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