OVERVIEW The problem of obesity Indications for bariatric surgery Bariatric surgery Procedures Conclusions Dr. Yogesh agarwala beriatric surgeion

1. Dr. Sharda Jain
Dr. Jyoti Agarwal
Dr. Yogesh Agarwal
Morbid obesity
Needs Surgery
…Caring hearts, healing hands

3. OVERVIEW
• The problem of obesity
• Indications for bariatric surgery
• Bariatric surgery
• Procedures
• Conclusions

5. What is morbid obesity & its
Prevalence
Morbid obesity is a disease, which is chronic and lifelong
Causative factor of the disease is due to excessive fat
storage
• More than 20% of Indian adults are over weight
• The number of over weight children has doubled in last
20 years.

6. It is calculated by the following formula

7. What is BMI?
The BMI of a person who is:
Western Asian / India
Average built 21-25 18-22.5
Over Weight 25-30 22.5-37.5
Obese 30-40 27.5-37.5
Morbidly Obese >40 >37.5
Super Obesity >50 >47.5

8. CLINICALLY
SEVERE OBESITY
100 Lbs above idea body weight
OR
BMI > 40 kg/m2
India >37.5kg/m2

9. How does morbid obesity differ from
being overWeight/ obese?
• Being over Weight and obese are
reversible condition that can be
treated by medical management
dedicated weight loss program
Whereas Morbid Obesity require
surgical intervention

10. How does morbid obesity differ from
being overWeight/ obese?
• The body mechanisms that control a person’
Weight are set in such a manner in morbidly
obese patients that they gain Weight easily
• These patients find it
difficult to lose Weight
and even more difficult
to sustain it

11. MORBID OBESITY
• The estimated number of annual
deaths attributable to obesity among
US adults is approximately 325,000
• More than 80% of these deaths
occurred among individuals with a
BMI of > 30 kg/m2
• Do not Ignore it !!
JAMA , 282(16), 1530-1538

12. OBESITY
• Results from a complex interaction of
genetic, behavioral, and
environmental factors
• Second leading cause of preventable
death, exceeded only by cigarette
smoking
• Do Not Ignore it !!

13. MORBID OBESITY IS ASSOCIATED
• HTN
• Diabetes
• CAD
• CHF
• Cirrhosis
• Osteoarthritis
• Vascular disease
• Gallbladder disease
• Sleep apnea
• Breast cancer
• Uterine cancer
• Prostate cancer
• Colon cancer
• Psychiatric disease

14. What are the risks associated with
morbid obesity
• Morbidly obese person are victims of
prejudice and public ridicule due to their
size This repeated mental trauma leads to
psychological illnesses such as depression
• Discrimination at work result in poor
socio-economic condition

15. What are the risks associated with morbid
obesity
• Morbid obesity is an extreme health
hazard with medical, psychological social,
physical and economic co-morbidities.
• There is increased risk of developing high
blood pressure, diabetes (type2),heart
disease, stroke, gallstone disease ,cancer of
breast, prostate and colon

16. Morbid obesity is a treatable
cause of early preventable
deaths

17. Morbid Obesity is treatable
Morbid obesity is a disease like any other disease
It is need to fixed up early necessary to recognise
this entity as a cause of mental and physical
morbidity which show significant improvement
following Weight loss It is more important for the
patients themselves to understand this disease, its
morbid implications and their inability to control it
on their own.

21. • Reduce – 2.5 BMI for INDIAN

22. What is bariatric surgery?
• Bariatric surgery is a treatment option
for patients with morbid obesity.
• This surgery helps you lose Weight by
altering your body’s food digestion and
absorpticn
• There are several surgical options,each
having their benefits and risks(see Fig.)

