Surgical Treatment of Obesity:Bariatrics is the branch of medicine that deals with the causes,prevention, and treatment of obesity.Bariatric surgery (weight-loss surgery) includes a variety ofprocedures performed on obese.
Surgical Treatment of Obesity:• According to the NATIONAL INSTITUTE OF HEALTH (NIH)• BARIATRIC SURGERY IS THE PERMANENT TREATMENT OF CHOICE AND THE ONLY TREATMENT THAT HAS BEEN PROVEN TO BE SUCCESSFUL IN THE LONG TERM ( MORE THAN 10 YEARS).
BARIATRIC SURGERY GUIDELINESTHE CONSENSUS GUIDELINES ON BARIATRIC SURGERYCALIFORNIA ASSOCIATION OF HEALTH PLANS OBESITY INITIATIVEWORKGROUP (CAHP) JUNE 2006THE U.S. NATIONAL INSTITUTE OF HEALTHTHE AMERICAN GASTROENTEROLOGICAL ASSOCIATION (AGA)CLINICAL GUIDELINES DEVELOPED BY THE NATIONALHEART, LUNG, AND BLOOD INSTITUTE EXPERT PANELSOCIETY OF AMERICAN GASTROINTESTINAL &ENDOSCOPIC SURGEONS
Recommends bariatric surgery for obese people: BMI > 40 without co morbidities BMI >35 with 1 or more co morbidities. or BMI of 30 to 35 with significant or serious co morbidities. or When less invasive methods of weight loss have failed and the patient is at high risk for Obesity-associated morbidity and mortality.
Patient Criteria for surgery1. A Body Mass Index (BMI) ≥ 40 or a BMI ≥ 35 with obesity related co-morbid conditions.2. Age – 16 to 65 yrs 3. Screening for mental or behavioral disorders that may interfere with post- operative outcomes (e.g. eating disorders, depression, and substance abuse).4. Counselling and advise to stop using tobacco products & alcohol, 4 weeks prior to surgery.5. No absolute contraindication to major abdominal surgery
6. Should have completed a weight loss program is recommended but not required.eg: dieting, nutritional counseling, an exercise program and commercial/hospital based weight lossprograms.7. Received counseling by a credentialed expert on the risks and benefits of the procedure and thepotential complications of the surgery (including death) and the realistic expectations of post-surgical outcomes.8. To adhere to post-surgical attention to lifestyle, an exercise program and dietary changes and
SPECIAL POPULATIONS criteria• Over 65 years of age– Careful consideration on a case-by-case basis, due to the potential forincreasing risk of complications with advanced age.• Under 16 Years of Age (adolescent obesity)– Careful consideration on a case-by-case basis,due to the unique needs of adolescent patients. – Benefits of performing the surgery on the adolescent patient outweigh the benefits of waiting until the patient reachesadulthood.
– Need for family inclusion in pre-assessment and counseling.– Attainment of skeletal maturity and Tanner Stage IV • Girls ≥ 13 years of age • Boys ≥ 15 years of age– Higher BMI, > 40 may be appropriate– Sufficient Bone Age, may be necessary for determination of physiological
WOMEN OF CHILD BEARING AGE – Special counseling is important due to high-risk nature ofearly post- operative pregnancies, which require specialmonitoring by OB/GYN and the bariatric surgeon. – Counseled to wait 12-18 months until weight loss is stable prior to conception.
Contraindications to Bariatric SurgeryBariatric surgery carries the potential for serious complications, morbidity andpossibly mortality.1. Cardiac complications with poor myocardial reserve.2 Chronic obstructive airways disease or respiratory dysfunction.3.Significant psychological disorders, or significant eating disorders.
