Bariatric surgery
Bariatric Surgery: A Path to Healthier Living
Bariatric surgery, including procedures like sleeve gastric and gastric bypass, involve making changes to the digestive system to promote weight loss.
Dr. Ajay Kumar Kriplani specializes in performing advanced bariatric procedures, offering personalized care to help patients achieve sustainable weight loss and improved health.
This type of surgery is recommended for individuals who struggle with severe obesity, especially when diet and exercise have not been successful, or when weight-related health conditions pose serious risks. Some bariatric procedures reduce the amount of food you can eat, while others decrease the body’s ability to absorb nutrients. Certain procedures combine both approaches to achieve effective and lasting results.
While bariatric surgery offers significant health benefits, it is a major undertaking, requiring life style changes along with surgery. Success depends on your commitment to adopting lifelong healthy habits, including a balanced diet and regular exercise. With Dr. Ajay Kumar Kriplani’s expert guidance and care, you can embark on a safe and transformative journey toward better health and quality of life.
Contact Dr. Ajay Kumar Kriplani today to explore your options and take the first step toward a healthier future.
Obesity?
What is Obesity?
Obesity is a progressive, life-threatening condition marked by excess accumulation of body fat, which can significantly reduce life expectancy. Obesity is defined as “morbid” when excessive weight causes obesity related diseases. Morbid Obesity is being 40kg above ideal weight or having a body mass index of 37.5 kg/m2 or above.
What is BMI?
Body Mass Index (BMI) is a method of calculating degree of obesity based on weight and height.
BMI is calculated by using following formula:
\[\text{BMI} = \frac{\text{Weight (In Kilograms)}}{\text{Height (m)} \times{\text{Height (m)}}}\]BMI Calculator
IS OBESITY SURGERY FOR YOU?
One would qualify for weight loss surgery if
- BMI is 37.5 Kg/m2 and above or is 32.5 Kg/m2 and above with diabetes, high blood pressure, arthritis, breathing difficulties, etc. Long term results of lifestyle modifications & drug therapy, without surgery, have been disappointing in this population.
- Unable to perform daily routine activities or maintain hygiene due to severe obesity.
- Failure to lose weight through diet and exercise.
- Committed to making life long dietary & lifestyle changes (increased physical activities)
- Understood the surgical procedure and willing for regular follow-up.
WHAT ARE THE BENEFIT OF WEIGHT LOSS SURGERY?
- Significant and sustained weight loss. One can lose about 80% of excess weight and maintain it in the long run.
- Decreased appetite with prolonged satiety. One does not feel hungry/deprived.
- Improvement in weight related diseases e.g. Diabetes: 82% of the patients will be cured of Diabetes. In other 18%, diabetes control improves and medicine requirement decreases.
- Breathing problems & Sleep Apnoea improve by 74% to 98% and patients may come off CPAP machine.
- Increased longevity. This is due to decrease in death by heart diseases, diabetes and cancer.
- Improvement in blood pressure in majority of the cases.
- Joint pain decreases, improving physical activity and movement.
- Improves Reflux disease.
- Improved quality of life, body image and self-esteem.
WHAT IS LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG)?
Also called a vertical sleeve gastrectomy or stomach stapling, it is a restrictive procedure. In this procedure the stomach is divided vertically to create a sleeved stomach of the size and shape of a banana. About 80% of the stomach, including the fundus and the left portion of the stomach is removed. The new stomach measures about 60 to 120 ml. The nerves to the stomach and the outlet valve (pylorus) remain intact. This smaller stomach can not hold much food and signals early satiety with a small portion size. Fundus is also the source of hunger hormone “Ghrelin”. Removal of fundus reduces the production of this hormone, which may decrease the desire to eat. These factors combined, lead to weight loss. There is a suggestion that a tighter sleeve yeilds better weight loss results than a loose sleeve in the long term. There is no intestinal bypass.
Click here To Watch Video of lap sleeve gastrectomy.
The procedure requires hospitalisation of three days and has replaced adjustable gastric banding and to some extent r-n-y gastric bypass also. |
WHAT IS ROUX-EN-Y GASTRIC BYPASS & HOW DOES IT WORK?
