Bariatric & Weight Loss Surgery and Best Surgeon In Delhi NCR
Bariatric Surgery (also called Weight Loss Surgery) is performed on obese patients for reduction of weight & also for relief from co-morbidities like diabetes, hypertension and obstructive sleep apnoea. This weight loss is usually achieved by reducing the size of the stomach with an implanted medical device (gastric banding); or through removal of a portion of the stomach (sleeve gastrectomy); or by resecting and re-routing the small intestines to a small stomach pouch (Roux en y gastric bypass/Minigastricbypasssurgery).
Types of Bariatric Surgery
LSG (Sleeve Gastrectomy)
Sleeve Gastrectomy includes the removal of the stomach sleeve to allow it to hold between 50 and 150 milliliters of fluid based on the size of the bougie.
Sleeve Gastrectomy is an irreversible process. The advantage of sleeves is that it eliminates the stomach portion, which produces hormones that trigger appetite (Ghrelin). It is also less likely to cause dumping because of the protection of pylorus. By avoiding the bypass of the intestinal and the possibility of obstruction in the intestinal tract (blockage) and osteoporosis, anemia, vitamin deficiency, and protein deficiency are greatly decreased. Highly effective as a one-stage procedure for patients with high BMI sufferers (BMI over 55kg/m2) with limited results, it has been observed as a one-stage procedure for lower BMI people (BMI 35 to 45 kilograms/m2).
LRYGB (Gastric bypass)
Laparoscopic Roux-en-Y bypass of the gastric includes a mix of both malabsorptive and restrictive components. It comprises a 25-30 cc pouch and bypasses 70 to 100 cm of the biliopancreatic leg and 100 to 130 cm of the alimentary limb.
The benefit of gastric bypassing is weight loss and better control of diabetes. However, it can be linked to dumping syndrome, nutrition deficiencies, etc. Patients must consume a lifetime supply of multivitamins and minerals.
Laparoscopic Mini Gastric bypass (LMGB)
Laparoscopic Mini Gastric bypass creates an extended gastric tube and connects it from 180 to 200 cm below the small bowel using only one anastomosis. In contrast to traditional gastric bypass, it is less prone to early and long-term complications and may result in weight loss comparable to that of. However, there is a drawback - that it can cause bile reflux. It is discussed, but very few patients notice it.
If we evaluate the four procedures, sleeves gastrectomy has advantages and disadvantages. It has a lower risk of infection than bypasses and is more efficient in weight loss.
Because it doesn't require any bypass or diverting of the intestinal tract, there is a lower possibility that patients will need long-term vitamin minerals, protein, or mineral supplements. Contrary to gastric bypasses, you have normal gut anatomy and thus routine diagnostic procedures like Gastroscopy as possible post-operatively. There isn't any "dumping" with the sleeve gastric surgery, as is the case with gastric bypasses, and significant diet changes are not necessary compared to that of the gastric band. But, unlike gastric bypasses that are permanent, the stomach is eliminated. There is also the possibility of transforming the gastrectomy sleeve into another weight loss process, typically gastric bypass if the need arises in the future. After you have completed the initial perioperative phase and have completed the procedure, the chance of having further issues with a gastric sleeve is very low.
Take your time weighing the benefits and drawbacks of each bariatric option before deciding which to consider the best option that is right for you. If I believe that a specific procedure has advantages, I'll advise you during our appointment.
SLS (Scarless) Surgery for bariatrics
Single-incision procedures are growing in popularity, and bariatric surgery is not an exception. One-incision bariatric surgery may be carried out in a select subgroup of patients, particularly young females less than 180 centimeters and who have not had any previous umbilical surgery.
Laparoscopic Roux-en-Y Gastric Bypass:
A common form of gastric bypass surgery is the Roux-en-Y gastric bypass. Here, a small stomach pouch (25-30 ml) is created with a stapler device, and connected to the distal small intestine. The upper part of the small intestine is then reattached in a Y-shaped configuration. The patient can lose about 70 to 80% of excess weight and motivated patients can achieve ideal body weight with resolution of their co morbidities. The patients need to know that they have to take vitamins and minerals and iron supplements for a long time (lifelong). Dumping Syndrome, mineral and vitamin deficiencies and marginal ulcer at anastomotic site are few of the complications associated with this procedure.
Laparoscopic Mini Gastric Bypass:
Laparoscopic Mini Gastric Bypass consists of forming a long gastric tube and attaching it 200 cm down to small bowel with single anastomosis. Unlike conventional gastric bypass it has fewer early and long term complications and can achieve weight loss similar to it. The disadvantage is bile reflux which is mentioned but practically very few patients observe it.
- Laparoscopic Gastric Plication
- SILS Surgery
- Revisional surgery
FOOD ITEMS TO AVOID:
- Food items are cooked with excessive spice.
- Fruits like kiwi, strawberries
- The vegetables that are hard to digest include broccoli and cauliflower.
- The final step is eating soft foods, chewable foods like eggs and baked fruits, fish, etc.
- The final phase is the stabilization of your diet. Now, you can eat smaller portions of solid food, and it generally takes about two months to get to this point. Do not eat foods that cause abdominal discomfort.