CLASSIFICATION OF BARIATRIC SURGERY:Bariatric surgery procedures can be categorized into operations utilizing 3methods to produce weight loss: gastric restriction, mal absorption, or acombination of the two.1. PREDOMINANTLY RESTRICTIVE PROCEDURES2. PREDOMINANTLY MALABSORBTIVE PROCEDURES3. MIXED OR COMBINATION PROCEDURES
RESTRICTIVE PROCEDURES: Procedures that are solely restrictive by creating a small gastric pouch& a degree of outlet obstruction leading to delayed gastric emptying.The goal is to reduce oral intake by limiting gastric volume, produceearly satiety, and leave the alimentary canal in continuity, minimizingthe risks of metabolic complications 1.VERTICAL BANDED GASTROPLASTY 2.ADJUSTABLE GASTRIC BANDING (LAGB ) 3. SLEEVE GASTRECTOMY 4.GASTRIC PLICATION 5. INTRA GASTRIC BALLOON (GASTRIC BALLOON)
MALABSORPTIVE PROCEDURESMalabsorption is achieved by creating a short gut syndrome and/or byaccomplishing distal mixing of bile and pancreatic juice with ingestednutrients thereby reducing absorption.. Some purely malabsorptiveoperations are no longer recommended due to their potential hazard tocause serious nutritional deficiencies.1. BILIOPANCREATIC DIVERSION2. THE JEJUNAL-ILEAL BYPASS3. ENDOLUMINAL SLEEVE
MIXED PROCEDURES:The following procedures combine restrictive and malabsorptive approaches.By adding malabsorption, food is delayed in mixing with bile and pancreaticjuices that aid in the absorption of nutrients. The result is an early sense offullness, combined with a sense of satisfaction that reduces the desire to eat.1. GASTRIC BYPASS ROUX-EN-Y ( RYGBP)2. SLEEVE GASTRECTOMY WITH DUODENAL SWITCH3. IMPLANTABLE GASTRIC STIMULATION
SUCCESS OF BARIATRIC SURGERYBariatric surgery has been available for decades. Most procedures are nowperformed laparoscopicaly.Although various procedures have been described and attempted, the 3 mostcommon procedures performed:1.Laparoscopic adjustable gastric banding (LAGB),2.Laparoscopic roux-en-Y gastric bypass (LRYGB) and3.Laparoscopic sleeve gastrectomy (LSG).Endoscopic Procedures like – Intra- Gastric Balloon / Endo- Barrier System
Vertical Banded Gastroplasty (VBG)The stomach is partitioned along its axis with a non-adjustable poly-urethane band and with linear&circular staples to create a small upper stomach pouchwith a restrictive orifice to the rest of the stomach.No malabsorption of micro or macro nutrients isexpected.No longer done was practised in 1980.
ADJUSTABLE GASTRIC BANDING (LAP BAND SURGERY/ LAGB)Restrictive ProcedureAn inflatable silicone BAND is placed around the topportion of the stomach, to form a small stomach pouch &sewed .This band is connected to a tube that leads to a port abovethe abdominal muscles placed below the skin (FILL –PORT).During follow up visits, we inject or remove saline solutionto make the band tighter or looser.
Adjustable Gastric Band• This Band in the stomach and induces weight-loss in 3 ways: 1. The small stomach pouch causes a sensation of fullness 2. “Squeezing of the stomach pouch like an hour glass prolongs the sensation of fullness. 3. Suppresses appetite by central action.
Complications of Gastric Lap-Band®• Perforation of Stomach• Mal positioning• Abdominal Pain• Heartburn• Vomiting• Inability to Adjust the Band• Failure to Lose Weight• Slippage• Gastric Erosion• Dilated Esophagus• Infection of System• Fatigue or malfunction
LAP SLEEVE GASTRECTOMYLaparoscopic sleeve gastrectomy (LSG) is a standalone procedurefor the surgical management of morbid obesity.It is a rapid and less traumatic operation and thus far isdemonstrating good resolution of co-morbidities and good weightloss.A further second surgical step is then easily feasible, if necessary.
SLEEVE GASTRECTOMYSleeve gastrectomy is a procedure inwhich the stomach is reduced to about25% of its original size, by surgicalremoval of a large portion of the stomachalong the greater curvature. This is doneby using surgical staplers to form a sleeveor a tube with a banana shape.A bougie or GCT between 36 - 40 Fr isused with the procedure .Ideal approximate capacity of the stomachafter the procedure is about 30- 60 mlpouch
BASICS OF THE PROCEDURE:DEFINITION AND PRINCIPLES:-The sleeve gastrectomy is also known as thegreater curvature gastrectomy,vertical or longitudinal gastrectomy orPylorus preserving ‘gastric tube creation’.
The sleeve gastrectomy (SG) induces weight loss by 2 mechanisms:1.MECHANICAL RESTRICTION by reducing the volume of the stomach andimpairing stomach mobility. Also called ‘Food limiting’ operation.2.HORMONAL MODIFICATION by removing a great part of the Ghrelin(Hunger Hormone) production tissue. (Ghrelin is a 28 amino-acid-peptide, secreted by the oxyntic glands of the gastricfungus. It is a potent orexigenic (appetite-stimulating) peptide mediated by theactivation of its receptors in the hypothalamus or pituitary area.)The gastric fundus contains 10 to 20 times more ghrelin per one gram of tissue thanthe duodenum. In the SG, resection of the fundus removes the major portion ofghrelin release, therefore, appetite decreases.