24. Some Bariatric Procedures
“Procedure of past”

25. Vertical Sleeve Gastrectomy
Popular Method

26. Roux – en – Y Bypass
Popular Method

27. Mini Gastrectomy Bypass
Popular Method

28. Is morbid obesity surgery for you?
• You will qualify for morbid obesity
surgery if:
• You are classified as Morbidly obese,(BMI
more than 37.5)
• Your BMI is 32.5-37.5 with severe obesity
related medical e.g. other methods of
Weight loss(dietary/medicines)have
been unsuccessful

29. Is morbid obesity surgery for you?
• You are unable to perform routine
activities/daily chores due to the Weight
problem
• You have understood the surgical
procedure for Weight loss; the risks and
after effects involved and are committed
to making lifelong behavioral changes
pertaining to dietary and physical
activities

30. How does morbid obesity surgery change life?
lifestyle adjustments is the key
• Patient must learn to food in small
amounts chew well and eat slowly
• Follow-up is necessary in the first
year after surgery as advised by your
surgeon for dietary/nutritional
experts

31. How does morbid obesity surgery
change your life
Lifestyle adjustments:
Patient must learn to eat food in small
amounts and chew it well and slowly
Follow-up is necessary in the first year `after
surgery and then as advised by your surgeon
for dietary/nutritional counseling
Weight loss starts soon after surgery and
continues for 2 years

32. How does morbid obesity surgery change
your life
Improvements occur in obesity related medical
condication
There is enhanced quality of life with improved
stamina,mood esteem h body image
Care for the morbidly obese requires a
comrehensive set-up.The management team
comprises of the surgeon, Dietician,
Endocrinologist, Physiotherapist and
Psychologist.

33. Post operative instruction and information
• After the operation you will be kept in
the recovery room .This period may vary
few minutes to few hours the anaesthetic
decides about your shifting to room The
decision depends on many technical
factors.
• You will be sleepy immediately after the
operation due to sedation given during
the recovery period.

34. Post operative instruction and information
• You may have some discomfort When coming out of
the effect of sedation . It gradually reduces to a
tolerable level within hours few minutes Without
any pain killer However, if necessary may ask for
pain killer injection/ tablets. You Should try to avoid
these drugs because they produce drowsiness and
you may sleep for a longer period which is not
desirable

35. Post operative instruction and information
You may feel nauseated in the
immediate post- operative period,
and you may even vomit which
should not cause any worry. This
generally gets over after few
hours.

36. Post operative instruction and information
• You may be allowed sips of water on day of
procedure and will be able to walk in few
hours after the procedure. You may undergo
contrast study the next day followed by full
liquid diet
• diet which includes
water/tea/coffee/milk/juices or some clear
soups. Aerated drinks to be avoided.

37. Post operative instruction and information
• The diet will progress gradually from liquids
to pureed to soft to solid over a period of 4-6
week A detailed diet chart will be provided
which needs to be strictly followed.
• You will be required to take regular oral
supplement consisting of lron , Calcium and
Vitamins for period Which will be decided by
the surgeon during follow up

38. Post operative instruction and information
• You should try to move the limbs and can sit
up immediately after operation .There are no
restriction Whatsoever for the Physical
movement. In fact majority of the patients will
feel much better after they have started the
movement. The pain also dramatically
reduces once you start sitting up, moving and
Walking

39. Post operative instruction and information
• There is no restriction on climbing of stairs,
lifting Weight etc .You may even drive two
Wheelers or car as soon as You as you feel fit
.This infact is one of the major advantages of
the Laparoscopic procedure.
• You will be discharged after resumption of
adequate oral liquid intake on liquid diet with
advise for follow-up visit.

40. Post operative instruction and information
• In very few cases there may be same blood
/whitish discharge from the wound in the post
operative period. This should not bother you
because it is generally harmless. You can wipe
the discharge and apply band –aid so as to
avoid staining of the clothes. If it is more you
should report to the surgeon during the next
visit .please feel free to ask question that may
come to your mind for treating surgery.

41. CONCLUSIONS
• OBESITY IS A MAJOR PROBLEM IN
INDIA
• CURRENT DIET AND DRUG
THERAPY OFFERS LIMITED
SUCCESS FOR THE MORBIDLY
OBESE PATIENT

42. CONCLUSIONS
• BARIATRIC SURGERY OFFERS THE MORBIDLY
OBESE LONG-TERM WEIGHT LOSS WITH
IMPROVEMENT IN MORBIDITY AND
MORTALITY
• LAPAROSCOPIC BARIATRIC SURGERY CAN BE
PERFORMED SAFELY WITH EXCELLENT
RESULTS

43. Dr. Yogesh Agarwal
has Completed
500 cases of
Bariatric Surgery on
3/3/2015