Bariatric surgery ppt o&g

SHANTI MEMORIAL HOSPITAL PVT LTD A MULTI SPECIAILTY MEDICAL CENTRE

SURGERY TO COMBAT OBESITY(BARIATRIC SURGERY)

DR. SREEJOY PATNAIK

LIFE MEMBER , SAGES, OSSI & IFSO

MINIMAL ACCESS , BARIATRIC & METABOLIC

SURGERY

IFSO 2010, LONG BEACH, CALIFORNIA

IFSO , 2011 HAMBURG

IFSO-2011 HAMBURG, GERMANY

HIS HOLINESS DALAI LAMA AT IFSO 2012, NEW DELHI

MENSTRUAL DISORDERS

INFERTILITY

HYPERANDROGENISM

METABOLIC SYNDROME

TREATMENT OF OBESITY:

Surgical Treatment of Obesity:

Bariatrics is the branch of medicine that deals with the causes, prevention, and treatment of obesity.

Bariatric surgery (weight-loss surgery) includes a variety of

procedures performed on obese.

Surgical Treatment of Obesity:

• According to the NATIONAL INSTITUTE OF HEALTH (NIH)

• BARIATRIC SURGERY IS THE PERMANENT TREATMENT OF CHOICE AND THE ONLY TREATMENT THAT HAS BEEN PROVEN TO BE SUCCESSFUL IN THE LONG TERM ( MORE THAN 10 YEARS).

THE CONSENSUS GUIDELINES ON BARIATRIC SURGERY

CALIFORNIA ASSOCIATION OF HEALTH PLANS OBESITY INITIATIVE

WORKGROUP (CAHP) JUNE 2006THE U.S. NATIONAL INSTITUTE OF HEALTH

THE AMERICAN GASTROENTEROLOGICAL ASSOCIATION (AGA)

CLINICAL GUIDELINES DEVELOPED BY THE NATIONAL HEART, LUNG, AND BLOOD INSTITUTE EXPERT PANEL

SOCIETY OF AMERICAN GASTROINTESTINAL & ENDOSCOPIC SURGEONS

BARIATRIC SURGERY GUIDELINES

Recommends bariatric surgery for obese people:

BMI > 40 without co morbidities BMI >35 with 1 or more co morbidities. or BMI of 30 to 35 with significant or serious co morbidities.

or

When less invasive methods of weight loss have failed and the patient is at high risk for Obesity-associated morbidity and mortality.

Patient Criteria for surgery

1. A Body Mass Index (BMI) ≥ 40 or a BMI ≥ 35 with obesity related co-morbid

conditions.

2. Age – 16 to 65 yrs

3. Screening for mental or behavioral disorders that may interfere with post-

operative outcomes (e.g. eating disorders, depression, and substance abuse).

4. Counselling and advise to stop using tobacco products & alcohol, 4 weeks prior

to surgery.

5. No absolute contraindication to major abdominal surgery

6. Obesity of long standing

6. Should have completed a weight loss program is recommended but not required.

eg: dieting, nutritional counseling, an exercise program and commercial/hospital based weight loss

programs.

7. Received counseling by a credentialed expert on the risks and benefits of the procedure and the

potential complications of the surgery (including death) and the realistic expectations of post-

surgical outcomes.

8. To adhere to post-surgical attention to lifestyle, an exercise program and dietary changes and

post-surgical follow-up with applicable professionals (e.g. nutritionist, psychiatrist, exercise ,

physical therapist, support group participation, on regular basis.

• Over 65 years of age– Careful consideration on a case-by-case basis, due to the potential for

increasing risk of complications with advanced age.

• Under 16 Years of Age (adolescent obesity)– Careful consideration on a case-by-case basis,

due to the unique needs of adolescent patients.

– Benefits of performing the surgery on the adolescent patient

outweigh the benefits of waiting until the patient reaches

adulthood.

– Adolescent patients should have sufficient psychological maturity and

cognitive development to participate in the discussion of treatment

options.

