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Bariatric Surgery (also known as obesity surgery or weight loss surgery) includes a variety of procedures performed on people suffering from Obesity. Obesity is a life threatening disease as declared by WHO (World Health Organisation) that needs to be treated like any other disease because it triggers over 60 different co-morbidities including type 2 diabetes, hypertension, infertility, sleep apnea etc that are documented to reduce life span of an obese patient by 7- 10 years. Diet and Exercise should be the first choice of treatment for Obesity patients. If weight does not reduce or the lost weight quickly bounces back in spite of strict diet and exercise regimen, then Bariatric surgery may be a safe and scientifically proven choice under certain conditions.

Not everyone can opt for Bariatric surgery procedures. There are guidelines based on BMI and pre-existence of one or more co-morbid conditions. ASMBS (American Society of Metabolic and Bariatric Surgeons) has set up a widely followed guideline for bariatric surgery where patient has to meet at least one of the conditions below:

1. BMI ≥ 40, or more than 100 pounds (45.3 kilos) overweight. For example, an adult who is 5’11” tall and weighs 132 kilos would have a BMI over 40.

2. BMI ≥35 and at least one or more obesity-related co-morbidities such as type II diabetes (T2DM), hypertension, sleep apnea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.
3. Inability to achieve a healthy weight loss sustained for a period of time with prior weight loss efforts.

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Not every center or hospital is qualified to offer this surgery. The apex medical body National Institutes of Health (NIH) of USA, American College of Surgeons (ACS), American Society for Metabolic and Bariatric Surgery (ASMBS), International Excellence Federation (IEF) Taiwan etc recommend that Bariatric surgery be performed by a board certified surgeon with specialized experience/training in bariatric and metabolic surgery, and at a center that has a multidisciplinary team of experts for follow-up care. This may include a nutritionist, an exercise specialist, and a mental health professional such as psychologist. Our center meets all these qualifications and more. We are the only center in Pune and Western Maharashtra to be accredited by Taiwan based clinical excellence body International Excellence Federation (IEF). We meet all the above requirements and more.

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgically removing a large portion of the stomach along the greater curvature. The result is a sleeve or tube like structure. The procedure permanently reduces the size of the stomach to restrict overeating, although there could be some dilatation of the stomach later on in life. The procedure is best performed laparoscopically and is irreversible. The actual surgery takes about 50 minutes and at DOSS we perform surgeries as a team to reduce time further. Weight loss following sleeve gastrectomy results from eating less because of the much smaller stomach. Patient also feels full and satisfied with smaller portions of food due to removal of part of the stomach that produces the hunger hormone (Ghrelin). What Are the Benefits of Sleeve Gastrectomy? Patients lose 50-60% of their extra weight within the first 2 years after the surgery. With a complementing exercise routine and healthy diet patients are seen to lose 80-90% of excess weight in one to two years from surgery. In addition to this weight loss, if you have any of these conditions, they will improve or totally resolve after the surgery: Type 2 Diabetes High blood pressure Sleep apnea Abnormal lipids/cholesterol Asthma Low back pain Weight-bearing arthritis of the hips, knees, ankles, and feet Skin fold dermatitis Urinary stress incontinence Acid reflux Metabolic Syndrome Most importantly, the health benefits gained with Sleeve Gastrectomy surgery can reduce your risk of death by as much as 89% compared to staying morbidly obese. Contraindications: There are certain situations in which Sleeve Gastrectomy should not be done: Lung disease requiring oxygen therapy Extremely limited mobility Untreated psychiatric disorders and substance abuse or narcotic dependency Endocrine disorders such as Cushing’s Syndrome and Prader Willi Syndrome Psychological instability Drug or alcohol abuse Inability to cope with the changes in diet and life modification after surgery Refusal to be assessed by psychologist or psychiatrist Complex medical conditions increase the risk of surgery and are considered on a patient-by-patient basis.

