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Obesity / Metobolic Syndrome & Surgery

3 June 2020

Obesity is preventable and also reversible issue declared as a disease by WHO.

Patients in the Overweight & Obesity categories are at higher risk than Underweight patients.

WHAT IS OBESITY?

  • Obesity in simpler outlook is abnormal or excessive fat accumulation that impairs health. But this abnormal fat starts working as Large Endocrine organ producing some hormones.
  • Fat should ideally be 20% of body weight.
  • Consuming more calories than to burn, can lead to accumulation or storage of either carbohydrates which is converted to fats in the body or whilst consuming fats along with carbohydrates.
  • Occurs more in an urban setting, as the urban setting provides them with a sedentary lifestyle rather than an active lifestyle in the name of convenience.

EFFECTIVE MANAGEMENT

  • In patients with morbid obesity associated with comorbidities, Bariatric surgery is the only available therapeutic modality associated with clinically significant and relatively sustained weight loss.
  • Bariatric/Obesity surgery, substantially cures/significantly reduces the morbidities associated with severe obesity.
  • Surgery can be offered to all at from age of 16-65 yrs as per fitness.

Bariatric Surgery can be Endoscopic Approach where in an inflatable & Deflatable balloon is placed in the Stomach, so that person feels mechanically full & reduces desire to eat. This Balloon can be left for 6-12 months. Together with Life Style management, Dietary advice & staged Exercise programs one can lose the weight so that OPEN / Laparoscopic Definitive procedures can be done to achieve for sustained weight loss.

Endoscopic — Balloon

 

Definitive Bariatric Procedures are varied techniques based on the principle of reducing the stomach capacity, modifying the internal hormonal environment including Insulin & adding Malabsorption procedures.

 Few of Definitive Procedures:

  1. Sleeve Gastrectomy.

It is a procedure where stomach is reduced to the size 3 ounces by removing a part of stomach and is quite effective. Usually Done by Laparascopic/Robotic technique/open procedure.

  1. Gastric Plication is a procedure of Sleeve Gastrectomy, where stomach is plicated like a curtain & made smaller by laparascopic /Endoscopic way.

 3.Gastric By-pass ( Roux –Y) procedures

It is done by reducing the stomach capacity & also bypassing the intestine so that malabsorption component is added for better efficacy.

  1. MGB-Mini Gastric Bypass is simpler procedure of Bypass especially for sweet eaters

More Complicit Procedures, involves intestinal bypasses. Many Morbid/Super Obese people may require more than one procedure.

Is Surgery Free of Complications?

Surgery has its own complications especially related to anastomoses, BUT success rate is excellent in controlling and maintaining weight, appearance of a person cosmetically, feeling of wellbeing, control or Potential cure of Diabetes, Cholesterol related, cardiac & all other morbidities.The success of weight reduction depends also on persons compliance.

 

Article By: Dr. Anantha Kumar Chinnaswamy

Consultant General &  Endo/Laparoscopic Surgeon