SPECIAL POPULATIONS

criteria

– Need for family inclusion in pre-assessment and counseling

.– Attainment of skeletal maturity and Tanner Stage IV

• Girls ≥ 13 years of age

• Boys ≥ 15 years of age

– Higher BMI, > 40 may be appropriate

– Sufficient Bone Age, may be necessary for determination of physiological

maturity.

– Special counseling is important due to high-risk nature of

early postoperative pregnancies, which require special

monitoring by OB/GYN and the bariatric surgeon.

– Counseled to wait 12-18 months until weight loss is stable

prior to conception.

WOMEN OF CHILD BEARING AGE

Bariatric surgery carries the potential for serious complications, morbidity and possibly mortality.

1. Cardiac complications with poor myocardial reserve. 2 Chronic obstructive airways disease or respiratory dysfunction.

3.Significant psychological disorders, or significant eating disorders.

Contraindications to Bariatric Surgery

CLASSIFICATION OF BARIATRIC SURGERY:

1. PREDOMINANTLY RESTRICTIVE PROCEDURES

2. PREDOMINANTLY MALABSORBTIVE PROCEDURES

3. MIXED OR COMBINATION PROCEDURES

Bariatric surgery procedures can be categorized into operations utilizing 3

methods to produce weight loss: gastric restriction, mal absorption, or a

combination of the two.

Procedures that are solely restrictive by creating a small gastric pouch & a degree of outlet obstruction leading to delayed gastric emptying. The goal is to reduce oral intake by limiting gastric volume, produce early satiety, and leave the alimentary canal in continuity, minimizing the risks of metabolic complications

1.VERTICAL BANDED GASTROPLASTY

2.ADJUSTABLE GASTRIC BANDING (LAGB )

3. SLEEVE GASTRECTOMY

4.GASTRIC PLICATION

5. INTRA GASTRIC BALLOON (GASTRIC BALLOON)

RESTRICTIVE PROCEDURES:

Malabsorption is achieved by creating a short gut syndrome and/or by accomplishing distal mixing of bile and pancreatic juice with ingested nutrients thereby reducing absorption.. Some purely malabsorptive operations are no longer recommended due to their potential hazard to cause serious nutritional deficiencies.

1. BILIOPANCREATIC DIVERSION2. THE JEJUNAL-ILEAL BYPASS3. ENDOLUMINAL SLEEVE

MALABSORPTIVE PROCEDURES

MIXED PROCEDURES:

1. GASTRIC BYPASS ROUX-EN-Y ( RYGBP)

2. SLEEVE GASTRECTOMY WITH DUODENAL SWITCH

3. IMPLANTABLE GASTRIC STIMULATION

The following procedures combine restrictive and malabsorptive approaches. By adding malabsorption, food is delayed in mixing with bile and pancreatic juices that aid in the absorption of nutrients. The result is an early sense of fullness, combined with a sense of satisfaction that reduces the desire to eat.

Bariatric surgery has been available for decades. Most procedures are now performed laparoscopicaly.

Although various procedures have been described and attempted, the 3 most common procedures performed:

1.Laparoscopic adjustable gastric banding (LAGB),

2.Laparoscopic roux-en-Y gastric bypass (LRYGB) and

3.Laparoscopic sleeve gastrectomy (LSG).

Endoscopic Procedures like – Intra- Gastric Balloon / Endo- Barrier System

SUCCESS OF BARIATRIC SURGERY

Armamentarium in OT

VALLEYLAB STERRAD

EXTRA LONG TROCARS

OPTI-VIEW TROCARS GASTRIC CALIBRATION TUBE

SERIAL COMPRESSION DEVICE

The stomach is partitioned along its axis with a non-

adjustable poly-urethane band and with linear&

circular staples to create a small upper stomach pouch

with a restrictive orifice to the rest of the stomach.

No malabsorption of micro or macro nutrients is

expected.

No longer done was practised in 1980.

Vertical Banded Gastroplasty (VBG)

IFSO 2010, CALIFORNIA WITH MAL FOBI

ADJUSTABLE GASTRIC BANDING (LAP BAND SURGERY/ LAGB)

Restrictive Procedure An inflatable silicone BAND is placed around the top portion of the stomach, to form a small stomach pouch & sewed .