PREOPERATIVE EVALUATIONLABORATORY EVALUATION:Basic chemistry panel, full blood count, thyroid function tests. Serum cortisol, urinecortisol, lipid profile, vitamin (A, B1, B6, B12, C).Serum Insulin, C-Peptide.UPPER ENDOSCOPY:Rule out inflammatory ulcerous gastric pathology, search and treat H pylori infection whenpresent.ULTRASOUND OF THE ABDOMEN:To rule out cholelithiasis, which would indicate cholecystectomy along with the gastricsleeve.CARDIOVASCULAR/RESPIRATORY EVALUATION:Exclude any contraindications to anesthesia by TMT, Echo, PFT, ABG , CXR etc.PSYCHIATRIC EVALUATION:To rule out any behavioral abnormalities that would contraindicate limited food intake.ENDOCRINE EVALUATION: Rule out an endocrine abnormality as the etiology ofmorbid obesity.DENTAL EVALUATION
TEN STEPS OF LSG1. Assembly of instruments, in order of use2. OT set up and Trocar Position3. Liver Retraction –using Nathansons Liver Retractor4. Gastrolysis of greater curvature- distal to prox. Upto> of His.5. Resection of stomach by Stapling – starts from 4 cm distal to pylorus6. Suturing for staple line reinforcement7. Leak test- Methylene blue, air or UGIE8. Extraction of specimen- fish tail technique9. Closure of Ports- by needle passer.
Laparoscopic ProcedureDONE UNDER G.A5 TO 6 PORTSThe benefits are:•Less Pain•Quicker recovery and return to normalactivity•Fewer complications•Less noticeable scar•Shorter hospital stay
POSTOPERATIVE PERIODNo nasogastric tube is placed at the end of the procedure.GASTROGRAFFIN STUDY:A water-soluble upper gastrointestinal study is performed all cases , and forpatients with clinical symptoms and signs of leakage.If no leak observed, then patient is allowed to drink.From D2 to D14, the patient remains on a liquid diet. Over the next 3weeks on pureed diet.Normal diet after 1 month.
ComplicationsPeri-operative Complications of anesthesia, bleeding, positioning or pressure, and those of atechnical nature. Injury to Liver or Spleen.Early Post-operative Complications (30 days) Bleeding: anastomosis leak, infection secondary toleak, wound or other infection, strictures, and deep venous thrombosis/pulmonary embolism.Pulmonary complication -Atelectatsis, pneumonia, pulmonary embolism, respiratory arrestsecondary to sleep apnea, and acute respiratory distress syndrome (ARDS).Gastrointestinal (GI) complication - Ulcer, stricture, anastomonic obstruction, and small bowelobstruction.Late Complications (greater then 30 days) GI ulcer (stricture, obstruction), nutrition deficiency(one or more nutrients, protein, vitamin or mineral), internal/ incisional hernia, redundant skin,failure of weight loss or regain of lost weight, and psychological.
BIB –INTRA GASTRIC BALLOONIntragastric balloon involves placing a deflated ballooninto the stomach, and then filling it to decrease theamount of gastric space.The balloon can be left in the stomach for a maximum of6 months and results in an average weight loss of 5–9 BMI over half a year.Done endoscopicallyThe intragastric balloon may be used prior to anotherbariatric surgery as a stepdowm procedure.
ENDO BARRIER LINER SYSTEM The EndoBarrier gastrointestinal liner mimicsthe effects of gastric bypass surgery.It’s designed to work by inserting a flexibletube-like barrier into the duodenum & prox.Jejunum..The barrier is placed endoscopically via themouth and thus helps patients to loose weightby delaying digestion..Has to be removed after 6 months
B. MAL- ABSORPTIVE PROCEDURES Malabsorptive surgeries rearrange and/or remove part your digestive system which then limits the amount of calories and nutrients that your body can absorb. Treatments with a large malabsorbtive component result in the most weight loss but tend to have slightly higher complication rates.1. JEJUNAL ILEAL BYPASS – no longer performed for high complication rates.2. ILEAL TRANSPOSITION- New malabsoptive procedure on trial for treatment of DM type 2 and metabolic disorders.
