Bariatric surgery an overview
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Transcript of Bariatric surgery an overview
Bariatric Surgery- An overview
Dr. Deep Goel, FACS (USA), FRCS (England)
Director
Department of Surgical Gastro Onco, Bariatric & Minimal
Access Surgery
Centre for Digestive and Liver Disease
BLK Super Specialty Hospital, New Delhi.
Obesity in India5% population obese – rapidly increasing
63.5 million obese/ 1.27 billion
Prevalence is high in North India
Urbanization and Westernization major factors
Obesity + Diabetes = Diabesity
World Capital of Diabesity
Diabesity
Obesity and Type II DM strongly linked
‘Diabesity’- coined in 1970
44% of Type II -diabetic population is obese
Impact of Diabesity on Society
7th leading cause of death
2.8 million deaths worldwide
Cardiovascular deaths in 50%
> 350 million US$ being spent at present & by 2030 500 million US$
Diabetes Cancer HTN CKD
CAD PCOD
Hyperlipidemia Infertility
Osteroarthritis
Social Impact of Diabesity
• Depression childhood adult• Marital discord psychological physical emotional
BMI Chart
Bariatric Surgery
Definition of Bariatric Surgery
• Bariatric surgery or weight loss surgery is a
spectrum of surgical procedures performed on
obese patients
• Types :
Restrictive : Sleeve & Band
Malabsorbtive : Bilo Pancreatic Diversion Mini Gastric BypassCombined : R&YGB
Patient Selection Criteria
BMI ≥ 35 without any co-morbidities
BMI ≥ 32 with co-morbidities
History of Bariatric Surgery1950
Intestinal Bypass(in dogs) 1963Open jejunoileal bypass by Payne & DeWind
1980Vertical banded gastroplasty
1994 Laproscopic gastric bypass
2000Laproscopic gastric sleeve
1978Gastric band
1986Duodenal switch
1997Open sleeve gastrectomy
2001Lap-band system approved by FDA2015
Gastric balloons approved by FDA
1970Open gastroplasty
Bariatric Surgery in India
• The number of surgeries has increased by
almost 10 times in the last decade and almost
14000 bariatric surgery were performed last
year in India.
Trends in No. of procedures Worldwide
2003 2008 2011 2013 20160
100000
200000
300000
400000
500000
600000
146301
344221 340768
468609
548677
Sleeve Gastrectomy
• Stomach reduced without loss of function or change in anatomy• 75-80% EWL
Roux-en-Y Gastric Bypass
• General Features– Pouch size: 1 oz– 70-80 % of excess weight
Gastric Banding
Intra Gastric Balloon
Indications• Patients who don’t want
surgery but want to loose weight.
Problems• Time period one year• Rebound hunger • Weight regain
Medical Co-Morbidities Resolved after Bariatric Surgery
Type 2 Diabetes 95%
Hypertension 92%
Cardiac Function 95%
improvement
Osteoarthritis 82%
Sleep Apnea 75%
GERD 98%
Stress Incontinence 87%
Hypercholesterolemia 97%
Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass roux-n-y-500 patients. Obes Surg 2000. And others.
Complications
• Bowel obstruction
• Deep venous thrombosis/Pulmonary embolism
• Leak
• Bleeding
• Nutritional deficiencies
Source: Direct Research, LLC, Center for Medicare and Medicaid Services, FY 2010 MedPAR, Medicare Fee-for-Service Inpatient Discharges with Selected Procedures
Risk of surgery
Is Bariatric Surgery a cosmetic surgery ?
No• It is approved by Central Government • No service tax
Insurance Coverage
Weight Regain
“Procedure failed the patientor
Patient failed the procedure”
?
• Realistic Expectation
• > 10% weight regain
- Re-surgery
Weight Regain
Loose Skin after Bariatric surgery
Is a reality…
Shape your own future
Contouring Procedures
When to do?
• Minimum 12 months after bariatric surgery
• 3 months of stable body weight• BMI < 30• Staged procedures
Lost 70 Kg in 12 months
Our Results
• 760 cases from March 2006 – July 2016• Mortality:
• Within 30 days (2)BleedingPulmonary embolism
• After 30 days (2)Liver failureHyperammonemia
Bariatric Surgery in News
Infertility
Bariatric Surgery in News
OSA
Bariatric Surgery in News
Diabetes
Bariatric Surgery in News
Lost 98 Kg in one year
Lost 47 Kg in 8 months
Lost 40 Kg in 14 months
Lost 18 Kg in 3 months
Lost 39 Kg in 6 months
Pledge
Surgical weight loss increases life span and it is an
effective means to achieve clinically significant,
permanent weight loss, which leads to significant
improvement in health risks associated with obesity
Take Home Message
Take Home Message
• We believe that surgery in recent future would
be an important tool to resolve DM-2 not only
obese people but for people with normal BMI.
Indications of surgery are being relaxed at
rapid pace.
“Treatment of morbid obesity should not
be deemed achieved unless plastic surgery
has been considered”
Obes Surg. 2013 Jan;23(1):24-30.doi: 10.1007/s11695-012-0735-8.
Take Home Message
GIS Team