Gastric bypass is a combination of restrictive and malabsorptive procedures. During the surgery, a small Gastric pouch (about 30 ml) is created from the upper part of the stomach using staples. This can hold only a small amount of food. The newly created stomach pouch is then connected directly to the small intestine. The ingested food now bypasses larger part of stomach and a part of small intestine. Patients do not feel hungry, and due to a small stomach pouch, the patient report early sense of fullness and satisfaction and feel full longer. This decreases food intake. Bypassing the stomach and part of intestine means fewer calories are absorbed. Gastric bypass surgery can also lead to changes in gut hormones, which can help improve metabolic health including remission of diabeties type 2.
Click here To Watch Video of Roux-En-Y Gastric Bypass.
The procedure requires hospitalisation of about three days supplements of iron, calcium and multi vitamins must be taken regularly to avoid deficiencies.
It is the oldest, the most time tested and studied weight loss procedure, in use for nearly 35 years. It leads to speedier weight loss than other procedures.
It is prompted now for treatment of Diabetes Mellitus Type 2 which is resolved in 84% of patients and often within weeks of surgery.
WHAT IS MINI GASTRIC BYPASS AND HOW DOES IT WORK?
Mini gastric bypass (MGB), also known as One Anastomosis Gastric Bypass (OAGB), is a bariatric procedure that promotes weight loss through restriction and malabsorption. It involves creating a small tubular stomach pouch by stapling the upper part of the stomach, which reduces the volume of the stomach and food intake. This pouch is then connected to a loop of the small intestine, bypassing a portion of the stomach and proximal small intestine. Bypassing the intestine creates malabsorption of calories. Unlike RNY gastric bypass, the small intestine is not divided and remains in continuity.
Mini gastric bypass pros and cons.
It is a safe surgery, technically easier to perform than a RNY gastric bypass and gives good weight loss results. It works primarily by malabsorption, which means that patients can still eat a sufficient quantity of food to feel satiated, and it doesn’t interfere with their long-term weight loss.
The downside of mini gastric bypass is the long-term risk of malabsorption and nutrient deficiency. Delayed complications are mostly related to nutrient deficiency and include weakness, hair fall, skin loosening, hernia, etc.
Patients have to maintain a very high daily protein intake, which may be difficult in typical Indian diet and take supplements of iron, calcium and multivitamins in larger quantities to avoid deficiencies. Sometimes, patients may experience diarrhoea and hair fall.
WHAT ARE THE ADVANTAGES OF GASTRIC BYPASS?
- Hunger is reduced and one does not feel deprived.
- Effective, weight loss starts soon after surgery and one can lose about 40-80 kgs post-surgery in 1.5 years.
- Indicated particularly with co-morbidities such as Diabetes.
- Safe in expert hands.
- Particularly recommended in patients above 40 yrs. of age, in diabetics and when BMI is above 50 Kg/m^2.
HOW TO PREPARE FOR LAPAROSCOPIC WEIGHT LOSS SURGERY?
You will be thoroughly evaluated including blood test, heart evaluation, and other tests to determine fitness for anesthesia and surgery. Screening for any nutritional deficiency will be performed. Diabetes should be controlled and other specialties involved when necessary. Smoking must be completely stopped weeks before surgery as it compromises healings. Special pre op diet is given for 7 to 10 days and chest physiotherapy started.
WHAT TO EXPECT AFTER SURGERY?
After surgery the patient is kept in the postoperative ward for a couple of hours and once the anaesthetist is satisfied, the patient is shifted to the room. A drainage tube comes out on the left side of upper abdomen for draining the staple line. The patient is encouraged to walk to the washroom on the day of surgery but is kept nil by mouth and intravenous fluids continued.
On the next day morning the staple line / anastomosis is checked by taking X ray after giving oral contrast solution. The patient should drink small sips of contrast because the stomach pouch is now small. Once satisfied, clear liquids are permitted by mouth. Intravenous fluids are continued on post op day 1. On the second day oral intake of liquids is increased. Once an intake of 1.5 liters is achieved in 2 to 3 days, patient can be discharged. The drain is removed on 7th postoperative day on outpatient basis. The patient takes injectable anticoagulants for 21 days to prevent thrombo embolic phenomenon and is encouraged to walk to prevent deep vein thrombosis. Stockings may be prescribed.
