Bariatric Surgery India Low Cost Benefits

Overview

Bariatric surgery is a term derived from the Greek words: weight and treatment. In simple terms, bariatric concerns the causes, prevention and treatment of severe overweight, a condition known as obesity. Obesity today ranks as a significant health challenge and studies show obesity to be a major cause of preventable mortality. Obesity, perhaps in the next 25 years will become the biggest financial drain on one’s family and country along with other associated life style disorders like Diabetes and Hypertension to name a few. Obesity refers to a spectrum of problems of excess weight ranging from being mildly overweight to being morbidly obese. Patients with morbid obesity do not tend to respond to medical means of weight loss.

What is Bariatric Surgery?

Bariatric Surgery, or weight loss surgery, includes a variety of procedures performed on people who are obese. Weight loss includes a variety of procedures performed on people who are obese. Weight loss is achieved by reducing the size of the stomach with an implanted medical device (gastric banding) or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestines to a small stomach pouch (gastric bypass surgery). Long-term studies show the procedures cause significant long-term loss of weight, recovery from diabetes, improvement in cardiovascular risk factors, and a reduction in mortality of 23% from 40%.

Why Bariatric Surgery?

Obesity leads to high risk for a number of other diseases, including high blood pressure, heart disease, type 2 diabetes, obstructive sleep apnea, gastroesophageal reflux disease, arthritis, gallbladder disease, liver disease, gout, gynecologic complications, and some cancers. Thus the best way to get rid of these problems is to have a Bariatric Surgery. The purpose of Bariatric Surgery is to promote weight loss.

Are you a Candidate for Bariatric Surgery?

Some bariatric surgeons accept patients in their 60's, and some even operate on teenagers. But because bariatric surgery is a last-gasp treatment solution for obesity, to be used when conventional weight loss programs have been tried and failed, candidates must have severe obesity-related health problems.

• Typically, to qualify for bariatric surgery you must be 'morbidly obese', which usually means being overweight by 100 pounds (man) or 80 pounds (woman) with a Body Mass Index (BMI) of 40+.
• Alternatively, bariatric surgery may be appropriate if you are 80 pounds overweight (BMI 35+) and have a serious obesity-related condition like type 2 diabetes or life-threatening cardio-pulmonary problems such as severe sleep apnea or obesity-related heart disease.
• "Patients should be referred to high-volume centers with surgeons experienced in bariatric surgery."

Types of Bariatric Surgery

There are a few types of Bariatric Surgery commonly practiced today. More specifically, there are eight surgical methods available, although depending on your medical history and your current medical condition only a few (if any) will be best suited for you. The following the eight recognized types of bariatric surgery:

• Adjustable Gastric Banding (AGB) : It is commonly referred to as a lap band, is an inflatable silicone device that is placed around the top portion of the stomach, via laparoscopic surgery, in order to treat obesity. Adjustable gastric band surgery is an example of bariatric surgery designed for obese patients with a body mass index (BMI) of 40 or greater—or between 35–40 in cases of patients with certain comorbidities that are known to improve with weight loss, such as sleep apnea, diabetes, osteoarthritis, GERD, Hypertension (high blood pressure), or metabolic syndrome, among others. The idea of gastric banding has been around for quite a number of years, and was pursued in Europe and Scandinavia particularly. During the Adjustable Gastric Banding procedure, a silicone elastomer band is placed around the upper part of the stomach to create a small stomach pouch which can hold only a small amount of food. The lower, larger part of the stomach is below the band. These two parts are connected by a small outlet created by the band. Food will pass through the outlet (“stoma” in medical terms) from the upper stomach pouch to the lower part more slowly, and one will feel full longer. The diameter of the band outlet is adjustable to meet individual needs, which can change as one loses weight. One of the top benefits of this procedure is that it doesn’t permanently change the anatomy of the stomach or small intestines and is a reversible medical procedure.
• Bariatric Bypass Surgery : One of the most efficient ways to combat obese risks is through bariatric surgery or bariatric bypass surgery. Bariatric bypass surgery is also commonly called gastric bypass surgery. In lay terms, it has been come to be called stomach stapling, but the term is often misleading. There are basically two kinds of bariatric bypass surgery: restrictive and malabsorption. With restrictive bariatric surgery, the stomach is made smaller, reducing the amount of food a patient is able to intake which results in weight loss. The malabsorption method is different, in that, the small intestine is shortened and a small pouch is inserted, carrying food directly from the esophagus to the small intestine for excretion. More specifically, a small pouch is created at the top of the stomach and the rest is permanently separated. The small intestine is then attached to the new pouch creating a new digestive tract. Restrictive operations for obesity include adjustable gastric banding (AGB) and vertical banded gastroplasty (VBG). Restrictive operations serve only to restrict food intake and do not interfere with the normal digestive process. To perform the surgery, doctors create a small pouch at the top of the stomach where food enters from the esophagus. Initially, the pouch holds about 1 ounce of food and later expands to 2-3 ounces. The lower outlet of the pouch usually has a diameter of only about ¾ inch. This small outlet delays the emptying of food from the pouch and causes a feeling of fullness. Malabsorptive operations are the most common gastrointestinal surgeries for weight loss. They restrict both food intake and the amount of calories and nutrients the body absorbs.
• Biliopancreatic Diversion (BD) : It is a type of bariatric surgery that restricts the amount of food allowed into the stomach. More specifically, the stomach is made smaller than it is, promoting weight loss for people who suffer from morbid obesity. In this procedure, portions of the stomach are removed. The small pouch that remains is connected directly to the final segment of the small intestine, completely bypassing the duodenum and the jejunum. A common channel remains in which bile and pancreatic digestive juices mix prior to entering the colon. Weight loss occurs since most of the calories and nutrients are routed into the colon where they are not absorbed. This procedure has two components. A limited gastrectomy results in reduction of oral intake, inducing weight loss, especially during the first postoperative year. The second component of the operation is a construction of a long limb Roux-en-Y with a short common channel of 50 cm length. The BPD is unique because it is the only current procedure that allows you to eat normal quantities of food and still achieve excellent weight loss. But there’s a catch. The procedure still carries some malabsorptive complications, including loose stools, malodorous gas, and serious deficiencies in protein and minerals such as calcium. BPD patients must take vitamin supplements for the rest of their lives to avoid malnutrition and bone demineralization.
• Duodenal Switch (DS) : This procedure is an effective Bariatric Surgery to significantly combine both restrictive and malabsorptive aspects for the goal of long-term weight loss. The operation has two parts. The first is a” sleeve gastrectomy”. This part of the operation has several effects and accounts for the restrictive effects (i.e., restricting food intake). By removing a large portion of the stomach, the capacity to store food is markedly decreased. This gives the feeling of fullness quickly after starting a meal. The second part of the operation is the malabsorptive portion. Most food is absorbed in the small intestine after it is broken down by bile and pancreatic juices. The purpose of bile is to dissolve fats into a form that can be absorbed by the small intestine. Pancreatic juices also dissolve fats (as well as proteins and sugars). Both bile and pancreatic juices enter the intestines at the duodenum (the first part of the small intestines). The intestines are reconnected, switching out the duodenum, where these fluids normally enter. By connecting your intestines in such a way that food is diverted from these bilio-pancreatic juices until the very last portion, food is not fully absorbed. Instead the person will pass a lot of fats undigested and unabsorbed. The duodenal switch operation is so named because the functional portion of the duodenum (the upper small intestine) is bypassed from digestive continuity in a reversal or "switch" technique. The most important feature of the operation is that it rearranges the small intestines, so that the food is diverted and only absorbed in the last 75-100 cm, otherwise known as the "common channel."