This band is connected to a tube that leads to a port above the abdominal muscles placed below the skin (FILL – PORT).

During follow up visits, we inject or remove saline solution to make the band tighter or looser.

Adjustable Gastric Band

• This Band in the stomach and induces weight-loss in 3 ways:

1. The small stomach pouch causes a sensation of fullness

2. “Squeezing of the stomach pouch like an hour glass prolongs the sensation of fullness.

3. Suppresses appetite by central action.

LAP GASTRIC BANDING

Complications ofGastric Lap-Band®

• Perforation of Stomach

• Mal positioning

• Abdominal Pain

• Heartburn

• Vomiting

• Inability to Adjust the Band

• Failure to Lose Weight

• Slippage

• Gastric Erosion

• Dilated Esophagus

• Infection of System

• Fatigue or malfunction

Laparoscopic sleeve gastrectomy (LSG) is a standalone procedure for the surgical management of morbid obesity.

It is a rapid and less traumatic operation and thus far is demonstrating good resolution of co-morbidities and good weight loss.

A further second surgical step is then easily feasible, if necessary.

LAP SLEEVE GASTRECTOMY

WITH DR. MICHEL GAGNER

CANADA

SLEEVE GASTRECTOMY

Sleeve gastrectomy is a procedure in which the stomach is reduced to about 25% of its original size, by surgical removal of a large portion of the stomach along the greater curvature. This is done by using surgical staplers to form a sleeve or a tube with a banana shape.

A bougie or GCT between 36 - 40 Fr is used with the procedure .

Ideal approximate capacity of the stomach after the procedure is about 30- 60 ml pouch

SLEEVE GASTRECTOMY

BASICS OF THE PROCEDURE:

DEFINITION AND PRINCIPLES:-

The sleeve gastrectomy is also known as the

greater curvature gastrectomy,

vertical or longitudinal gastrectomy or

Pylorus preserving ‘gastric tube creation’.

The sleeve gastrectomy (SG) induces weight loss by 2 mechanisms:1.MECHANICAL RESTRICTION by reducing the volume of the stomach and impairing stomach mobility. Also called ‘Food limiting’ operation.

2.HORMONAL MODIFICATION by removing a great part of the Ghrelin (Hunger Hormone) production tissue.

(Ghrelin is a 28 amino-acid-peptide, secreted by the oxyntic glands of the gastric fungus. It is a potent orexigenic (appetite-stimulating) peptide mediated by the activation of its receptors in the hypothalamus or pituitary area.)

The gastric fundus contains 10 to 20 times more ghrelin per one gram of tissue than the duodenum. In the SG, resection of the fundus removes the major portion of ghrelin release, therefore, appetite decreases.

LABORATORY EVALUATION:Basic chemistry panel, full blood count, thyroid function tests. Serum cortisol, urine cortisol, lipid profile, vitamin (A, B1, B6, B12, C).Serum Insulin, C-Peptide.UPPER ENDOSCOPY:Rule out inflammatory ulcerous gastric pathology, search and treat H pylori infection when present.ULTRASOUND OF THE ABDOMEN:To rule out cholelithiasis, which would indicate cholecystectomy along with the gastric sleeve.

PREOPERATIVE EVALUATION

CARDIOVASCULAR/RESPIRATORY EVALUATION:Exclude any contraindications to anesthesia by TMT, Echo, PFT, ABG , CXR etc.PSYCHIATRIC EVALUATION:To rule out any behavioral abnormalities that would contraindicate limited food intake.ENDOCRINE EVALUATION: Rule out an endocrine abnormality as the etiology of morbid obesity.DENTAL EVALUATION

TEN STEPS OF LSG

1. Assembly of instruments, in order of use2. OT set up and Trocar Position3. Liver Retraction –using Nathansons Liver Retractor4. Gastrolysis of greater curvature- distal to prox. Upto> of His.5. Resection of stomach by Stapling – starts from 4 cm distal to pylorus6. Suturing for staple line reinforcement7. Leak test- Methylene blue, air or UGIE8. Extraction of specimen- fish tail technique9. Closure of Ports- by needle passer.

