Bariatric Surgery India

Morbid Obesity Management

Morbid obesity is the term that is used to refer to individuals who are so overweight that it adversely affects their health.

Morbid obesity may be defined as being

  • 100 pounds above recommended weight
  • BMI more than 40
  • BMI more than 35 with associated obesity related illness

BMI categories include:

  • Normal BMI 19 to 24
  • Overweight BMI 25 to 29
  • Obese BMI 30 to 39
  • Extreme (Morbid) Obesity BMI 40 to 49
  • Super Morbidly Obese BMI 50+
  • Obesity related problems

    • Type 2 diabetes
    • High blood pressure/heart disease
    • Osteoarthritis of weight-bearing joints
    • Sleep apnea/respiratory problems
    • Gastroesophageal reflux disease (hiatal hernia and heartburn
    • Depression
    • Infertility
    • Urinary stress incontinence
    • Coronary artery disease
    • Cerebrovascular accident
    • Congestive cardiac failure
    • Dyslipidemia
    • Cholelithiasis and gallbladder disease
    • Menstrual abnormalities
    • Cancer (inluding esophageal, stomach, liver, pancreatic, kidney, non-Hodgkin’s lymphoma, multiple myeloma, prostate, ovarian, uterine, gallbladder, and colon malignancies)

    The goal of bariatric surgery is to improve health in morbidly obese patients by achieving long-term, durable weight loss. It involves reducing caloric intake and/or absorption of calories from food, and may modify eating behavior by promoting slow ingestion of small boluses of food.

    There are five main types of bariatric surgery operations

    • Laparoscopic adjustable gastric band (LAGB)
    • Roux-en-Y gastric bypass (RYGB)
    • Biliopancreatic bypass with a duodenal switch (BPD)
    • Vertical banded gastroplasty (VBG)
    • Sleeve gastrectomy (SG)

    Laparoscopic adjustable gastric band
    LAGB works primarily by decreasing food intake. Food intake is limited by placing a small bracelet-like band around the top of the stomach to produce a small pouch about the size of a thumb. The outlet size is controlled by a circular balloon inside the band that can be inflated or deflated with saline solution to meet the needs of the patient. Gastric banding is the least invasive of the purely restrictive bariatric surgery procedures

    Roux-en-Y Gastric Bypass
    RYGB works by restricting food intake and by decreasing the absorption of food. Food intake is limited by a small pouch that is similar in size to the adjustable gastric band. In addition, absorption of food in the digestive tract is reduced by excluding most of the stomach, duodenum, and upper intestine from contact with food by routing food directly from the pouch into the small intestine.

    Biliopancreatic diversion with a duodenal switch
    Biliopancreatic diversion with duodenal switch is a complex bariatric operation that includes removing the lower portion of the stomach and creating a gastric sleeve with the small pouch that remains. That pouch is connected directly to the small intestine, completely bypassing the duodenum and upper small intestine from contact with food. BPD produces significant weight loss. However, the mortality rate is higher than with other bariatric operations and there are more long-term complications because of decreased absorption of food, vitamins, and minerals.

    Vertical banded gastroplasty
    The vertical banded gastroplasty, introduced in the early 1970s, is a relatively fast and simple operation to perform. It consists of the creation of a small upper gastric pouch with a restricted orifice to the rest of the stomach. It has the advantage of not bypassing, resecting, or rearranging any part of the gastrointestinal.

    Gastric sleeve
    A gastric sleeve operation restricts food intake and does not lead to decreased absorption of food. However, most of the stomach is removed, which may decrease production of a hormone called ghrelin. A decreased amount of ghrelin may reduce hunger more than other purely restrictive operations, such as gastric band.

    Contraindications

    • Who are unable to undergo general anesthesia because of cardiac, pulmonary, or hepatic disease
    • Who are unwilling or unable to comply with postoperative lifestyle changes, diet, supplementation, or follow-up.
    • Patients with ongoing substance abuse, unstable psychiatric illness, or inadequate ability to understand the consequences of surgery are also considered to be poor surgical candidates.