Foods to avoid during the final phase of post-surgery care
- Fried food
- Dry food items
- The tough meat
- Products that have excess sugar
What is Minimal Access Surgery or Keyhole Surgery?
Minimal Access Surgery is an advanced technique for doing all types of surgical procedures. A thin telescope known as laparoscope and working instruments are inserted through small incisions (3-12mm) in the abdominal wall. The laparoscope is connected to a tiny video camera which projects the inside view of patient's body to a high resolution monitors in the operating room. These incisions are usually covered with surgical glue/ closed with absorbable sutures and after a few weeks are barely visible thus avoiding any follow-up visit for suture removal.
Benefits of Minimal Access Surgery
There are numerous benefits of MAS over Open surgery: Faster recovery, shorter hospital stay, minimal pain, minimal scarring, early resumption of normal activity to name a few.
Who are the candidates for Bariatric/Weight Loss surgery? (Am I a Candidate?)
- BMI > 37.5 kg/m2.
- BMI > 32.5Kg/m2 & co-morbidities like Hypertension, Diabetes, etc.
- Failed supervised medical weight-loss program.
- Age between 18 to 65 years.
- Committed and motivated.
- If you are fit enough to undergo an anesthetic procedure and surgery.
How can I lose weight?
Mild form of obesity can be treated with Diet, Exercise & Medication, however for people who are severely obese after conventional approaches to weight loss such as diet and exercise - have failed, or for patients who have obesity - related complications, surgery may be the best treatment option and life saving at times.
When can I start walking after surgery?
Same day after surgery doctors will require you to get up and move about when you have recovered fully from anesthesia. Patients are asked to walk or stand at the bedside on the night of surgery, take several walks the next day and thereafter.
When do I get discharged from the hospital and resume work?
In a good surgical set-up and excellent team patient may be discharged 2nd day after surgery. Most patients go home after 3 days and some with preop co morbidities may need few more days to settle their co morbidities. You could start your office/desk work after 7 days of surgery.
What about the post surgery scars?
Scars like any other laparoscopic surgery are almost invisible in patients with good healing and also we use absorbable sutures so there is no need of stitch removal. Patients can bath the next day after surgery.
Can I get pregnant after surgery?
Yes, of course but it is strongly advised that pregnancy should be postponed for at least one year after surgery, as by then your body will be fairly stable and nutritional status in place with that you should be able to carry a normal healthy foetus. However, you should consult your surgeon and get evaluated before you plan for pregnancy.
When can I resume my normal sexual activity?
As early as you are pain free and once you resume your normal activity. Vigorous sexual activity should be avoided till 2 months after surgery.
When can I start to drive?
You could start driving from third day of surgery. However, it is recommended that you dont take a long drive as it increases the chances of DVT (Deep Vein Thrombosis).
Will my Diabetes be corrected with weight loss surgery?
It is known that type 2 Diabetes Mellitus is strongly associated with Obesity and with weight loss surgery patients become Euglycaemic and also it depends on duration of diabetes, family history and duration of use of insulin. It is observed that those patients who don't get remission from diabetes have better glycemic control after surgery.
Why Choose Surgeons at Rg Hospital For Bariatric Surgery ?
Obesity has become a global concern. Bariatric Surgery is a good option if you’re failing to lose weight and facing severe medical issues because of it. Prospering bariatric surgery requires a team of experts, including your surgeon, dietitian, psychologist, nurse case manager, and obesity medicine specialist, who will be beside the patient on different paths of the weight loss journey. Patients will do better & have a speedy recovery if they continue to eat healthily, work out regularly, follow all the instructions and advice of the doctor post-surgery.
Meet Our Bariatric Expert:
Dr. Pankaj Gupta
Sr. Consultant - General & Laparoscopic Surgery
MBBS, MS, MRCS(UK), FIAGES, MIMSA
Dr. Pankaj Gupta is Senior Consultant Laparoscopic Surgeon in RG Stone, East of Kailash. He completed MBBS from Calcutta National Medical College, Kolkata in 2002, MS (General Surgery) from Institute of Post Graduate Medical Education and Research (IPGME&R) & SSKM Hospital, Kolkata in 2008 and MRCS from The Royal College of Surgeons, Edinburgh, United Kingdom in 2012. Dr. Pankaj has done his Senior Residency (Registrar) in Surgery from AIIMS, Delhi, where he got extensive exposure and experience for 3 years (June 2008 - June 2011).
In his past 13 years of experience, Dr. Pankaj Gupta has worked as Consultant General & Laparoscopic Surgeries with various reputed hospitals in Delhi & NCR like Indraprastha Apollo Hospital (Delhi), Paras Hospital (Gurgaon). He has also worked as Speciality Doctor for General, Laparoscopic and Robotic Surgery at Medway NHS Foundation Trust, United Kingdom.
Dr. Pankaj Gupta is a member of Indian Association of Gastrointestinal Endosurgeons (IAGES), Association of Minimal Access Surgeons of India (AMASI), Indian Hernia Society (IHS).
MSc ( Food & Nutrition)