C. COMBINATION PROCEDURES RESTRICTIVE + MALABSORBTIVE When surgery combines both restrictive and malabsorptive techniques, it is know as a “combination” procedure. Most types of bariatric surgery carry at least a small element of both components, but the following surgeries achieve a notable portion of weight loss from each…1. LAP. GASTRIC BYPASS – ROUX-EN- Y – more malabsorption than the restrictive2. MINI- GASTRIC BYPASS- mainly restrictive3. DUODENAL SWITCH – the sleeve stomach is the restrictive portion &the intestinal bypass( duodenal switch) is the mal absorptive component
1. LAP. GASTRIC BYPASS/ LGBThe Roux-en-Y gastric bypass(known simply as the LRYGBP) isthe most commonly performedprocedure.It primarily causesweight loss by restricting thefood intake, however there ismore amount of mal absorption thatoccurs with this operation.
Bariatric surgery represents the main option for substantial and long-term weight lossin morbidly obese subjects..Two hypotheses have been proposed to explain the early effects of bariatric surgeryon diabetes--The Hindgut hypothesis theory- Diabetes control results from the more rapid deliveryof nutrients to the distal small intestine, thereby enhancing the release of hormonessuch as glucagon-like peptide-1 (GLP-1).The foregut hypothesis theory – Exclusion of the proximal small intestine reducesor suppresses the secretion of anti-incretin hormones, leading to improvement ofblood glucose control as a consequence increases GLP-1 plasma levels whichstimulate beta cells to produce insulin secretion and suppress glucagon secretion,thereby improving glucose metabolism.
INDICATIONS :1. BMI 35-40: WITH SIGNIFICANT CO-MORBIDCONDITIONS SUCH AS DM, HTN2. BMI 40-60 OR SUPER OBESE3. PATIENTS >18 YEARS4. PATIENTS MUST HAVE ATTEMPTEDSUPERVISED WEIGHT REDUCTION PROGRAMS.
ADVANTAGES:1. Most commonly performed.2. Most reliable operation for long term weight loss.3. Long term weight loss averages 60 to 75 percent of EBW.6. Malnutrition is unusual.7. Substantial improvement & resolution in many co-morbid obesity conditions: Type 2 DM – 90% Sleep apnea -90% Hypertension-70% Hyperlipidaemia-70% Heartburn from GERD- all patients.Urinary stress incontinence-75%89%reduction in mortality over 5 yrs. Following surgery, compared to non-surgically treated group.
GASTRIC BYPASS/ LRYGBP• The stomach is stapled into 2 pieces, one small and one large.The small piece becomes the “new” stomach pouch.• The larger portion of the stomach stays in place, however will lie dormant for the remainder of the patient’s life.
GASTRIC BYPASS/ LGB• The small intestine (the jejunum) isdivided using a surgical staplerApprox. 50-70 cm from the DJ Junction.
GASTRIC BYPASS/ LGB• The end of the Roux limb is then attached to the newly formed stomach pouch . Roux limb or alimentary limb• The Roux limb carries food to the distal intestine. Y- LIMB/ BP • The Y limb or BPD limb carries digestive LIMB 100-150 cmjuices from the pancreas, gall bladder, liver and duodenum to the intestines• The food and the digestive juices mix where the Roux limb and Y limb meet much belowsay 100-170 cm from DJ
LAPAROSCOPIC GASTRIC BYPASS COMPLICATIONS1. Not reversible.2. Mortality 0.5- 1%3. Peri operative complications 5-10%4. Stricture of gastrojejunostomy.-10% (long term)5. Long term risk of protein &vitamin deficiency, and marginal ulceration of GJA.6.Long term risk of intestinal obstruction – 2%.
Bariatric surgery can be effective in achieving significant weight loss, restoration of thehypothalamic pituitary axis, reduction of cardiovascular risk and even in improvingpregnancy outcomes.Ultimately, bariatric surgery should be considered part of the treatment in PCOSwomen, especially in those with MS.
Weight and type 2 diabetes after bariatric surgery: systematicreview and meta-analysis.Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I.SourceDepartment of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. firstname.lastname@example.org 1. METABOLIC IMPROVEMENTS AFTER BARIATRIC SURGERYBariatric surgery ameliorates metabolic abnormalities.BMI and excess body weight decreases substantially after surgery .Marked improvement is noted in glucose abnormalities, dyslipidemia and hypertensionImprovement of DM II @ 2YR follow up after surgery is proportional to weight loss.
