Dr Manish Agarwal

Bariatric & Metabolic Surgery

Obesity today is recognized as a health problem of epidemic proportions. Obesity refers to a spectrum of problems of excess weight ranging from mild overweight to the morbidly obese. Patients with morbid obesity do not respond to medical means of weight loss. Efforts to treat morbid obesity through controlled diets, behavior modification and exercise programs are only temporarily successful with the patient invariably regaining even more weight than the amount lost.

 

Obesity surgery is the only method by which long-term weight loss can be achieved in these patients. Seven to nine percent (20-25%) people in India are overweight, of which 7-9% are morbidly obese which amounts to a staggering 2 - 2.5 million people. Incidence of child hood obesity is on the rise due to changing lifestyles. These people are more likely to develop obesity related complications at an earlier age. If not addressed today this problem is likely to compound imposing heavily on medical resources.

 

Roux-en-Y gastric bypass

Roux-en-Y gastric bypass (RYGB) is a type of weight-loss surgery that reduces the size of your stomach to a small pouch – about the size of an egg. It does this by stapling off a section of it. This reduces the amount of food you can take in at meals. The surgeon then attaches this pouch directly to the small intestine, bypassing most of the rest of the stomach and the upper part of the small intestine. This reduces the amount of fat and calories you absorb from the foods you are able to eat for even more weight loss.

 

Mini gastric Bypass

The first use of the gastric bypass employed a loop of small bowel for re-construction, rather than a Y-construction as is prevalent nowadays. Although simpler to create, the approach allowed bile and pancreatic enzymes from the small bowel to enter the esophagus, sometimes causing severe inflammation and ulcerationyes either the stomach or the lower esophagus. If a leak into the abdomen were to happen, corrosive fluid can cause severe consequences.

The mini gastric bypass surgery, is considered a minimally invasive procedure and works similarly to the standard gastric bypass in that the stomach is separated into 2 parts. Instead of a small pouch, the stomach is reconstructed to resemble a tube, which is attached near the end of the small intestine.

 

Sleeve gastrectomy

About 80 percent of the bariatric procedures performed in the United States are gastric bypass procedures. The other 20 percent are comprised of restrictive procedures, such as the laparoscopic adjustable gastric band. The laparoscopic sleeve gastrectomy (LSG), a relative newcomer to bariatric surgery, is growing in popularity.

 

The sleeve gastrectomy originated as the restrictive part of the duodenal switch operation. In the last several years, though, it has been used by some surgeons as a staging procedure prior to a gastric bypass or duodenal switch in very high risk patients. It has also been used as a primary, stand-alone procedure by some surgeons.

 

Laparoscopic adjustable gastric banding (LAGB)

Laparoscopic adjustable gastric banding (LAGB) is a surgical procedure that involves the placement of an adjustable belt around the upper portion of the stomach. The band is made of silicone and can be tightened by adding saline to fill the band (like blowing air into a doughnut-shaped balloon). The band is connected to a port that is placed under the skin in the abdomen. This port is used to introduce or remove saline into the band.

 

LAGB ultimately restricts the size of the stomach and the amount of food it can hold. It also slows the passage of food to the intestine. By doing so, signals to the brain from the gut allow for a sensation of fullness and satiety with the consumption of less food.