will now be attached directly to the upper small stomach pouch.
Your must be wondering where do the stomach acid and various digestive enzymes that are normally secreted, go! The larger remaining part of the stomach continues to make digestive juices and enzymes. However, the food does not pass through it.
The digestive juice with digestive enzymes is directed to the lower part of the intestine by reattaching the free end of the bypassed part of the intestine which is still connected to the remaining larger part of the stomach, to the lower part of the jejunum resulting in their mixing with the food eventually. This whole new arrangement of the intestine is in the shape of "Y" and hence the name of the surgery and “Roux” name has been taken after the name of the surgeon who invented this procedure.
Q3. What the the different ways in which Roux-en-Y Gastric Bypass Surgery can be carried out?
A3. Roux-en-Y surgery can be done either through Open surgery wherein 8 to 10 inches long incision is made in the middle of the abdomen. At times, Gall bladder is also removed during this surgery as the probability of Gall bladder stones becomes high when a significant amount of weight is lost in short time, say initial 4 to 6 months post surgery.
Other minimally invasive surgical approach is Laparoscopic Roux-en-Y Gastric Bypass Surgery, that involves, few (4 to 5) small key hole incisions in the abdomen through which specialized surgical instruments and an endoscope(laparoscope) is passed to view, access the surgical site and perform the surgery. Laparoscope has a tiny video camera at its end that helps in the projection of the images from inside onto the monitor.
Q4 What are the benefits of Roux-en-Y Gastric bypass surgery?
A4 Roux-en-Y Gastric Bypass Surgery has several benefits, such as
Long term considerable weight loss
Cause changes in the gut hormones resulting in decreased appetite and early satiety.
Maintenance of weight for a long period
Improvement in the health conditions such as Diabetes,High blood pressure post surgery
Q5.What does BMI mean?
A5 BMI means Body Mass Index. It is a valuable tool that measures body fat indirectly and screen obesity. It is calculated as the ratio of weight measured in Kgs and height in Metre squared. BMI is a scientific method that classifies the person as underweight, normal weight, overweight and obese depending upon its value. BMI is not a perfect body fat measurement indicator; it gives a rough estimate of body fat and tells you your ideal body weight for your height. Besides BMI, there are other body fat indicators such as waist circumference and thickness of the skin fold. BMI value may also come high in muscular people with low body fat.
Q6 On what principles does Bariatric Surgery work?
A6. Bariatric surgery works on the following principles:
• Restriction: The size of the stomach is considerably restricted so that it can hold a very small amount of food thereby leading to feeling of fullness and less consumption of calories.
• Malabsorption: The part of the intestine that absorbs the nutrients and calories is bypassed resulting in decreased calories and nutrients absorption.
Weight loss surgery works on either one of these principles or both of them combined.
Q7 What is Obesity?
A7. A highly complex health condition wherein the affected person has astronomically high amount of fat accumulation in his body making the person susceptible to health disorders such as coronary artery disease, high blood pressure, Diabetes, stroke and the list goes on. A person is considered an obese if his/her BMI is 30 Kg/m2 or more or we can simply put it as a person being 20% or more than his/her ideal body weight.
Q8. What are the health problems associated with obesity?
A8. The Obesity associated health problems are:
• Coronary Artery Disease
• High Cholesterol
• Type 2 Diabetes
• Cancer (Breast,Endometrial and Colon)
• GERD(Gastro-Oesophageal Reflux Disease)
• Hypertension(High blood pressure)
• Gall bladder stones(Cholelithiasis)
• Fatty Liver Disease
• Sleep Apnea
• Degenerative Joint Disease of weight bearing joint
• Urinary Stress Incontinence
Q9. What are the available options in the weight loss surgery?
A9. Bariatric Surgery is classified into two main types:
Restrictive procedures-reduce the size of the stomach thereby decreasing the amount of food it can hold. The person feels full quickly and ingests less food.
Malabsorptive procedures-The part of the small intestine that is responsible for the absorption of nutrients and calories is bypassed in these procedures. Food does not pass through it.
• Roux-en-Y Gastric Bypass Surgery-Restrictive and Malabsorptive surgery
• Gastric Sleeve surgery or VSG(Vertical Sleeve Gastrectomy)surgery- Restrictive surgery
• Mini Gastric Bypass Surgery- Restrictive and Malabsorptive surgery
• Laparoscopic Adjustable gastric banding-Restrictive
Q10 Who is the right candidate for Bariatric surgery?
A10. The conditions under which a person can be considered as a right candidate for undergoing bariatric or weight loss surgery are:
• BMI more than or equal to 40 Kg/m2 or gain of over 100 pounds of weight.
• BMI more than or equal to 35 Kg/m2 with at least two major obesity associated health problems such as Type 2 Diabetes, High blood pressure, High Cholesterol levels.
• Unable to lose excessive weight over long duration of time even after religiously following various weight loss measures such as sticking to strict diet plans, exercising hard and changing lifestyle for the better and is highly susceptible to obesity related health problems.
Behavioral changes and compliance with diet play a crucial role along with the bariatric surgery in making weight loss successful in the long term. Please remember your weight, age and your medical condition are very important factors in determining your eligibility for the bariatric surgery. You and your team of specialists will determine if it’s a viable option in your case and also the most suitable type of surgery for you.