Laparoscopic Procedure

DONE UNDER G.A

5 TO 6 PORTSThe benefits are:

•Less Pain•Quicker recovery and return to normal activity•Fewer complications•Less noticeable scar•Shorter hospital stay

No nasogastric tube is placed at the end of the procedure.

GASTROGRAFFIN STUDY:A water-soluble upper gastrointestinal study is performed all cases , and for patients with clinical symptoms and signs of leakage.If no leak observed, then patient is allowed to drink.

POSTOPERATIVE PERIOD

From D2 to D14, the patient remains on a liquid diet. Over the next 3 weeks on pureed diet.

Normal diet after 1 month.

Peri-operative Complications of anesthesia, bleeding, positioning or pressure, and those of a

technical nature. Injury to Liver or Spleen.

Early Post-operative Complications (30 days) Bleeding: anastomosis leak, infection secondary to

leak, wound or other infection, strictures, and deep venous thrombosis/pulmonary embolism.

Pulmonary complication -Atelectatsis, pneumonia, pulmonary embolism, respiratory arrest

secondary to sleep apnea, and acute respiratory distress syndrome (ARDS).

Gastrointestinal (GI) complication - Ulcer, stricture, anastomonic obstruction, and small bowel

obstruction.

Late Complications (greater then 30 days) GI ulcer (stricture, obstruction), nutrition deficiency

(one or more nutrients, protein, vitamin or mineral), internal/ incisional hernia, redundant skin,

failure of weight loss or regain of lost weight, and psychological.

Psychological Side effects -include increased manifestations of depression, disruption of social

relationships.

Complications

Intragastric balloon involves placing a deflated balloon into the stomach, and then filling it to decrease the amount of gastric space.

The balloon can be left in the stomach for a maximum of 6 months and results in an average weight loss of 5–9 BMI over half a year.

Done endoscopically

The intragastric balloon may be used prior to another bariatric surgery as a stepdowm procedure.

BIB –INTRA GASTRIC BALLOON

BIB –INTRA GASTRIC BALLOON

ENDO BARRIER LINER SYSTEM The EndoBarrier gastrointestinal liner mimics the effects of gastric bypass surgery. It’s designed to work by inserting a flexible tube-like barrier into the duodenum & prox. Jejunum..

The barrier is placed endoscopically via the mouth and thus helps patients to loose weight by delaying digestion.

.Has to be removed after 6 months

B. MAL- ABSORPTIVE PROCEDURES

Malabsorptive surgeries rearrange and/or remove part your digestive system which then limits the amount of calories and nutrients that your body can absorb. Treatments with a large malabsorbtive component result in the most weight loss but tend to have slightly higher complication rates.

1. JEJUNAL ILEAL BYPASS – no longer performed for high complication rates.

2. ILEAL TRANSPOSITION- New malabsoptive procedure on trial for treatment of DM type 2 and metabolic disorders.

C. COMBINATION PROCEDURES RESTRICTIVE + MALABSORBTIVE

1. LAP. GASTRIC BYPASS – ROUX-EN- Y – more malabsorption than the restrictive

2. MINI- GASTRIC BYPASS- mainly restrictive

3. DUODENAL SWITCH – the sleeve stomach is the restrictive portion &the intestinal bypass( duodenal switch) is the mal absorptive component

When surgery combines both restrictive and malabsorptive techniques, it is know as a “combination” procedure. Most types of bariatric surgery carry at least a small element of both components, but the following surgeries achieve a notable portion of weight loss from each…

1. LAP. GASTRIC BYPASS/ LGB

The Roux-en-Y gastric bypass(known simply as the LRYGBP) is the most commonly performed procedure.

It primarily causesweight loss by restricting thefood intake, however there ismore amount of mal absorption that occurs with this operation.

Bariatric surgery represents the main option for substantial and long-term weight loss in morbidly obese subjects..

Two hypotheses have been proposed to explain the early effects of bariatric surgery on diabetes--

The Hindgut hypothesis theory- Diabetes control results from the more rapid delivery of nutrients to the distal small intestine, thereby enhancing the release of hormones such as glucagon-like peptide-1 (GLP-1).

