Dr. Upendra Reddy Marreddy (MS, FRCS)
Consultant Bariatric & Upper GI Surgeon
Weight Loss (Bariatric) Surgery
2www.upendrareddy.com
Dr. Upendra Reddy Marreddy
• Surgical Experience
– Highly experienced Obesity and Gastrointestinal s...
3www.upendrareddy.com
Agenda
• Obesity: Impact on Health
• Weight Loss Surgeries
• Post-Operative Care
4www.upendrareddy.com
What is Obesity?
• Obesity: Obesity is excess fat accumulation, 20% or more over an
individual's ide...
Obesity in India
• Obesity has reached epidemic proportions in India, 5% of overall
population is affected by Morbid Obesi...
6www.upendrareddy.com
Obesity Epidemic
Lack of Activity Over indulgence!
Thrifty genes
7www.upendrareddy.com
Medical and Health Implications
• With BMI > 30
– 70% increased chances of coronary artery disease
–...
8www.upendrareddy.com
Co-Morbidities with Obesity
Pulmonary disease
abnormal function
obstructive sleep apnea
hypoventilat...
9www.upendrareddy.com
What are the Options?
1. Diet, Exercise, Behavioral Changes
 up to 10% loss of excess body weight
...
10www.upendrareddy.com
Who qualifies for weight loss surgery?
Normal Weight
(BMI 18.5 to 22.9)
Overweight
(BMI 23 to 24.9)...
11www.upendrareddy.com
Bariatric Surgery is an Option if:
• 20-30 kgs above your Ideal Body Weight
• Body Mass Index:
– 32...
Bariatric Surgery is NOT Liposuction
www.upendrareddy.com 12
• Liposuction is purely cosmetic
surgery that aims to produce...
13www.upendrareddy.com
Surgical Options
• Restrictive
– Stomach Capacity reduced
– Feel Full More Quickly
– Food/Calorie I...
14www.upendrareddy.com
Surgical Options
• Restrictive and Malabsorptive
– Stomach Capacity reduced
– Part of the small int...
15www.upendrareddy.com
Adjustable Gastric Band (AGB)
Adjustable Gastric Band (AGB)
Advantages Disadvantages
www.upendrareddy.com 16
• Lowest mortality and
complication rate
• ...
17www.upendrareddy.com
Vertical Sleeve Gastrectomy (VSG)
Vertical Sleeve Gastrectomy (VSG)
Advantages Disadvantages
www.upendrareddy.com 18
• No Malabsorption – No
micronutrient d...
19www.upendrareddy.com
Roux-en-Y Gastric Bypass (RYGB)
Roux-en-Y Gastric Bypass (RYGB)
Advantages Disadvantages
www.upendrareddy.com 20
• Rapid initial weight loss
• Time tested...
21www.upendrareddy.com
How much Weight Loss?
• Depends on the surgery and the follow-up
• 75% of excess weight with Gastri...
22www.upendrareddy.com
Possible Risks and Complications
• These will be discussed during the first appointment.
• With the...
23www.upendrareddy.com
Life After Surgery
• Lifestyle Change
• Diet Restrictions (Type, speed, Consistency, Volume)
• Vita...
People who are not successful?
www.upendrareddy.com 24
• Go back to old eating habits
• Avoid exercise
• Eat high fat diet...
People who are successful
www.upendrareddy.com 25
• Change lifestyle
• Change eating habits
• Are physically active
• Exer...
26www.upendrareddy.com
Good News
• Weight Loss
• Improved Self Esteem
• Improvement in co-morbidities
– Diabetes
– Hyperte...
Thank You
Dr. Upendra Reddy Marreddy (MS, FRCS)
Phone: +91 8790077333
Email: u.marreddy@gmail.com
Website: www.upendraredd...
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Weight Loss (Bariatric) Surgery

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Weight Loss (Bariatric) Surgery

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Dr. Upendra Reddy Marreddy (MS, FRCS)
Phone: +91 8790077333
Email: u.marreddy@gmail.com
Website: www.upendrareddy.com
Facebook: facebook.com/upendramarreddy

