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Bariatric surgery an overview
- 1. Bariatric Surgery- Anoverview 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 TypeII DM strongly linked ‘Diabesity’- coined in 1970 44% of Type II -diabetic population is obese
- 7. Impact of Diabesityon 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 ofDiabesity • Depression childhood adult • Marital discord psychological physical emotional
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- 11. Definition of BariatricSurgery • 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 BariatricSurgery 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 inIndia • 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 • Stomachreduced 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
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- 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 Resolvedafter 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 Surgerya cosmetic surgery ? No • It is approved by Central Government • No service tax
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- 27. Weight Regain “Procedure failedthe patient or Patient failed the procedure” ?
- 28. • Realistic Expectation •> 10% weight regain - Re-surgery Weight Regain
- 29. Loose Skin afterBariatric surgery Is a reality…
- 30. Shape your ownfuture
- 31. Contouring Procedures When todo? • Minimum 12 months after bariatric surgery • 3 months of stable body weight • BMI < 30 • Staged procedures
- 32. Lost 70 Kgin 12 months
- 33. Our Results • 760cases from March 2006 – July 2016 • Mortality: • Within 30 days (2) Bleeding Pulmonary embolism • After 30 days (2) Liver failure Hyperammonemia
- 34. Bariatric Surgery inNews Infertility
- 36. Bariatric Surgery inNews OSA
- 38. Bariatric Surgery inNews Diabetes
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- 42. Lost 98 Kgin one year
- 43. Lost 47 Kgin 8 months
- 44. Lost 40 Kgin 14 months
- 45. Lost 18 Kgin 3 months
- 46. Lost 39 Kgin 6 months
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- 48. Surgical weight lossincreases 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 morbidobesity 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
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