Obesity and Metabolic Surgery

Obesity is not just a problem, it is a disease. The weight loss surgery enables a person to loose weight in short time. An average person can expect to lose 50-90% of their excess weight 12-18 months after surgery. Many patients find they no longer need medications for diabetes, hypertension, sleep apnoea, arthritis and back pain.

Classification of Obesity
BMI Status BMI Status
18.5 – 24.9 Normal 35 – 39.9 Severe Obesity
25 – 29.9 Overweight > 40 Morbid Obesity
30 – 34.9 Obese > 50 Super Morbid Obesity
Body Mass Index = Body weight (in Kgs) / Height (in Meter square)

The American Gastroenterological Association (AGA) and National Institute of Health, USA statement on obesity recommends surgery for patients with:

  1. Body mass index (BMI) >40 kg/m2 or
  2. BMI >35 kg/m2 associated with 1 or more following comorbid conditions or weight-induced physical problems interfering with performance of daily life activities or less invasive methods of weight loss have failed.

The most commonly performed obesity surgeries are Sleeve Gastrectomy, Mini Gastric Bypass and Gastric bypass. All the procedures are performed by laparoscopy. The selection of type of surgery depends one several factors like age, BMI, dietary habits, comorbid conditions, etc.

Sleeve Gastrectomy

Sleeve Gastrectomy

Mini Gastric Bypass

Mini Gastric Bypass

Gastric Bypass

Gastric Bypass

Co-morbid conditions associated with obesity:

  1. Diabetes Mellitus Hypertension Cardiac disease
  2. Cerebro-vascular disease Osteoarthritis Sleep apnoea syndrome
  3. Reflux Disease Polycystic Ovarian Disease
  4. Nonalcoholic Steatohepatitis (NASH) & Nonalcoholic Fatty Liver Disease(NAFLD)

Suitable patient for Obesity Surgery:

  • Patient with BMI of 40 or greater with significant co-morbidity.
  • Failed diet control and exercises.
  • There is no endocrine cause of obesity
  • Absence of drug or alcohol problems
  • No uncontrolled psychological conditions
  • The patient should be willing and determined to have a change in life-style

Co-morbid conditions associated with obesity:

  1. Diabetes Mellitus, Hypertension, Cardiac disease
  2. Cerebro-vascular disease, Osteoarthritis, Sleep apnoea syndrome
  3. Reflux Disease, Polycystic Ovarian Disease, Irregular periods, Infertility
  4. Nonalcoholic Steatohepatitis (NASH) & Nonalcoholic Fatty Liver Disease(NAFLD)
  • Failed diet control and exercises.
  • There is no endocrine cause of obesity
  • Absence of drug or alcohol problems
  • No uncontrolled psychological conditions
  • The patient should be willing and determined to have a change in life-style

Evaluation before surgery

  • Routine blood tests
  • Endocrinology, Heart and Lungs evaluation

Details of Surgery

There are 2 types of Obesity surgeries are currently being performed in India. The surgeon is the best person to tell you which one is best for you.

  1. SLEEVE GASTRECTOMY
  2. ROUX-EN-Y-BYPASS. This is most effective and widely accepted surgery.

Obesity surgery is a major surgery. The patient has to be prepared for long-term commitment, lifestyle changes including diet and exercise. It can be done by open or laparoscopic method. Laparoscopic surgery is a minimally invasive approach that involves a surgeon to operate through multiple tiny incisions, most of which are less than a half-centimetre in size. After surgery, the patient is put on a liquid diet and then is slowly encouraged to have soft and regular diet. This surgery usually involves a 3 to 6-day hospital stay.

Benefits of laparoscopic surgery:

Tiny Incisions, tiny scars, faster healing, less discomfort, less risk of hernias, shorter hospital stay and quick recovery.

Benefits of obesity surgery:

Obesity surgery can cure diabetes mellitus. The percentages of disappearance of the comorbid diseases after obesity surgery are shown below:
  • Diabetes Mallietus 95%
  • Hypertension 92%
  • Hypercholesterolemia 97%
  • Heart function improvement 95%
  • Osteoarthritis ( Joint pains) 87%
  • Sleep Apnoea 75%
  • GERD 98%
  • Stress incontinence 87%
  • Infertility 67%

Complications:

These are more or less similar to any other abdominal surgery like nausea, vomiting, diarrhoea, respiratory problems, infection, bleeding, anastomotic leaks, deep vein thrombosis, heart attack, stroke weight regain or failure to lose weight, anaemia, osteoporosis (decreased calcium in bones), gall bladder disease

Follow up:

Patients who have undergone obesity surgery require longterm follow up.

Cost of obesity surgery:

In India cost of obesity surgery has come down in the recent times. The cost is equal to any other abdominal surgery.