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  • A band goes around the top of the stomach.Intestines are not operated on.Performed with the a laparoscope.(telescope) A port is placed under the skin.Saline can be added or withdrawn from the Band depending on speed of weight loss and symptoms.
  • A band goes around the top of the stomach.Intestines are not operated on.Performed with the a laparoscope.(telescope) A port is placed under the skin.Saline can be added or withdrawn from the Band depending on speed of weight loss and symptoms.
  • This procedure is carried out through key hole cuts using laparoscopic methods80% of stomach is removedThe remaining stomach has the capacity of less than a glass
  • A band goes around the top of the stomach.Intestines are not operated on.Performed with the a laparoscope.(telescope) A port is placed under the skin.Saline can be added or withdrawn from the Band depending on speed of weight loss and symptoms.
  • A band goes around the top of the stomach.Intestines are not operated on.Performed with the a laparoscope.(telescope) A port is placed under the skin.Saline can be added or withdrawn from the Band depending on speed of weight loss and symptoms.
  • Weight Loss (Bariatric) Surgery

    1. 1. Dr. Upendra Reddy Marreddy (MS, FRCS) Consultant Bariatric & Upper GI Surgeon Weight Loss (Bariatric) Surgery
    2. 2. 2www.upendrareddy.com Dr. Upendra Reddy Marreddy • Surgical Experience – Highly experienced Obesity and Gastrointestinal surgeon who worked as consultant Upper GI surgeon in Greater London, with 10 years experience of more than 1500 bariatric operations and 10000 GI surgeries. • Surgical Training – Senior Bariatric Fellow from Homerton Bariatric surgery unit (2years) – Specialist Registrar in Gastrointestinal, Bariatric & General surgery from London Deanery hospitals (5 years), – All India Institute of medical sciences- New Delhi (Junior & Senior Residency-6 yr.). • Research – Research fellow and Lecturer in Surgery from Barts and The London Medical School – Presented Papers: 10 @ IFSO Hamburg Germany, 5 @ Bristol BOMSS, 10 @ IFSO New Delhi, 3 @ DDW New Orleans (USA), DDW Washington (USA)
    3. 3. 3www.upendrareddy.com Agenda • Obesity: Impact on Health • Weight Loss Surgeries • Post-Operative Care
    4. 4. 4www.upendrareddy.com What is Obesity? • Obesity: Obesity is excess fat accumulation, 20% or more over an individual's ideal body weight. It is associated with increased risk of illness, disability, and death. • Morbid Obesity: Overweight by over 30 kgs. Or using Body Mass Index (BMI) i.e. Weight(kg)/Height(m)2 of 37 or higher
    5. 5. Obesity in India • Obesity has reached epidemic proportions in India, 5% of overall population is affected by Morbid Obesity • They are GENETICALLY prone to waist circumference increase- scientists have discovered single nucleotide polymorphism named rs12970134s. • Amongst the states, AP males are ranked as 5th most obese overall in India, as far as females they are rated 10th obese amongst the states
    6. 6. 6www.upendrareddy.com Obesity Epidemic Lack of Activity Over indulgence! Thrifty genes
    7. 7. 7www.upendrareddy.com Medical and Health Implications • With BMI > 30 – 70% increased chances of coronary artery disease – 75% increased chances of stroke – 400% increased chances of diabetes – 55% increased chances of mortality
    8. 8. 8www.upendrareddy.com Co-Morbidities with Obesity Pulmonary disease abnormal function obstructive sleep apnea hypoventilation syndrome Nonalcoholic fatty liver disease steatosis steatohepatitis cirrhosis Coronary heart disease Diabetes Dyslipidemia Hypertension Gynecologic abnormalities abnormal menses infertility polycystic ovarian syndrome Osteoarthritis Skin Gall bladder disease Cancer breast, uterus, cervix colon, esophagus, pancreas kidney, prostate Phlebitis venous stasis Gout Idiopathic intracranial hypertension Severe pancreatitis
    9. 9. 9www.upendrareddy.com What are the Options? 1. Diet, Exercise, Behavioral Changes  up to 10% loss of excess body weight  ineffective long-term, less than 5% sustain significant weight loss 2. Weight Loss Drugs  minimal sustained weight loss  side effects prevent long-term use 3. Weight-Loss Surgery  55 to 75% loss of excess body weight
    10. 10. 10www.upendrareddy.com Who qualifies for weight loss surgery? Normal Weight (BMI 18.5 to 22.9) Overweight (BMI 23 to 24.9) Obese (BMI >25) Severely Obese (BMI 32.5 to 37 ) Morbidly Obese (BMI >37.5 ) BMI 18.5-22.9 BMI 23-24.9 BMI >25 BMI 32-37 BMI>37.5