The foregut hypothesis theory – Exclusion of the proximal small intestine reduces or suppresses the secretion of anti-incretin hormones, leading to improvement of blood glucose control as a consequence increases GLP-1 plasma levels which stimulate beta cells to produce insulin secretion and suppress glucagon secretion, thereby improving glucose metabolism.

INDICATIONS :

1. BMI 35-40: WITH SIGNIFICANT CO-MORBID CONDITIONS SUCH AS DM, HTN

2. BMI 40-60 OR SUPER OBESE

3. PATIENTS >18 YEARS

4. PATIENTS MUST HAVE ATTEMPTED SUPERVISED WEIGHT REDUCTION PROGRAMS.

1. Most commonly performed.2. Most reliable operation for long term weight loss.3. Long term weight loss averages 60 to 75 percent of EBW.6. Malnutrition is unusual.7. Substantial improvement & resolution in many co-morbid obesity conditions:

Type 2 DM – 90% Sleep apnea -90% Hypertension-70% Hyperlipidaemia-70% Heartburn from GERD- all patients. Urinary stress incontinence-75%

89%reduction in mortality over 5 yrs. Following surgery, compared to non-surgically treated group.

ADVANTAGES:

GASTRIC BYPASS/ LRYGBP

•The stomach is stapled into 2 pieces, one small and one

large. The small piece becomes the “new” stomach

pouch.

• The larger portion of the stomach stays in place, however will lie dormant for the remainder of the patient’s life.

GASTRIC BYPASS/ LGB

• The small intestine (the jejunum) is divided using a surgical stapler

Approx. 50-70 cm from the DJ Junction.

GASTRIC BYPASS/ LGB

Y- LIMB/ BP LIMB

• The end of the Roux limb is then attached to the newly formed stomach pouch .

• The Roux limb carries food to the distal intestine.

• The Y limb or BPD limb carries digestive juices from the pancreas, gall bladder, liver and duodenum to the intestines

• The food and the digestive juices mix where the Roux limb and Y limb meet much below say 100-170 cm from DJ

Roux limb or alimentary limb

100-150 cm

1. Not reversible.

2. Mortality 0.5- 1%

3. Peri operative complications 5-10%

4. Stricture of gastrojejunostomy.-10% (long term)

5. Long term risk of protein &vitamin deficiency, and marginal ulceration of GJA.

6.Long term risk of intestinal obstruction – 2%.

LAPAROSCOPIC GASTRIC BYPASSCOMPLICATIONS

LAP GASTRICT BYPASS

Bariatric surgery can be effective in achieving significant weight loss, restoration of the hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving pregnancy outcomes.

Ultimately, bariatric surgery should be considered part of the treatment in PCOS women, especially in those with MS.

Bariatric surgery ameliorates metabolic abnormalities. BMI and excess body weight decreases substantially after surgery .

Marked improvement is noted in glucose abnormalities, dyslipidemia and hypertension

Improvement of DM II @ 2YR follow up after surgery is proportional to weight loss.

1. METABOLIC IMPROVEMENTS AFTER BARIATRIC SURGERY

Weight and type 2 diabetes after bariatric surgery: systematic review and meta-analysis.Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I.SourceDepartment of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. [email protected]

http://www.ncbi.nlm.nih.gov/pubmed?term=Buchwald%20H%5BAuthor%5D&cauthor=true&cauthor_uid=19272486

http://www.ncbi.nlm.nih.gov/pubmed?term=Estok%20R%5BAuthor%5D&cauthor=true&cauthor_uid=19272486

http://www.ncbi.nlm.nih.gov/pubmed?term=Fahrbach%20K%5BAuthor%5D&cauthor=true&cauthor_uid=19272486

http://www.ncbi.nlm.nih.gov/pubmed?term=Banel%20D%5BAuthor%5D&cauthor=true&cauthor_uid=19272486

http://www.ncbi.nlm.nih.gov/pubmed?term=Jensen%20MD%5BAuthor%5D&cauthor=true&cauthor_uid=19272486

Fasting glucose and insulin resistance measured by (HOMA-IR ie; HOMEOSTASIS MODEL ASSESMENT INSULIN RESISTANCE) can decrease > 50% within 1 month of surgery.