Q11. What is Dumping syndrome and how to avoid it?
A11 Dumping syndrome is a group of symptoms that develop as a result of dumping (rapid gastric emptying) of food from your stomach into small intestine without being digested. It happens because the food passes too rapidly through the stomach, literally equivalent to dumping. It is most common after weight loss surgery although it may happen after any surgery involving removal of part or all of stomach or bypassing it, such as in case of stomach cancer, oesophagectomy amongst many others.
It can be classified into two types:
Early dumping syndrome-Symtoms occur 10 to 30 minutes after meals
Late dumping syndrome- Symptoms occur 1 to 3 hrs after meals.
Early dumping syndrome symptoms occur because a big mass of food gets into the small intestine too early in the digestive process, making the intestine react to its presence by releasing gut hormones, body also react by shifting fluid circulation into the intestines making them bloated and fuller and in turn causing symptoms such as diarrhea within an hour, dizziness, increased heart rate and so on.
Late dumping syndrome occur due to drastically low sugar level in the blood, often referred to as the Reactive hypoglycemia that happen 1 to 3 hrs after meals. This usually happen after meals that are high in sugar content as you mentioned sugary sodas and sweets. Since increased insulin amount is released to deal with high sugar levels, this surge of insulin may in turn lower your blood sugar level dramatically. This rapid swing in your blood sugar level-very high to very low blood sugar level is the culprit which is more common after high sugar or simple carbohydrate diet.
Dumping syndrome, as mentioned earlier, is most common after Gastric bypass surgery or weight loss surgery. Not all persons who have undergone Gastric bypass surgery suffer from dumping syndrome, only a fraction of them do.
Most people experience early dumping syndrome characterized by abdominal cramps, nausea, bloating,sweating, stomach rumbling, dizziness, increased heart beat and diarrhea.
1 out of 4 experience late dumping symptoms such as sweating, confusion, heart palpitations, hunger, tremors and fatigue.
You can avoid dumping syndrome with the following little but important changes in their diet:
Substitute high sugar laden simple carbohydrates with fibre rich complex carbohydrates such as whole grains, vegetables.
Add high proteins to your diet.
Take frequent small meals instead to few large meals.
Lying down after meals may help prevent some symptoms
Avoid liquids until half hour after your meal, otherwise, take adequate amount of sugar free liquids.
Avoid alcohol, to your best.
Keep away from foods that you think trigger your symptoms for eg dairy products.
Take your vitamins and other nutritional supplements regularly as prescribed by your doctor.
If changes in diet do not help you in avoiding or controlling your symptoms, then consult your Bariatric surgeon to see if you need any prescription medicine for your condition.
Availability of wide horizon of weight loss surgeries, best suited as per your medical needs.
Most affordable cost coupled with high quality treatment.
Keyhole or Laproscopic surgery options
Team Approach:A team of specialists such as Bariatric surgeon, Cardiologist, Nutritionist, Psychologist and Physiotherapist carry out comprehensive evaluation and provide complete care and support throughout.
World class hospitals with state of the art infrastructure and equipped with most advanced technology, keeping in mind the comfort and safety of Obese patients.
Highly experienced, globally trained Bariatric surgeons.
Good success rate.
Caring and compassionate staff
No waiting period.
Hospitals accredited with international organizations such as JCI(Joint commission International) for quality standards.
Language no barrier. English speaking people and if required, translators are available for your convenience.
Most economical accommodation available at a walking distance from the hospital. Wide range of options starting from guest house, service apartments to five star hotels, best suited to your budget and choice.
Good flight connectivity.
India has a diverse and rich cultural heritage. You can witness its beauty and uniqueness. It offers most conducive environment for recuperation.
Dr Rajesh Kapoor
MBBS,MS(General Surgery),MCh(Surgical Gastroenterology)
Training in advanced Laparoscopic Surgery at Leeds Institute of Minimal Invasive Surgery in U.K.
National Cancer Centre, Kashiwa East Japan & National Cancer Centre, Tokyo
Hepatopancreatobiliary Unit at Memorial Sloan Katering Cancer Centre, New York
Minimal Access Surgery & Bariatric & Metabolic Surgery at University of Illinois Medical Centre, Chicago
Colorectal Surgery Severance Hospital Seoul for Gaining Experience in Laparoscopic Colorectal Surgery
GI & Hepatopancreaticobiliary Sciences
Jaypee Hospital,Noida, Delhi-NCR
Dr Adarsh Choudhary
Chairman, Division of GI Surgery, GI Oncology, Minimal Access and Bariatric Surgery
Medanta The Medicity, Gurgaon,Delhi-NCR
Dr Pradeep Chowbey
MS, MNAMS, FRCS (London), FIMSA, FAIS, FICS, FACS, FALS, FIAGES
Chairman - MAMBS (Minimal Access,Metabolic and Bariatric Surgery)
Chairman Surgery and Allied Surgical Specialities
Executive Vice Chairman Max Healthcare
Dr Randeep Wadhawan
MBBS, M.S, FIAGES, FMAS, FAIS, FICS ( U.S.A.)
Director & Head , Department of Minimal Access , Bariatric Surgery & Gastrointestinal Surgery
Fortis group of Hospitals.
Saket, New Delhi
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