ROLE OF BARIATRIC SURGERY IN TREATMENT OF MORBIDLY OBESE

PATIENTS

• Dr. Ashish AhujaDr. Ashish Ahuja• M.S (Surgery), Fellowship Bariatric Surgery, (Australia)M.S (Surgery), Fellowship Bariatric Surgery, (Australia)

• Consultant Surgeon & Asst. Prof. of Surgery,Consultant Surgeon & Asst. Prof. of Surgery,• Dayanand Medical College & Hospital, LudhianaDayanand Medical College & Hospital, Ludhiana

• BARIATRIC SURGERY IS NOT LIPOSUCTION

• BARIATRIC SURGERY IS A SAFE SURGERY

• DOES NOT CAUSE ANY SIDE EFFECTS

• RISKS OF UNDERGOING BARIATRIC SURGERY ARE FAR LESS THAN RISKS OF OBESITY

What is Bariatric Surgery?

• Comes from Greek words –Baros: - Weight–Iatreia: - Medical Treatment

Obese patients who undergo weight loss surgery live longer,

studies suggest The Associated Press

Published: September 7, 2006 The Associated Press

Published: September 7, 2006

SYDNEY, Australia — Stomach stapling and other surgical procedures to help overweight people eat less may be radical, but they also could be safer than staying obese, new research suggests. ……………………..

Obesity ‘harms sexual health’Obesity ‘harms sexual health’

Why Surgery for the Treatment of the Why Surgery for the Treatment of the Clinically Severe Obese?Clinically Severe Obese?

“Only surgery has proven effective over the long term for most patients with clinically severe obesity.”

- NIH Consensus Conference Statement, 1991

Surgery for the treatment of clinically severe obesity is endorsed by:

The National Institutes of Health

The American Medical Association

The National Institute of Diabetes and Digestive and Kidney Diseases

American Association of Family Practitioners

• Bariatric Surgical and Procedural Interventions

• in the Treatment of Obese Patients • with Type 2 Diabetes • A position statement from the • International Diabetes Federation Taskforce • on Epidemiology and Prevention

Complication of ObesityComplication of Obesity

B.M.I.

Diet Exercise

How To Lose Weight?How To Lose Weight?

When diets and exercise don’t

work?

Types of bariatric procedures1. Sweedish adjustable gastric band

2. Gastric sleeve resection

3. Roux-en-y gastric bypass

4. Bilio-pancreatic diversion with duodenal switch

Adjustable Silastic Gastric Banding Adjustable Silastic Gastric Banding (ASGB): LapBand(ASGB): LapBand

– Inflatable balloon within the band orifice can be adjusted via a reservoir under the skin

Average Weight loss– 50% of excess weight

Gastric sleeve resection

• Restrictive procedure

• No complication rates

• Weight loss around 50-60%

Roux-en-Y Gastric Bypass Roux-en-Y Gastric Bypass (RYGBP)(RYGBP)

General Features– Pouch size: 15-20 cc– Pouch opening: 0.5 in– Roux-en-Y limb– Standard: 2 ft

Average Weight Loss– 70 % of excess weight

“The Pouch-Tool”

Procedure Swedish

adjustable Gastric band

Gastric sleeve

resection

Roux-en-y Gastric bypass

Laparoscopic

Hospital Stay X

Abdominal drain X

Operative time (<1 hour)

X X

Post operative supplements X X

Post operative adjustments

X X

Weight loss

Comparison of different procedures

Contra indications for obesity Contra indications for obesity surgery surgery

• Only be offered to patients suffering from morbid obesity who are willing, motivated and high level of intelligence.

• Patient unfit for general anesthesia, advanced cancer disease.

• Patients having underlined endocrine disorders and major psychiatric illness .

Patients

Before And After

Bariatric Surgery

170 kgs with BMI-72, HTN, TYPE-2 DM, OSA, 170 kgs with BMI-72, HTN, TYPE-2 DM, OSA, AFTER 1 year 2 months 110 kgsAFTER 1 year 2 months 110 kgs

145 kgs with BMI, HTN, TYPE-2 DM,145 kgs with BMI, HTN, TYPE-2 DM,AFTER 10 MONTHS 90 kgsAFTER 10 MONTHS 90 kgs

128 kgs 128 kgs HTN & THYROID DISEASEHTN & THYROID DISEASEafter 9 months present weight 74 kgsafter 9 months present weight 74 kgs

130 kgs with HTN ,after 1 year 4 130 kgs with HTN ,after 1 year 4 months present weight 70 kgsmonths present weight 70 kgs

Morbid obesity with Blood Pressure, Morbid obesity with Blood Pressure, SugarSugar

BeforeBefore AfterAfter

World Anti Obesity Day

Before 106 kgs After 65 kgs

After surgery Today 60

Before surgery 100

117 kgs with HTN 117 kgs with HTN AFTER 12 MONTHSAFTER 12 MONTHS65 kgs and resolved HTN,D.M type 265 kgs and resolved HTN,D.M type 2

105 kgs, HTN, 105 kgs, HTN, AFTER 5 MONTHS 70 kgs resolved HTNAFTER 5 MONTHS 70 kgs resolved HTN

102 kgs sugar + blood pressure Now 48 kgs

DM Type-2 with HTN,DM Type-2 with HTN,Before 127 kgs – Present 70 kgsBefore 127 kgs – Present 70 kgs

110 kgs with HTN 110 kgs with HTN AFTER 9 MONTHS 78 kgsAFTER 9 MONTHS 78 kgs

102 kgs, Unmarried,Polycystic Ovarian

Disease

BEFORE SURGERY

AFTER 8 MONTHS 55 KGS

Dental Surgeon from Delhi115 kgs, HTN (Before Surgery)

A 32 year old male, 170 kg weight

Gastric bypass done

When we choose to live with When we choose to live with ObesityObesity

• Frequent hospitalization• High cost of medicine• Frequent visit to specialist doctors• Dependability on others,

– e.g. wearing socks, changing clothes, domestic works.

• Various diseases• Laughing stock

Option is yours……

Or

Famous bollywood singer

Before

After surgery