After weight loss surgery, diet begins with sugar-free, noncarbonated liquids for the first fifteen days. One does not feel hungry at all, but consuming 1.5 liters of fluid is essential to maintain hydration and good urine flow. From third week, pureed foods are started for two weeks. From 5th week, soft diet is consumed and finally after 6 weeks regular foods are permitted. Bypass patients will be required to take a multivitamin twice a day, calcium supplement and iron once a day and vitamin B-12 for life.
WHAT ARE THE RISKS ASSOCIATED WITH WEIGHT LOSS SURGERIES?
These can include:
- Excessive bleeding.
- Infection.
- Adverse reactions to anesthesia.
- Blood clots.
- Lung or breathing problems.
- Leaks from the cut edge of the stomach
Longer-term risks and complications can include:
- Vomiting.
- Gastrointestinal blockage.
- Gastro esophageal reflux.
- Hernias.
- Malnutrition amongst others.
WHAT ARE THE LIFE STYLE CHANGES REQUIRED AFTER WEIGHT LOSS SURGERY?
- Since the stomach pouch is small, the patients should eat slowly to avoid vomiting, chew the food well as the stomach is small and will not be able to handle big bites.
- Food choices have to be proper. It is important to avoid simple carbs (like sugar, juices, sodas) and fat (which yields twice the amount of calories than protein) for good weight loss. The diet should mainly consist of protein with fresh fruits and vegetables.
- Other lifestyle changes include walking / exercising every day to promote weight loss and build up muscles.
- Regular physical activity is essential to burn fat and prevent muscle loss and minimum is walking 3 kms per day. Gradually exercises should be started and the best option is a sport of choice or swimming. The weight loss reaches a plateau at 18 months and life style changes must be continued to maintain weight.
- Smoking and alcohol are completely forbidden.
- Regular medical checkups to monitor health are essential for the first several months after weight-loss surgery, which include laboratory testing, blood work and various exams.
- Sometimes one may experience changes as the body reacts to the rapid weight loss in the first 3 to 6 months after weight loss surgery including:
Feeling tired, as if you have the flu.
Dry skin.
Hair thinning and hair loss.
These indicate that protein intake is insufficient and needs to be increased.
The weight loss is maximum in the first month and significant till 3 months and then slowly reaches a plateau at 15 to 18 months. To achieve optimal weight loss it is essential to follow the life style changes.
How does morbid obesity affect health?
Obesity is a silent killer and causes many diseases.
- Decreased longevity and premature death. Morbidly obese persons (BMI above 37.5) lose seven years of life. One will not see many obese persons crossing 70 years. If they lose weight, their life span can become normal.
- Diabetes mellitus Type 2 is 40 times more common in morbidly obese people. Diabetes causes damage to eyes, heart, kidney and brain. Diabetes is cured or improved in majority of the cases after weight loss surgery.
- Arthritis of knee and ankle joints can cripple and affect movement & activity.
- Breathing Problems, Disturbed Sleep And Sleep Apnoea. Sudden death may occur during apnoea.
- High Blood pressure.
- Heart disease and Sudden Death Syndrome. If a heart emergency occurs, sudden death is more common in obese people.
- Infertility or irregular periods.
- Gastro esophageal reflux or heart burn.
- Metabolic syndrome & Psychological Disorders (Depression).
- Cancer of Breast, Colon, Prostate and Uterus are more common in morbidly obese individual.
ALL ABOVE CONDITIONS IMPROVE AFTER WEIGHT LOSS SURGERY
How can we calculate severity of obesity?
- Body Mass Index (BMI)
It has been shown that the higher the body mass index (BMI), the greater the risk for associated illnesses such as diabetes, hypertension, sleep apnea, high cholesterol, coronary artery disease and others. When morbidly obese individuals have one or more of the above diseases, their risk for death increases, and quality of life is severely diminished.