• Laparoscopic Bariatric Surgery : This Surgery is intended to be the most effective and least invasive kind of bariatric surgical methods. Known to many as videoscopic surgery, the laparoscopic procedure is an advanced surgical technique often using a video camera to perform operations through very small incisions. Most operations are performed by making small incisions (usually 1/4 to 1/2 inch) and gently separating the patient’s muscles to enter the abdomen or chest without cutting. A fiber optic lighted tube is inserted which transmits an internal picture of the patient onto a television screen for the surgeon and nurses to view. Small instruments are then inserted and the surgical procedure is completed. The space-age technology reduces the trauma associated with traditional open surgery. This can greatly reduce the patient’s pain, hospital stay, recovery time and scarring. The overall outcome following a Laparoscopic Bariatric Surgery appears to be comparable to that of the following equivalent open procedures. Virtually all bariatric operations can be performed with laparoscopic techniques. When performed by appropriately trained surgeons, laparoscopic approaches appear to speed the patient’s recovery and help patients return to a normal, productive life. Advantages of the laparoscopic bariatric surgery include reduced post-operative pain, shorter hospitalization, faster return to work and improved appearance.
• Roux-en-y (RNY) : It falls under the area of bariatric bypass surgery and is the most common gastric bypass procedure. With this procedure a portion of the stomach is sectioned off, creating a small pouch for reduced food intake. The pouch will usually hold about one ounce of food or less, which causes the feeling of fullness after just a few bites. In short, the RNY procedure reduces the size of your stomach and reroutes the digestive system. Three major steps are involved in the RNY procedure: first, the stomach is stapled just below the esophagus, forming a 1 ounce stomach pouch above the staples, severely restricting the amount and kind of food or liquid that can be consumed at one time. The second step includes the division of the small bowel about one foot below the stomach. Then a new 1.5 centimeter opening (stoma) is created in the stomach pouch. Finally, the open end of the small bowel is attached to the new opening. Food and fluids can now pass from the stomach pouch into the small bowel. The remaining end of the small bowel forms a "Y-shaped" intestinal junction at the base of the stomach. An opening is made to allow digestive juices from the bypassed part of the stomach to flow into the small bowel. Additionally, the Roux-enY gastric bypass can be performed using both the” open” and laparoscopic techniques. According to the vast majority of health experts and officials, the Roux-en-Y gastric bypass continues to set the standard for bariatric surgery and is the current gold standard procedure for weight loss surgery. It is also one of the most frequently performed weight loss procedures in the United States. The Roux-en-Y procedure is not a cure for morbid obesity; it is merely a tool. Patients have been known to ingest large quantities of high caloric foods that can result in less than satisfactory weight loss. If a patient adheres to the proper dietary guidelines, and if exercise becomes a part of the patient’s regular routine, a substantial weight loss usually results.
• Sapala-Wood Micropouch : This procedure is the result of lessons learned over the past 17 years in several thousand bariatric patients. It is an operation in which the stomach is reduced in size. The pouch is durable and does not stretch over time. The pouch also contains very few acid cells, so patients with heartburn or GERD are virtually cured of their acid reflux symptoms. The bottom of the stomach still has its nerve supply. Consequently, acid production in the cephalic phase of gastric acid secretion is intact as well as normal gastric emptying. In other words, the bottom of the stomach still produces acid even though food does not pass through it. This innovative smaller pouch empties more rapidly than the traditional 30-cc pouches. When patients eat slowly and chew thoroughly, a medium-sized meal (one salad plate) can be eaten in 30 minutes. Patients are encouraged to eat 6-8 small meals a day with fluids taken between meals. Multiple small meals minimize insulin production, so fat can be burned as an energy source. This great innovation in bariatric medicine has since grown and the procedure can now be performed by incorporating the Roux-en-Y method. In the Sapala-Wood Micro pouch operation the very top of the stomach is completely divided. It is not stapled. This division results in the creation of a small "micro pouch" completely separate from the lower part of the stomach. The Sapala-Wood Micro pouch operation allows you to absorb a normal amount of calories, not an excess amount. This is why patients will have a weight loss close to normal and do not keep losing beyond their ideal body weight.
• Vertical Banded Gastroplasty (VBG) : One of the most known procedures in the world of Bariatric Surgery is the vertical banded gastroplasty, an operation that many people have called stomach stapling. Although the procedure is still well respected, patients generally lose less weight than with the RNY, and it is much more common to see a patient not lose a satisfactory amount of weight following the VBG. The primary cause for this is that patients continue to eat sugary foods and/or liquids, which are high in calories. VBG is performed under general anesthesia, through an incision in the upper abdomen measuring several inches, and requires usually four or five days in the hospital postoperatively. A circular "window" is made through the stomach a few inches below the esophagus. A surgical stapler is then used to create a small vertical pouch by putting a row of staples from the window toward the esophagus. The pouch is carefully measured at the time of surgery and will hold about one tablespoon of solid food. A polypropylene band is placed through the window, around the outlet of the pouch and secured to itself with stitches. The band controls the size of the outlet and keeps it from stretching. VBG is one of the two major types of operations recognized by major health groups for the treatment of clinically severe obesity. It is a purely restrictive procedure with no malabsorptive effect. The goal of this procedure is to severely restrict the patient’s capacity to eat certain foods. About 30 percent of those who undergo VBG achieve normal weight, and about 80 percent achieve some degree of weight loss. Some patients regain weight. Others are unable to adjust their eating habits and fail to lose the desired weight.

