Bariatric and Metabolic Surgery

Obesity & Diabetic Surgery

Obesity and Diabetes are two diseases prevalent in the contemporary society. One often resorts to fast food and fizz primarily due the current hectic lifestyle while losing a count of the rising calories. We use cars for faster and comfortable transportation instead of walking and are often at a loss of time for regular exercise .The net result is Obesity and complications which follow it, e.g High blood pressure, Diabetes, heart disease, lipid abnormalities etc. Diet, exercise and lifestyle modification are the initial steps in reducing weight, but this is generally time consuming and at times people find it difficult to stick to a specific regimented schedule of exercise and diet . In some cases people reach a level of morbid obesity which makes regular exercise a very difficult task ,some have joint pains and rest are depressed and do not know what to do. For them Bariatric and metabolic surgery, (OBESITY & DIABETIC SURGERY), is a reliable and permanent way to reduce weight and weight related complications. Bariatric surgery is an advanced Laparoscopic surgery, done through few key-holes . However, it requires training and experience for perfection. Dr Debashis Deb is a senior consultant surgeon specialized in Advanced laparoscopic and Bariatric surgery, practicing in Kolkata since the last 14 years. He is well known among the medical fraternity of Kolkata. He has been trained in AIIMS , where he honed his laparoscopic skills, and later fine tuned his Bariatric skills under Dr Shashank Shah, who holds the record for operating India`s heaviest person so far.

Frequently Asked Questions

Is it Liposuction?

No, this not Liposuction. In Liposuction, fat is sucked out through holes made in the abdomen, thighs etc .This is not permanent, and leaves an asymmetric body contour. This is a cosmetic surgical procedure and not suitable for severe obesity. Bariatric surgery (Obesity surgery) is a kind of laparoscopic surgery done through key-holes. It is a surgery of stomach and intestine. We reduce the capacity of stomach and reduce the appetite stimulating hormone as well .We can also alter the passage of food, reaching a particular area of the small intestine first ,which helps cure diabetes.
Is it really done in India? or Kolkata

Yes. Last few years many centres have come up in metro cities.
Are Indians so obese that they need surgery?

More than 5% of Indians are now obese, a real surprise if you take our population of 110 crores into account. It is definitely going to increase unless taken seriously.We all know India is called the diabetic capital of the world and the number of people suffering from obesity in on the rise. So, the need for bariatric surgery is not hypothetical, it is real.
I can eat as before after the surgery is done?

You need to understand that your obesity is the result of your consumption of more calories than you actually need or could manage to burn. Now, if you are to reduce your weight, you have to cut down on your intake but, you will eat everything later on but in small portions.
If I have to eat less and exercise even after surgery ,then why should I do it in first place?

Bariatric (obesity) surgery is not really a magical procedure. It helps you to lose weight by decreasing both appetite and capacity of the stomach. After losing 60-70% of your excess weight, you feel better both physically and mentally. To maintain the well-being for rest of your life , you need to exercise and eat less.
Is any reversible procedure available?

Yes, Lap band is the reversible procedure
Why not Lap Band?

Lap band needs a very motivated patient who is convinced enough not to cheat, because one can easily cheat by deflating the band. Besides, though initial weight loss is good but sustained loss of weight is less as compared to other procedures. Complications are common and most patients need another procedure some times. Moreover, the procedure is not cheap and in fact expenses are almost same as gastric bypass.
What surgery do you recommend?

Sleeve gastrectomy and gastric bypass are two procedures commonly recommended, and out of the two, sleeve gastrectomy has least complication, equally effective, does not alter anatomy of GI tract . If the indication for surgery is only obesity then sleeve suits you best, but if you have significant metabolic component, like diabetes, lipid abnormalities etc, then a gastric by-pass would be more effective
What is the cost of the surgery?

It is difficult to answer this question in absolute values because there are so many variables like ,type of surgery, cost of disposable items, need for ICU care . however it can range from Rs 1 lac to 4 lacs.
How many days do I need to be in the hospital?

Generally 3 to 4 days are enough
What are precautions and restrictions after surgery?

You need to take liquid diet for one week after surgery, for next three weeks you would take purred diet. At one month you resume your normal diet, albeit in a small portions. You will avoid colas, chocolates, ice-creams and fruit juices because these are foods with invisible very high calorie. You are encouraged to resume your normal activity as soon as you like except perhaps deferring heavy physical exercise for 6 weeks
What are the complications? Is there a chance of death?

Name any surgery without a complication! So, this one also has it`s share of complications. But specific to bariatric surgery, the main complications are the leaks from the anastomosis. Like any other surgery, deep vein thrombosis, pulmonary embolism, bleeding, a heart attack, sepsis, wound infection etc all are possible. The possibility of death from a bariatric surgery has been found to be almost the same as for Laparoscopic cholecystectomy by the researchers.
What precautions are taken for this?

You are put to a liquid diet about a week before, will have to take DVT prophylaxis( blood thinning agents) from the previous night. We put Pneumatic compression device during the procedure (means we massage your leg continuously) to avoid getting clots in the leg veins
Will my diabetes be cured?

If you have mild diabetes, then you will get cured and perhaps won`t need your tablets anymore. If you are insulin dependent and have enough pancreatic reserve ( C-Peptide value> 4) it is possible that you can stop insulin.
I am not obese, but slightly over-weight and have nasty diabetes, will this help me?

If you features of Metabolic syndrome ,a Gastric bypass or a LSG+IS could be the best option for you and in 85% of cases your diabetes will get either fully cured or easily manageable
What are the surgeries?
1. Sleeve Gastrectomy
2. Gastric By pass
3. Sleeve Gastrectomy with ileal interposition (Good result in short term, yet not Universally accepted)
4. Gastric Plication (New technique, cheaper,but not enough study available)
How Surgery helps weight loss and Cures Diabetes?

Greater curvature and fundus of the stomach secretes appetite stimulating hormone, Ghrelin. In bariatric surgery, the Ghrelin containing part of the stomach is either excised or excluded ,hence appetite becomes less than before. Besides this, as stomach capacity also becomes less, the person needs less volume of food. Food reach ileum earlier and in turn increase GLP-1 , which stimulates insulin secretion and decrease insulin resistance. Less calorie intake helps weight loss, and GLP-1 mechanism acts independently to correct Diabetes. People with Metabolic syndrome benefit from mal-absorptive procedures like Gastric By-pass.
What are long term effects? Does it cause vitamin deficiency?

Long years of research on obesity and bariatric surgery ( it is in vogue in USA, and Europe since last 50 years ) has shown that mal-absorptive procedure like gastric by-pass may cause deficiency of B12, Calcium, Folic acid, and some micro-nutrients. But all these can be supplemented. In post operative period, patients are screened routinely for deficiencies and given adequate advise