Whereas INSULIN SENSITIVITY measured by the eug lycemic –hyper insulinemic clamp does not change as quickly.

Hypertension – 75% saw improvement, in 50% there was complete resolution.

WC, Lipid Profile, Insulin resistance along with in prevalence of MS from 55% - 0% in 1 yr.

A limited number (n = 17) of PCOS patients with an average age of 30 years were followed prospectively for up to 26 mo after bariatric surgery. Most women (12/17) regained normal menstrual function and most (10/12) had documented spontaneous ovulation. .

Significant improvement in hirsutism, androgen profiles and about a 50% reduction in HOMA-IR

Follow up for more than 2 years showed that all women resumed normal menstrual cycles, HbA1C decreased from 8.2% to 5.1% in < 3 months.

78% saw improvement in metabolic syndrome & 48% showed improvement in PCOS .

2. ROLE OF BARIATRIC SURGERY IN PCOS PATIENTS

Clin Endocrinol Metab. 2005 Dec;90(12):6364-9. Epub 2005 Sep 27.The polycystic ovary syndrome associated with morbid obesity may resolve after weight loss induced by bariatric surgery.Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, Sancho J, San Millán JL.SourceDepartment of Endocrinology, Hospital Ramón y Cajal, Madrid E-28034, Spain. [email protected]

Key features of polycystic ovarian syndrome and improvements seen after bariatric surgery. BMI: Body mass index.

COMPLEXDISORDER

3. BARIATRIC SURGERY IN ADOLESCENTS

35% reduction in BMI and resolution of hypertension.

BMI decreases by more than 10 units

Reduction in glucose abnormalities > 80%

Excess weight loss > 80%

Reduction in Metabolic Syndrome

Improved Insulin Sensivity.

Decrease menstrual irregularities. PCOS women have less hyper androgenism

Sex hormone binding globulin increases LH and FSH levels have been reported to increase

Ovulatory function measured by luteal LH and Progesterone secretion improved . Leptin levels decrease , reflecting improved reproductive metabolic status.

Subclinical hypothyroidism significantly reduced.

4. BARIATRIC SURGERY IN REPRODUCTIVE WOMEN:

The incidence of gestational diabetes were drastically decreased.

No effect on post-partum hemorrhage, infection, shoulder dystocia or fetal demise.

Improvements in pregnancy induced hypertension and diabetes mellitus and a decrease in cesarean delivery rate.

The length of labor decreased as well as neonatal birth weight.

Transmission of obesity to offspring was reduced by 50%

OR

The risk of fetal macrosomia was reduced

THE SAFE TIMING OF PREGNANCYoptimal or minimal time

>12 mo after bariatric surgery before becoming pregnant in order to allow the rapid weight loss and metabolic changes to subside.

104 pregnancies were followed in women who became pregnant < 1 year (mean 7.0 mo) of bariatric surgery compared to

385 pregnancies (age, BMI matched) conceived > 1 year (mean 56.7 mo) post-operatively.

There were no differences in Maternal complications

Fetal outcomes

Delivery complications

5. CONCLUSION

Overall, PCOS is highly prevalent and strongly associated with obesity and MS.

PCOS with obesity and/or MS develop coronary artery disease and glucose abnormalities at a very young age and are therefore at risk for life threatening cardiac events.

Bariatric surgery is a powerful tool that should not be overlooked simply because a woman is young or presents with PCOS and MS.

Every woman with PCOS and MS should be offered education and counseling regarding the role of bariatric surgery in reducing their illness.

Bariatric surgery should be considered along with other medical and lifestyle alterations as first line therapy in PCOS women with obesity and MS.

