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Laparoscopic Bariatric

What is Bariatric Surgery ?

Obesity is defined by excessive weight.

The excess weight is quantified by height and weight ratio called BMI

BMI =WEIGHT in KGS/HEIGHT in METRES squared

So normal BMI is between 18.5 to 25 and 25 to 30 is overweight and above 35 is obesity and it should be treated.

If BMI is above 32 in Asian population and patient has diabetes or hypertension then they need treatment too and will benefit due to the surgery.

Why does high BMI patient need to be treated?

Higher BMI leads to

  • Poor social acceptance,
  • Poor body image,
  • Diabetes,
  • Hypertension,
  • OSA (obstructive sleep apnea)
  • Osteoarthritis
  • Depression
  • Varicose veins
  • Cancer

How can obesity be treated?

Any underlying hormonal cause needs to be treated.

The caloric balance is to be restored(high calorie food to be replaced by nutritious low caloric food and expenditure of calories needs to be increased)
Diet and exercise are known to cause loss of 8 to 10 p cent of excess weight

Why is the weight loss restricted to 10 percent?

  • It is postulated that the set point of weight is adjusted by body to new excess of normal and weight loss is regained.
  • The built up of hunger hormone GHERLIN on fasting makes the fasting or dieting patient eat more.
  • Lowering of energy expenditure by our own body after weight loss for self preservation prevents further weight loss

What gives us sustainable weight loss?

Sustainable weight loss is obtained by operations that gives

  1. Early satiety and or
  2. Prevents absorption of high calorie food

Advantages of Bariatric Surgery

  • Bariatric surgery cures diabetes and hypertension in 80 to 85 percent patients especially if the disease is of early onset, in the rest of the patients, the doses of anti diabetic and anti hypertensive medicines are reduced after the surgery.
  • Bariatric surgery lowers the symptoms of OSA or obstructive sleep apnea and snoring.
  • The knee pain also reduces after Bariatric surgery and weight loss visible.
  • Since the patients body image becomes better after weight loss, the symptoms of depression and anxiety is reduced after weight loss.
  • Breathlessness due to weight gain reduces after Bariatric surgery.

What are the types of Bariatric Surgeries?

  • Restrictive like sleeve gastrectomy or gastric band
  • Malabsorptive like bpd or DS
  • Combination of the two
  • RGB(ROUX EN Y GASTRIC BYPASS)
  • Mini gastric bypass

What is the result of the Surgery?

Weight loss occurs after surgery over a period of one and half to two years, highest weight loss is achieved in BPD or DS

Almost 50 to 60 percent of the excess weight is lost.

This may also cause weakness and hair loss.These symptoms can be prevented by taking a high protein diet

Skin may sag especially in patients who don’t exercise.

What are the complications of Bariatric Surgery?

  • Bleeding from sutured site
  • Leakage of contents of intestine
  • Infection
  • Deep vein thrombosis
  • Intestinal obstruction
  • Herniation, internal and external through the operative scars.

Certain complications are due to the inability to absorb nutrients

  • Hair loss
  • Dehydration
  • Anemia
  • Vitamin deficiency
  • Calcium deficiency
  • Rarely neuropathies

Pre-op and post-op diet of Bariatric patients

  • Prior to surgery patients should start a low carbohydrate diet to reduce the size of the liver to make surgery easier to perform.
  • Patient is also encouraged to exercise to prevent clot formation in the legs
  • Deep breathing exercises prevent post operative chest complications
  • All essential micronutrient deficiencies need to be corrected preoperatively

Post op diet

  • Patients are advised liquid diet after the leak tests are negative and may continue the diet for 1 month post operatively
  • After 1 month patient is advised pureed diet
  • Patient is also advised to drink water atleast half an hour before meal or 1 hour after meal.
  • Thorough chewing of the food is advisable to prevent blockage of the newly created stoma or tubes
  • Vitamin and protein supplements are also advisable to prevent deficiencies of he same.

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