    11. 11. 11www.upendrareddy.com Bariatric Surgery is an Option if: • 20-30 kgs above your Ideal Body Weight • Body Mass Index: – 32.5 or greater with co-morbidities – 37.5 or greater even without any co-morbidities • Age of 18 to 65+ (assessed on individual basis) • Failed attempts at weight loss • Health complications related to obesity • No psychological contraindications • Understanding of the surgery/risks • Compliance with diet/exercise requirements
    12. 12. Bariatric Surgery is NOT Liposuction www.upendrareddy.com 12 • Liposuction is purely cosmetic surgery that aims to produce an attractive body-shape. • Although liposuction might seem attractive, it does not achieve the results in improved health and durable weight loss. • Liposuction is performed by Plastic/Cosmetic Surgeons. • Bariatric surgery, however, is a stomach operation which reduces caloric intake and the way fat is deposited. • Bariatric surgery can achieve a sustained and lasting weight loss for the treatment of morbid obesity. • Bariatric surgery helps improve health and increase the life-span. • Bariatric surgery is performed by Bariatric Surgeons.
    13. 13. 13www.upendrareddy.com Surgical Options • Restrictive – Stomach Capacity reduced – Feel Full More Quickly – Food/Calorie Intake Reduced – Weight Loss
    14. 14. 14www.upendrareddy.com Surgical Options • Restrictive and Malabsorptive – Stomach Capacity reduced – Part of the small intestine is bypassed or rerouted – Reduced assimilation of food – Weight Loss
    15. 15. 15www.upendrareddy.com Adjustable Gastric Band (AGB)
    16. 16. Adjustable Gastric Band (AGB) Advantages Disadvantages www.upendrareddy.com 16 • Lowest mortality and complication rate • Least invasive surgical approach • No stapling, cutting, or intestinal re-routing • Adjustable • Reversible • Low malnutrition risk • Shorter surgery • Slower initial weight loss than Gastric Bypass • Regular follow-up critical for optimal results: Need adjustments • Requires implanted medical device
    17. 17. 17www.upendrareddy.com Vertical Sleeve Gastrectomy (VSG)
    18. 18. Vertical Sleeve Gastrectomy (VSG) Advantages Disadvantages www.upendrareddy.com 18 • No Malabsorption – No micronutrient deficiency • No Strictures ? No Marginal Ulcerations ? • Maintains oral access to GI and Biliary tract • Creates restriction more than obstruction • Lesser Follow up • Non-adjustable • Irreversible
    19. 19. 19www.upendrareddy.com Roux-en-Y Gastric Bypass (RYGB)
    20. 20. Roux-en-Y Gastric Bypass (RYGB) Advantages Disadvantages www.upendrareddy.com 20 • Rapid initial weight loss • Time tested, proven efficacy • Best for metabolic abnormalities such as diabetes, Hyperlipidaemia etc. • Stomach cutting, stapling and intestinal re-routing required • Portion of digestive tract is bypassed, resulting in nutritional deficiencies- easily managed by two pills a day • “Dumping syndrome” can occur- sensible choice of foods and eating habits prevent this • Non-adjustable • Difficult to reverse! Very expensive!
    21. 21. 21www.upendrareddy.com How much Weight Loss? • Depends on the surgery and the follow-up • 75% of excess weight with Gastric bypass at the end of one year • 45% of excess weight with Band but increases to 65% at 2-3 year follow up with adjustments • Amount of weight loss varies from person to person • Must be compliant with follow-up!!!!!
    22. 22. 22www.upendrareddy.com Possible Risks and Complications • These will be discussed during the first appointment. • With the experience and skill at hand, these surgeries post no more risk in my hands than common surgical procedures, such as Gall Bladder removal surgery.
    23. 23. 23www.upendrareddy.com Life After Surgery • Lifestyle Change • Diet Restrictions (Type, speed, Consistency, Volume) • Vitamins and Medication • Regular Follow-Ups • Exercise
    24. 24. People who are not successful? www.upendrareddy.com 24 • Go back to old eating habits • Avoid exercise • Eat high fat diet • Eat High caloric diet • Graze, Snack • Drink “regular” soft drinks or high calorie beverages (ex. Juice, alcohol)
    25. 25. People who are successful www.upendrareddy.com 25 • Change lifestyle • Change eating habits • Are physically active • Exercise daily • Follow new diet • Follow up with their doctor as advised
    26. 26. 26www.upendrareddy.com Good News • Weight Loss • Improved Self Esteem • Improvement in co-morbidities – Diabetes – Hypertension – Hyperlipidaemia – Sleep apnoea • Improved Quality of Life
    27. 27. Thank You Dr. Upendra Reddy Marreddy (MS, FRCS) Phone: +91 8790077333 Email: u.marreddy@gmail.com Website: www.upendrareddy.com Facebook: facebook.com/upendramarreddy

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