BMI range - kg/m2 |
Category |
|---|---|
2. Waist Circumference as a Risk Indicator
Obesity may be peripheral obesity (fat in extremities, buttocks) or central (truncal /visceral). It is visceral fat that is the killer fat and is more linked to an increased risk of heart disease, type 2 diabetes, and other health problems. Waist circumference is a surrogate marker of truncal /visceral fat and Measuring waist circumference helps assess visceral / central obesity. A waist circumference of 102 cm (40 inches) or more is considered high-risk in men and 88 cm (35 inches) or more is considered high-risk for women among Caucasians. However some ethnic groups, like those of South Asian (including India), Chinese, or Japanese descent, may have increased cardio metabolic risk at lower BMI. This is because, for the same weight, they have more visceral fat as compared to Caucasians. In Indians, a waist circumference of 90 cm or more in men and 80 cm or more in women is considered a significant risk factor for cardiovascular disease, diabetes, and other metabolic disorders, requiring a shift in lifestyle and medical interventions.
3. Waist-to-Hip Ratio (WHR):
WHR is calculated by dividing waist circumference (measured at the narrowest point) by hip circumference (measured at the widest point). WHR is a useful indicator of abdominal fat, which is linked to a higher risk of various health problems, including heart disease, type 2 diabetes, and certain cancers. The World Health Organization (WHO) classifies abdominal obesity based on WHR. The cutoff points, considered indicative of upper-body obesity, is 0.90 for men and 0.85 for women.
IS OBESITY SURGERY FOR YOU?
One would qualify for weight loss surgery if
- BMI is 37.5 and above or is 32.5 and above with diabetes, high blood pressure, arthritis, breathing difficulties, etc. Long term results of lifestyle modifications & drug therapy have been disappointing in this population.
- Unable to perform daily routine activities or maintain hygiene due to severe obesity.
- Failure to lose weight through diet and exercise.
Committed to making life long dietary & lifestyle changes (increased physical activities) - Understood the surgical procedure and willing fora regular follow-up.
WHAT ARE THE BENEFIT OF WEIGHT LOSS SURGERY?
- Significant and sustained weight loss. One can lose about 80% of excess weight and maintain it in the long run.
- Decreased appetite with prolonged satiety. One does not feel hungry/deprived.
- Improvement in weight related diseases e.g. Diabetes: 82% of the patients will be cured of Diabetes. In other 18%, diabetes control improves and medicine requirement decreases.
- Breathing problems & Sleep Apnoea improve by 74% to 98% and patients may come off CPAP machine.
- Increased longevity. This is due to decrease in death by heart diseases, diabetes and cancer.
- Improvement in blood pressure in majority of the cases.
- Joint pain decreases, improving physical activity and movement.
- Improves Reflux disease.
- Improved quality of life, body image and self-esteem.
WHAT IS LAPAROSCOPIC SLEEVE GASTRECTOMY (LSG)?
Also called a vertical sleeve gastrectomy or stomach stapling, it is a restrictive procedure. In this procedure the stomach is, divided vertically to create a sleeve (tube) shaped stomach of the size of a banana. About 80% of the stomach, including the fundus and the left portion of the stomach is removed. The new stomach measures about 60 to 120 ml. The nerves to the stomach and the outlet valve (pylorus) remain intact. This smaller stomach can not hold much food and signals early satiety with a small portion size. Fundus is also the source of hunger hormone “Ghrelin”. Removal of fundus reduces the production of this hormone, which may decrease the desire to eat. This factors combined, lead to weight loss. There is a suggestion that a tighter sleeve yeilds better weight loss results than a loose sleeve in the long term. There is no intestinal bypass.
Click here To Watch Video.
The procedure requires hospitalisation of three days and has replaced adjustable gastric banding and to some extent r-n-y gastric bypass also. |
WHAT IS ROUX-EN-Y GASTRIC BYPASS & HOW DOES IT WORK?
Gastric bypass is a combination of restrictive and malabsorptive procedures.
