Bariatric surgery is gaining popularity worldwide. The number of surgeries has increased by almost 10 times in the last decade and almost 14000 bariatric surgery were performed last year in India.

1. Bariatric Surgery- An overview
Dr. Deep Goel, FACS (USA), FRCS (England)
Director
Department of Surgical Gastro Onco, Bariatric & Minimal
Access Surgery
Centre for Digestive and Liver Disease
BLK Super Specialty Hospital, New Delhi.

2. Obesity in India
5% population obese – rapidly increasing
63.5 million obese/ 1.27 billion
Prevalence is high in North India
Urbanization and Westernization major factors

5. Obesity + Diabetes = Diabesity
World Capital of Diabesity

6. Diabesity
Obesity and Type II DM strongly linked
‘Diabesity’- coined in 1970
44% of Type II -diabetic population is obese

7. Impact of Diabesity on Society
7th leading cause of death
2.8 million deaths worldwide
Cardiovascular deaths in 50%
> 350 million US$ being spent at present & by 2030 500 million US$
Diabetes Cancer
HTN CKD
CAD PCOD
Hyperlipidemia Infertility
Osteroarthritis

8. Social Impact of Diabesity
• Depression
childhood
adult
• Marital discord
psychological
physical
emotional

9. BMI Chart

10. Bariatric Surgery

11. Definition of Bariatric Surgery
• Bariatric surgery or weight loss surgery is a
spectrum of surgical procedures performed on
obese patients
• Types :
Restrictive : Sleeve & Band
Malabsorbtive : Bilo Pancreatic Diversion
Mini Gastric Bypass
Combined : R&YGB

12. Patient Selection Criteria
BMI ≥ 35 without any co-morbidities
BMI ≥ 32 with co-morbidities

13. History of Bariatric Surgery
1950
Intestinal Bypass(in dogs) 1963
Open jejunoileal bypass by
Payne & DeWind
1980
Vertical banded gastroplasty
1994
Laproscopic gastric bypass
2000
Laproscopic gastric sleeve
1978
Gastric band
1986
Duodenal switch
1997
Open sleeve gastrectomy
2001
Lap-band system approved by
FDA2015
Gastric balloons approved by
FDA
1970
Open gastroplasty

14. Bariatric Surgery in India
• The number of surgeries has increased by
almost 10 times in the last decade and
almost 14000 bariatric surgery were
performed last year in India.

15. Trends in No. of procedures Worldwide
0
100000
200000
300000
400000
500000
600000
2003 2008 2011 2013 2016
146301
344221 340768
468609
548677

16. Sleeve Gastrectomy
• Stomach reduced without loss of function or change in anatomy
• 75-80% EWL

17. Roux-en-Y Gastric Bypass
• General Features
– Pouch size: 1 oz
– 70-80 % of excess weight

18. Gastric Banding

19. Intra Gastric Balloon
Indications
• Patients who don’t want
surgery but want to loose
weight.
Problems
• Time period one year
• Rebound hunger
• Weight regain

20. Medical Co-Morbidities Resolved after Bariatric Surgery
Type 2 Diabetes
95%
Hypertension
92%
Cardiac Function
95%
improvement
Osteoarthritis
82%
Sleep Apnea
75%
GERD
98%
Stress Incontinence
87%
Hypercholesterolemia
97%
Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass roux-n-y-500 patients. Obes Surg 2000. And others.

21. Complications
• Bowel obstruction
• Deep venous thrombosis/Pulmonary embolism
• Leak
• Bleeding
• Nutritional deficiencies

22. Source: Direct Research, LLC, Center for Medicare and Medicaid Services, FY
2010 MedPAR, Medicare Fee-for-Service Inpatient Discharges with Selected
Procedures
Risk of surgery

23. Is Bariatric Surgery a cosmetic surgery ?
No
• It is approved by Central Government
• No service tax

25. Insurance Coverage

27. Weight Regain
“Procedure failed the patient
or
Patient failed the procedure”
?

28. • Realistic Expectation
• > 10% weight regain
- Re-surgery
Weight Regain

29. Loose Skin after Bariatric surgery
Is a reality…

30. Shape your own future

31. Contouring Procedures
When to do?
• Minimum 12 months after bariatric
surgery
• 3 months of stable body weight
• BMI < 30
• Staged procedures

32. Lost 70 Kg in 12 months

33. Our Results
• 760 cases from March 2006 – July 2016
• Mortality:
• Within 30 days (2)
Bleeding
Pulmonary embolism
• After 30 days (2)
Liver failure
Hyperammonemia

34. Bariatric Surgery in News
Infertility

36. Bariatric Surgery in News
OSA

38. Bariatric Surgery in News
Diabetes

40. Bariatric Surgery in News

42. Lost 98 Kg in one year

43. Lost 47 Kg in 8 months

44. Lost 40 Kg in 14 months

45. Lost 18 Kg in 3 months

46. Lost 39 Kg in 6 months

47. Pledge

48. Surgical weight loss increases life span and it is
an effective means to achieve clinically
significant, permanent weight loss, which leads
to significant improvement in health risks
associated with obesity
Take Home Message

49. Take Home Message
• We believe that surgery in recent future would
be an important tool to resolve DM-2 not only
obese people but for people with normal BMI.
Indications of surgery are being relaxed at
rapid pace.

50. “Treatment of morbid obesity should not
be deemed achieved unless plastic surgery
has been considered”
Obes Surg. 2013 Jan;23(1):24-30.doi: 10.1007/s11695-012-
0735-8.
Take Home Message

52. GIS Team