A major health problem, obesity poses as a risk factor to many diseases. For morbidly obese patients, bariatric surgery provides gradual, sustained and significant weight loss. As a result, there is a marked improvement in obesity-related comorbidities. Obesity is a chronic, multifactorial disease that is caused due to various reasons such as social, behavioral, genetic, and psychological components. Energy output is much lesser compared to energy input into the body.
It is the harbinger of cardiovascular diseases, respiratory dysfunctions such as asthma, obesity-hypoventilation syndrome, obstructive sleep apnea etc. Musculoskeletal, urologic and gastrointestinal diseases are aggravated due to obesity. Surgery for obesity is recommended when every other resort to reduce like exercise, dieting, drug treatments and psychotherapy, has failed. A typical workup before surgery for obesity will include CBC, liver and thyroid function tests, vitamin B-12 and urinalysis. Chest imaging and ultrasonography of the gallbladder are also obtained. The presence of any upper gastrointestinal diseases is dismissed with an upper endoscopy.
Techniques for bariatric surgery can be either open or laparoscopic. The laparoscopic approach has proven more beneficial against the open approach.
There are several surgical options:
Laparoscopic sleeve gastrectomy: 15- 20 % reduction of the stomach from its original size is accomplished with a sleeve gastrectomy. A large portion of the stomach is surgically removed at the greater curve. There is sufficient improvement in comorbidity and weight loss mechanisms due to gastric restriction. It is a 2-stage surgery and is a widely recommended stand-alone procedure. The operation restricts the amount of food intake due to the decrease in the appetite-prompting hormone ghrelin.
Laparoscopic adjustable gastric banding: A flexible, adjustable and inflatable band is placed around the proximal stomach. A gastric pouch of about 15 mL in volume is created along with a small stoma. Adjustability is with the help of a reservoir system attached to the band that adds or removes the saline from the inflatable band. The reservoir is accessible through a port that is attached to the band with a catheter. It takes approximately 2 years to experience about 60% loss of surplus weight.
Biliopancreatic diversion with duodenal switch: A tubular stomach is created and the duodenum is divided past the pyloric valve along with the ileum. The distal end is anastomosed to the proximal duodenum and a common channel is distally created with a Y-anastomosis. Protein absorption is minimized and fat malabsorption occurs resulting in weight loss.
A preoperative nutritional consultation is conducted by Dr. Deepak to obtain diet history and to offer effective postoperative diet protocols.