There are two types of Gastric Bypass Surgery: Roux-en-y Gastric Bypass and Mini Gastric Bypass. Roux-en-y Gastric Bypass (RYGB) RYGB divides stomach into a small upper pouch and a much larger lower “remnant” pouch. And then the small intestine is rearranged to connect to both. RYGB leads to significant reduction in the functional volume of the stomach, and an altered physiological and physical response to food, thereby deliberately introducing mal-absorption to prevent excessive digestion of the food in obese that causes stubborn weight gain in some people in spite of strict diet and exercise routine. The laparoscopic or minimally invasive RYGB is performed by introducing a laparoscope, a tiny video camera at the end of a thin long tube, through small abdominal incisions, giving the surgeon a magnified view of the internal organs on a television monitor. The entire operation is performed “inside” the abdomen after gas has been inserted to expand it. Special stapling instruments are used to separate about 5% of the stomach to create a small 10-25 ml Pouch. The remaining 95% of the stomach (Excluded Stomach) is not removed. It continues to produce digestive juices and some essential factors. The outlet from this newly formed Gastric Pouch is connected to the small intestine (Roux limb) so that food empties directly into the lower portion of the intestine (Small Intestine Common Channel) bypassing the stomach. Digestive juices produced by the stomach, pancreas, gall bladder and duodenum are directed by the Bilio-Pancreatic Limb back into the common channel in a “Y” shape hookup that gives the technique its name (Roux-en-Y gastric bypass). The small Gastric Pouch causes patients to feel full sooner and eat less (restriction); bypassing a portion of the intestine means the patient’s body absorbs fewer calories (mal-absorption). If you try to eat more than 4 parts of food at a meal, you may feel uncomfortable and may regurgitate. This reaction is common, but often is due to inappropriate eating behaviors. You quickly will learn how to eat to avoid discomfort and regurgitation. As you eat less food, your body will stop storing excess calories and it will begin to use its fat energy stores. Mini Gastric Bypass Mini-gastric bypass (MGB) is a promising bariatric procedure. It is also simpler procedure to perform compared to Roux-en-bypass. Tens of thousands of this procedure have been performed throughout the world since 1997. Mini gastric bypass has only one anastamosis between small pouch of stomach created just after esophagus and second part of small intestine called jejunum compared to Roux-en-y bypass that has two anastamoses. What are the benefits of Bypass Surgery? Firstly its reversible. If patients are not satisfied with the surgery, we can totally reverse the surgery. Secondly, patients report an early sense of fullness and satisfaction that reduces the desire to eat. Thirdly patients who have gastric bypass generally lose more weight sooner than patients who undergo purely restrictive procedures such as Sleeve Gastrectomy. Our patient follow-up statistics show that the Gastric Bypass operation performed by DOSS, results in the loss of 60-80% of the extra weight you carry and keep this weight from coming back if you follow our post-operative instructions. This means if you weigh 150 kilos and should weigh 75 kilos according to your height and body frame, you will lose an average of 45 kgs to 60 kgs with the operation. Some patients lose all their extra weight with complementing diet and exercise routine. While those who do not follow instructions will lose less excess weight and also run the risk of gaining back some weight after 2-3 years of surgery. In addition to excess weight loss, if you have any of these conditions, they will improve or totally resolve after the surgery: Type 2 Diabetes High blood pressure Sleep apnea Abnormal lipids/cholesterol Asthma Low back pain Weight-bearing arthritis of the hips, knees, ankles, and feet Skin fold dermatitis Urinary stress incontinence Acid reflux Metabolic Syndrome Finally, the health benefits gained with gastric bypass surgery can reduce your risk of death by as much as 89% compared to staying morbidly obese.   Endoscopic Intra Gastric Balloon: This is a non surgical procedure done in a day care setting. A soft silicone balloon filled with saline is placed in stomach and this limits food intake patients full all the time. So overeating is significantly reduced with causes excess weight loss. However, the balloon has to be removed after about six months and there is a risk of lost weight bouncing back if patient is well motivated to stick to the diet and exercise regimen. Robotic Bariatric Surgery: We are the only center in Pune and Western Maharashtra offering Robotic Bariatric Surgery. A key advantage of Robotic instrumentation is that they articulate just like human wrist whereas laparoscopic instruments don’t. As a result, complex Hernia surgeries now can be done by keyholes of laparoscopic surgery easily using robotic instruments. Some people may mistake that Robotic surgery is done by Robots. Actually it is not so. A surgeon controls movements of instruments like a pilot controls the plane. His commands are obeyed by instruments that are much more finer and flexible compared to traditional instruments. As a result superior surgical outcomes are achieved with minimal discomfort to patients.