Activities after Bariatric Surgery

Before you leave the hospital after surgery, you will be asked to stand up and move around a bit. You will also be directed to try to walk around the house several times throughout each day, over the course of your recovery. It is important to remember that you will require assistance leaving the hospital and at home for a period of time after surgery. Everyone recovers at a different rate: some people require assistance for a day or so, but others need help for several weeks. The type of assistance you will need includes driving you home from the hospital and driving you for a few days or weeks after that. It also includes meal preparation, medication assistance and dressing.

The type of pain management program you and your surgeon select may also impact the duration and severity of the recovery period. If you receive local anesthesia, you may require less assistance, and for a shorter duration, than if you have general anesthesia or require narcotic pain management. Patients can usually drive within two weeks after surgery and can return to normal activities within six to eight weeks. These times may vary, depending on the type of surgery, your general health and the type of activities you performed before surgery.

Diet after Bariatric Surgery

You will need to adjust your diet because of the changes that were made to your stomach during surgery. It is very important to adhere to your surgeon's diet recommendations. Some common recommendations include:

• Chew your food slowly and thoroughly, to reduce it to very small pieces. You may want to grind your meat before eating it.
• Wait two to three minutes between bites.
• Drink fluids at a time other than when you are eating, to avoid a premature feeling of fullness that may make you feel like vomiting.
• Avoid eating foods high in sugar and fat, such as nondiet soda, juices, high-calorie nutritional supplements and milkshakes.
• On the other hand, you should prioritize foods that contain high amounts of proteins, such as fish, dairy products, meat, beans and legumes. You should also try to eat plenty of fresh vegetables and fruits.
• Be careful with alcohol. It is absorbed and metabolized much more rapidly after surgery. In addition to the risk of rapid and unexpected intoxication, alcohol consumption can cause ulcers in your stomach pouch or intestine.
• Plan meal times, and avoid snacking. You should eat several small meals per day because of your stomach's smaller capacity. Below is an example of a daily diet.

Benefits of Bariatric Surgery

Bariatric Surgeries and procedures are designed to reduce illness and complications caused by obesity. For many, weight loss improves multiple conditions including high blood cholesterol, high blood pressure, diabetes, and coronary artery disease. In addition, other body systems, including digestive, endocrine, and immune system benefit. However, such procedures require dedication and determination for those who undergo them to maintain permanent lifestyle changes. After surgery, patients who follow instructions may enjoy as much as a 60% weight loss, improving health problems as an added benefit. Thus the benefits of Bariatric Surgery can be written in nutshell the following ways:

• Improvements to pre-existing medical conditions related to obesity
• Prevention of obesity-related diseases
• Increased energy
• Extended life span
• Increased self-esteem
• Weight loss

Risks of Bariatric Surgery

All surgeries come with the possibility of complications, but fortunately their incidence is quite small. These include, Slippage of the band due to food intolerances or even perforation of the stomach, vomiting after the surgery may develop which can lead to a small stomach pouch stretch.

Bariatric Surgery in India

India has become pioneer in healthcare service for procedures like Bariatric Surgery for the international patients coming all across the world. The healthcare facilities here in India conform to the advanced countries like US or UK thereby delivering similar or even better results than the later nations.

Most of the Bariatric surgeons and doctors in India performing various procedures of Bariatric Surgeries have ample of experience of dealing with patients with morbid obesity and are world renowned medical experts abreast with all the cutting edge technologies applied in medical sciences.

The hospitals catering various procedures for Bariatric Surgery in India are world class medical centres equipped with state-of-art facilities. Most of them have international accreditations from JCI and JCAHO. Thus a world-class low price facilitation services for the visiting overseas patients for their cheaper surgery treatment trip at the top rated private specialty hospital and clinical facilities in the following Indian cities:

Cost of Bariatric Surgery in India

The greatest benefit the foreign medical tourist can avail in India is the cost factor. They get personalized attention at incredible costs which are the root cause of driving the patients worldwide to India for different procedures of Bariatric Surgery. One can assess the significant differences at cost purse from the following table:

Some of the common countries from which patients travel to India for surgery are:

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