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Surgical Management of Obesity<br />Sandeep Malhotra, MBBS, FACS<br />Director Bariatric Surgery<br />Medanta - “The Medic...
Impact of Obesity<br />Comorbid Diseases<br />Disability<br />Premature<br />Death<br />OBESITY<br />MedicalCosts<br />Red...
Medical Implications of Obesity<br /><ul><li>Infertility and menstrual problems
Obstetric complications
Low back pain
DVT & thromboembolism
Depression
Immobility
Cancer (breast, colorectal,   prostate, endometrial, etc.)
Venous/stasis ulcers
Skin infections
Intertrigo
Accident proneness
Diabetes type II
Hypertension
Lipid disorders
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Losing weight made easy

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Transcript of "Losing weight made easy"

  1. 1. Surgical Management of Obesity<br />Sandeep Malhotra, MBBS, FACS<br />Director Bariatric Surgery<br />Medanta - “The Medicity”<br />
  2. 2. Impact of Obesity<br />Comorbid Diseases<br />Disability<br />Premature<br />Death<br />OBESITY<br />MedicalCosts<br />Reduced <br />QOL<br /><br />
  3. 3. Medical Implications of Obesity<br /><ul><li>Infertility and menstrual problems
  4. 4. Obstetric complications
  5. 5. Low back pain
  6. 6. DVT & thromboembolism
  7. 7. Depression
  8. 8. Immobility
  9. 9. Cancer (breast, colorectal, prostate, endometrial, etc.)
  10. 10. Venous/stasis ulcers
  11. 11. Skin infections
  12. 12. Intertrigo
  13. 13. Accident proneness
  14. 14. Diabetes type II
  15. 15. Hypertension
  16. 16. Lipid disorders
  17. 17. Heart disease
  18. 18. Asthma
  19. 19. Sleep apnea
  20. 20. Gallstones
  21. 21. NASH (non-alcoholic steatohepatitis)
  22. 22. Urinary incontinence
  23. 23. Acid reflux
  24. 24. Arthritis and gout</li></li></ul><li>Options for Weight Management<br /><ul><li>Medanta Weight Management Clinic
  25. 25. Intragastric Balloon
  26. 26. Bariatric Surgery</li></li></ul><li>Medical Weight Management<br /><ul><li>Endocrinologist – Evaluation of hormonal imbalance, basal metabolic rate. Prescribe medicines if necessary.
  27. 27. Dietician – Diet plan tailored to patient according to metabolic rate, food preferences, hormonal balance and other factors
  28. 28. Physiotherapist – Plans exercise regimen keeping in mind patients current limitations with gradual increase over time
  29. 29. Clinical Psychologist – Helps patients cope with stress by means other than food</li></li></ul><li>Intragastric Balloon<br />-For BMI less than 32.5<br />- Balloon placed in stomach via endoscopy<br />- Inflated to 400-700 ml<br />- Weight loss 10-12 Kg over 6 months<br />- Removed after 6 months<br />
  30. 30. Bariatric Surgery<br />Who Is A Surgical Candidate?<br /><ul><li>Age 18-65 Years
  31. 31. BMI 32.5-37.5 with associated obesity related medical problems
  32. 32. BMI>37.5
  33. 33. Waist to Hip Ratio >1 (Men) or >0.8 (Women)
  34. 34. Previous attempts at weight loss </li></li></ul><li>Procedures<br />Gastric Banding<br />Lap Sleeve Gastrectomy<br />Lap Gastric Bypass<br />
  35. 35. Percent Medical Co-Morbidities Resolved after Bariatric Surgery<br />Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass roux-n-y-500 patients. Obes Surg 2000. .<br />
  36. 36. Patients live longer………<br /> N Engl J Med. 2007 Aug 23;357(8):741-52.<br /> Effects of bariatric surgery on mortality in Swedish<br /> obese subjects. <br />Sjöström L, Narbro K, et al.<br />Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden. <br />CONCLUSIONS: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.<br />N Engl J Med. 2007 Aug 23;357(8):753-61.                    <br />Long-term mortality after gastric bypass surgery.<br />Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC.<br />Cardiovascular Genetics Division, University of Utah School of Medicine, Salt Lake City, UT 84108, USA. <br />CONCLUSIONS: Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer.<br />
  37. 37. Case Series<br /><ul><li>Total Cases: 955 ( Lap Band 112, Gastric Bypass 478, Sleeve Gastrectomy 365)
  38. 38. BMI Range: 33.5 – 84.0 </li></li></ul><li>
  39. 39. Cost?<br /><ul><li>Lap Sleeve Gastrectomy: 2.5 Lakh in twin sharing
  40. 40. Lap Band: 2.75 Lakh in twin sharing
  41. 41. Lap Gastric Bypass: 2.9 Lakh in twin sharing</li></li></ul><li>Why Medanta?<br />Facility<br />- State of the art with most advanced equipment in the World<br />- Led by Dr. Naresh Trehan, leading Cardiac Surgeon<br />Surgeon<br />- Certified by American Board of Surgery<br />- Fellowship trained in Bariatric Surgery<br />- 10-year experience with about 1000 cases<br />
  42. 42. Laparoscopic Surgery at Medanta<br /><ul><li>Gallbladder Removal
  43. 43. Hernia Repair
  44. 44. Appendix
  45. 45. GI Cancer Surgery
  46. 46. Other Bowel Surgery
  47. 47. Acid Reflux Surgery
  48. 48. Obesity Surgery</li></li></ul><li>Ask your questions on Bariatric surgery<br />Dr. Sandeep Malhotra<br />: +91-9871727401<br />Sandeep.malhotra@medanta.org<br />
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