Fasting glucose and insulin resistance measured by (HOMA-IR ie; HOMEOSTASISMODEL ASSESMENT INSULIN RESISTANCE) candecrease > 50% within 1 month of surgery.Whereas INSULIN SENSITIVITY measured by the eug lycemic –hyper insulinemicclamp does not change as quickly.Hypertension – 75% saw improvement, in 50% there was complete resolution.WC, Lipid Profile, Insulin resistance along with in prevalence of MS from 55% - 0%in 1 yr.
Clin Endocrinol Metab. 2005 Dec;90(12):6364-9. Epub 2005 Sep 27.The polycystic ovary syndrome associated with morbid obesity may resolve afterweight loss induced by bariatric surgery.Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, Sancho J, San Millán JL.SourceDepartment of Endocrinology, Hospital Ramón y Cajal, Madrid E-28034, Spain.email@example.com 2. ROLE OF BARIATRIC SURGERY IN PCOS PATIENTS A limited number (n = 17) of PCOS patients with an average age of 30 years were followed prospectively for up to 26 mo after bariatric surgery. Most women (12/17) regained normal menstrual function and most (10/12) had documented spontaneous ovulation. . Significant improvement in hirsutism, androgen profiles and about a 50% reduction in HOMA-IR Follow up for more than 2 years showed that all women resumed normal menstrual cycles, HbA1C decreased from 8.2% to 5.1% in < 3 months. 78% saw improvement in metabolic syndrome & 48% showed improvement in PCOS .
COMPLEX DISORDERKey features of polycystic ovarian syndrome and improvements seen afterbariatric surgery. BMI: Body mass index.
3. BARIATRIC SURGERY IN ADOLESCENTS35% reduction in BMI and resolution of hypertension.BMI decreases by more than 10 unitsReduction in glucose abnormalities > 80%Excess weight loss > 80%Reduction in Metabolic SyndromeImproved Insulin Sensivity.
4. BARIATRIC SURGERY IN REPRODUCTIVE WOMEN:Decrease menstrual irregularities.PCOS women have less hyper androgenismSex hormone binding globulin increasesLH and FSH levels have been reported to increaseOvulatory function measured by luteal LH and Progesterone secretion improved .Leptin levels decrease , reflecting improved reproductive metabolic status.Subclinical hypothyroidism significantly reduced.
The incidence of gestational diabetes were drastically decreased.No effect on post-partum hemorrhage, infection, shoulder dystocia or fetal demise.
Improvements in pregnancy induced hypertension and diabetes mellitus and a decrease incesarean delivery rate.The length of labor decreased as well as neonatal birth weight.
Transmission of obesity to offspring was reduced by 50%ORThe risk of fetal macrosomia was reduced
THE SAFE TIMING OF PREGNANCYoptimal or minimal time>12 mo after bariatric surgery before becoming pregnant in order to allow therapid weight loss and metabolic changes to subside.
104 pregnancies were followed in women who became pregnant < 1 year (mean 7.0mo) of bariatric surgery compared to385 pregnancies (age, BMI matched) conceived > 1 year (mean 56.7 mo) post-operatively.There were no differences inMaternal complicationsFetal outcomesDelivery complications
5. CONCLUSIONOverall, PCOS is highly prevalent and strongly associated with obesity and MS.PCOS with obesity and/or MS develop coronary artery disease and glucose abnormalitiesat a very young age and are therefore at risk for life threatening cardiac events.Bariatric surgery is a powerful tool that should not be overlooked simply because a womanis young or presents with PCOS and MS.Every woman with PCOS and MS should be offered education and counseling regardingthe role of bariatric surgery in reducing their illness.Bariatric surgery should be considered along with other medical and lifestyle alterations asfirst line therapy in PCOS women with obesity and MS.
Research Ranking scores using a combination of factorsTypes of Bariatric Category Average Long Term Complication Rate Research Ranking*Surgery Excess Weight Loss (and reason if below ‘A’ (approx. %)LGB Combination (primary 50 to 70% Up to 15% A restrictiveLap Gastric Banding Restrictive 25% to 80% Up to 33% ABPD/DS Mal absorptive 65% to 75% Up to 24% AVertical Banded Restrictive 50% TO 60% Up to 21% BGastroplastyVertical Sleeve Restrictive 65% to 75% Up to 10% BGastrectomyMini Gastric Bypass Combination (primary 60% to 70% Up to 8% CSurgery restrictiveTGVR Restrictive Needs more research n/a CTOGA System Restrictive n/a n/aEndobarrier Mal absorptive n/a n/a DEndoluminal LiningImplantable Maestro Neither restrictive nor n/a n/aSystem mal absorptive; electrical impulses said to affect hunger
SUMMARY OF ALL TYPES OF SURGERYLRYGBP – worlds best procedure, 60-70% WL, dumping syndrome,malnutrition.LAGB- low complications, varying range of wt. loss, frequent post-op visits ( 10)DS/BPD- more wt. loss , high complications, good for high BMI > 50,malabsorption +VBG – longest available results, good wt. loss, improved co-morbidities, right forsome pts.risks too high to justify rewardsSG- needs long term research, 1st step procedure, low risks, higher wt. loss,pouch could Stretch over time, long staple line could cause problems in future .