Research Ranking scores using a combination of factorsTypes of Bariatric Surgery

Category Average Long Term Excess Weight Loss (approx. %)

Complication Rate Research Ranking* (and reason if below ‘A’

LGB Combination (primary restrictive

50 to 70% Up to 15% A

Lap Gastric Banding Restrictive 25% to 80% Up to 33% A

BPD/DS Mal absorptive 65% to 75% Up to 24% A

Vertical Banded Gastroplasty

Restrictive 50% TO 60% Up to 21% B

Vertical Sleeve Gastrectomy

Restrictive 65% to 75% Up to 10% B

Mini Gastric Bypass Surgery

Combination (primary restrictive

60% to 70% Up to 8% C

TGVR Restrictive Needs more research n/a C

TOGA System Restrictive n/a n/a

Endobarrier Endoluminal Lining

Mal absorptive n/a n/a D

Implantable Maestro System

Neither restrictive nor mal absorptive; electrical impulses said to affect hunger

n/a n/a

SUMMARY OF ALL TYPES OF SURGERY

LRYGBP – worlds best procedure, 60-70% WL, dumping syndrome, malnutrition.

LAGB- low complications, varying range of wt. loss, frequent post-op visits ( 10)

DS/BPD- more wt. loss , high complications, good for high BMI > 50, malabsorption +

VBG – longest available results, good wt. loss, improved co-morbidities, right for some pts.risks too high to justify rewards

SG- needs long term research, 1st step procedure, low risks, higher wt. loss, pouch could Stretch over time, long staple line could cause problems in future.

RESOLUTION OF DISEASES FOLLOWING BARIATRIC SURGERY

S.LNO

PATIENT NAME

INTIAL BODY

WEIGHT

B.M.I I.B.W P.B.W WEIGHT LOSS (K.G)

D.OO PROCEDURE % OF WEIGHT LOSS

1 RAGHAV GOENKA

135 KG 44.5 76 KG 72 KG 63 KG 27.02.2010 SLEEVE GASTRECTOMY

96 %

2. SANJAY SWAIN

158 KG 56 72 KG 80 KG 68 KG 23.04.2010 SLEEVE GASTRECTOMY

79 %

3. DIGBIJAY SAHOO

127 KG 45 70 100 KG 27 KG 23.04.2010 SLEEVE GASTRECTOMY

47%

4. MANOJ DAS 139 KG 56 60 KG 90 KG 49 KG 09.12.2010 SLEEVE GASTRECTOMY

58%

5. SANTOSH PRASAD


80%

6. M.ARUNA 112 KG 44 63 KG 75 KG 32 KG 07.04.2011 SLEEVE GASTRECTOMY

65%

7. MANASMITA PRIYADARSINI


58%

8. UMESH GOENKA

100KG 35.5 72 KG 80 KG 20 KG 04.11.11 SLEEVE GASTRECTOMY

53%

9. HEENA AGARWAL


58%

10. KISHANLAL PANCH


70 %

TABLE SHOWING % OF WEIGHT LOSS AT SHANTI MEMORIAL HOPSPITAL

S.LNO

PATIENT NAME

INTIAL BODY

WEIGHT

B.M.I I.B.W P.B.W WEIGHT LOSS (K.G)

D.OO PROCEDURE % OF WEIGHT LOSS

11. CHANDAN MOHANTY


77%

2. PUSPITA DAS 100 KG 41 60 KG 75 KG 25 KG 10.06.2012 SLEEVEGASTRECTOMY

62.5%

3. GOPAL SIKARIA


61%

4. SUDATTA DAS 90 KG 43 52 KG 56 KG 34 KG 07.07.2012 SLE EVE GASTRECTOMY

84.5%

5. RABINDRANATH SENAPATI


63%

6. SMITARANI SWAIN


60%

7. VIJAY SHARMA


21.5%

8. VINOD SHARMA


35%

9. DINESH AGARWAL


42%

10. APARAJITA PATNAIK


33%

TABLE SHOWING % OF WEIGHT LOSS AT SHANTI MEMORIAL HOPSPITAL

Conclusions

• Bariatric surgery is an effective means to achieve clinically significant, permanent weight loss with low rates of complications

Bariatric surgery saves lives and money

MY SINCEREST THANKS TO ALL THE MEMBERS OF ASSOCIATION OF OBSTETRICIANS & GYNECOLOGISTS OF ODISHA

MY SPECIAL THANKS TO ORGANISING CHAIRPERSON DR. S. KANUNGO& ORGANISING SECRETARY DR. SUJATA MISHRA

Documents

Bariatric surgery ppt o&g