RESOLUTION OF DISEASES FOLLOWING BARIATRIC SURGERY
TABLE SHOWING % OF WEIGHT LOSS AT SHANTI MEMORIAL HOPSPITALS.L PATIENT INTIAL B.M.I I.B.W P.B.W WEIGHT D.OO PROCEDURE % OFNO NAME BODY LOSS (K.G) WEIGH WEIGHT T LOSS1 RAGHAV 135 KG 44.5 76 KG 72 KG 63 KG 27.02.2010 SLEEVE 96 % GOENKA GASTRECTOMY2. SANJAY 158 KG 56 72 KG 80 KG 68 KG 23.04.2010 SLEEVE 79 % SWAIN GASTRECTOMY3. DIGBIJAY 127 KG 45 70 100 KG 27 KG 23.04.2010 SLEEVE 47% SAHOO GASTRECTOMY4. MANOJ DAS 139 KG 56 60 KG 90 KG 49 KG 09.12.2010 SLEEVE 58% GASTRECTOMY5. SANTOSH 108 KG 46 57 KG 67 KG 41 KG 16.01.2011 SLEEVE 80% PRASAD GASTRECTOMY6. M.ARUNA 112 KG 44 63 KG 75 KG 32 KG 07.04.2011 SLEEVE 65% GASTRECTOMY7. MANASMITA 110 KG 43 60 KG 78 KG 29 KG 25.07.2011 SLEEVE 58% PRIYADARSINI GASTRECTOMY8. UMESH 100KG 35.5 72 KG 80 KG 20 KG 04.11.11 SLEEVE 53% GOENKA GASTRECTOMY9. HEENA 132 KG 53 63 KG 92 KG 40 KG 17.04.2011 SLEEVE 58% AGARWAL GASTRECTOMY10. KISHANLAL 109 KG 38 72 KG 83 KG 26 KG 12.05.2012 SLEEVE 70 % PANCH GASTRECTOMY
TABLE SHOWING % OF WEIGHT LOSS AT SHANTI MEMORIAL HOPSPITALS.L PATIENT INTIAL B.M.I I.B.W P.B.W WEIGHT D.OO PROCEDURE % OFNO NAME BODY LOSS (K.G) WEIGH WEIGHT T LOSS11. CHANDAN 149 KG 47 79 KG 95 KG 54 KG 12.05.2012 SLEEVE 77% MOHANTY GASTRECTOMY2. PUSPITA DAS 100 KG 41 60 KG 75 KG 25 KG 10.06.2012 SLEEVE 62.5% GASTRECTOMY3. GOPAL 107 KG 37.5 73 KG 86 KG 21 KG 10.06.2012 SLEEVE 61% SIKARIA GASTRECTOMY4. SUDATTA DAS 90 KG 43 52 KG 56 KG 34 KG 07.07.2012 SLE EVE 84.5% GASTRECTOMY5. RABINDRANA 107 KG 42 66 KG 81 KG 26 KG 15.07.2012 SLEEVE 63% TH SENAPATI GASTRECTOMY6. SMITARANI 100 KG 40.5 57 KG 71 KG 29 KG 19.08.2012 SLEEVE 60% SWAIN GASTRECTOMY7. VIJAY 174 KG 56 76 KG 153 KG 21 KG 03.09.2012 SLEEVE 21.5% SHARMA GASTRECTOMY8. VINOD 154 KG 55 71 KG 126 KG 28 KG 03.09.2012 SLEEVE 35% SHARMA GASTRECTOMY9. DINESH 122 KG 43 65 KG 98 KG 24 KG 01.10.2012 SLEEVE 42% AGARWAL GASTRECTOMY10. APARAJITA 100 KG 38 65 KG 83 KG 17 KG 04.11.2012 SLEEVE 33% PATNAIK GASTRECTOMY
Conclusions• Bariatric surgery is an effective means to achieve clinically significant, permanent weight loss with low rates of complications