During the surgery, a small Gastric pouch (about 30 ml) is created from the upper part of the stomach using staples. This can hold only a small amount of food. The newly created stomach pouch is then connected directly to the small intestine. and a section of intestine is attached directly to the pouch. The ingested food now bypasses larger part of stomach and a part of small intestine. Patients do not feel hungry, and due to a small stomach pouch, the patient report early sense of fullness and satisfaction and feel full longer. This decreases food intake. Bypassing the stomach and part of intestine means fewer calories are absorbed. Gastric bypass surgery can also lead to changes in gut hormones, which can help improve metabolic health including remission of diabeties type 2.
Click here To Watch Video.
The procedure requires hospitalisation of about four days.
It is the oldest, the most time tested and studied weight loss procedure, in use for nearly 35 years. It leads speedy weight loss than other procedures. It is the most commonly performed weight loss procedure in the USA.
It is prompted now for treatment of Diabetes Mellitus Type 2 which is resolved in 84% of patients and often within weeks of surgery.
WHAT IS MINI GASTRIC BYPASS AND HOW DOES IT WORK?
Mini gastric bypass (MGB), also known as One Anastomosis Gastric Bypass (OAGB), is a bariatric procedure that promotes weight loss through restriction and malabsorption. It involves creating a small tubular stomach pouch by stapling the upper part of the stomach, which reduces the volume of the stomach and food intake. This pouch is then connected to a loop of the small intestine, bypassing a portion of the stomach and proximal small intestine. Bypassing the intestine creates malabsorption of calories. Unlike RNY gastric bypass, the small intestine is not divided and remains in continuity.
Mini gastric bypass pros and cons.
It is a safe surgery, technically easier to perform than a RNY gastric bypass and gives good weight loss results. It works primarily by malabsorption, which means that patients can still eat a sufficient quantity of food to feel satiated, and it doesn’t interfere with their long-term weight loss.
The downside of mini gastric bypass is the long-term risk of malabsorption and nutrient deficiency. Delayed complications are mostly related to nutrient deficiency and include weakness, hair fall, skin loosening, hernia, etc.
Patients have to maintain a very high daily protein intake, which may be difficult in typical Indian diet and take supplements of iron, calcium and multivitamins in larger quantities to avoid deficiencies. Sometimes, patients may experience diarrhoea and hair fall.
WHAT ARE THE ADVANTAGES OF GASTRIC BYPASS??
- Hunger is reduced and one does not feel deprived.
- Effective, weight loss starts soon after surgery and one can lose about 40-80 kgs post-surgery in 1.5 years.
- Indicated particularly with co-morbidities such as Diabetes.
- Safe in expert hands.
- Particularly recommended in patients above 40 yrs. of age in diabetics and BMI above 50.
HOW TO PREPARE FOR LAPAROSCOPIC WEIGHT LOSS SURGERY?
You will be thoroughly evaluated including blood test, heart evaluation, and other tests to determine fitness for anesthesia and surgery. Screening from any nutritional deficiency will be performed. diabetes should be controlled and other specialties involved when necessary. Smoking must be completely stopped weeks before surgery as it compromises healings. Special pre op diet is given for 7 to 10 days and chest physiotherapy started.
WHAT TO EXPECT AFTER SURGERY?
After surgery the patient is kept in the postoperative ward for a couple of hours and once the anaesthetist is satisfied, the patient is shifted to the room. A drainage tube comes out on the left side of upper abdomen for draining the staple line. The patient is encouraged to walk to the washroom on the day of surgery but is kept nil by mouth on intravenous fluids.
On the next day morning the staple line / anastomosis is checked by taking X ray after giving oral contrast solution. The patient should drink small sips of contrast because the stomach pouch is now small. Once satisfied, clear liquids are permitted by mouth. Intravenous fluids are continued on post op day 1. On the second day oral intake of liquids is increased. Once an intake of 1.5 liters is achieved in 2 to 3 days, patient can be discharged. The drain is removed on 7th postoperative day on outpatient basis. The patient takes injectable anticoagulants for 21 days to prevent thrombo embolic phenomenon and is encouraged to walk to prevent deep vein thrombosis. Stockings may be prescribed.
After weight loss surgery, diet begins with sugar-free, noncarbonated liquids for the first fifteen days. One does not feel hungry at all, but consuming 1.5 liters of fluid is essential to maintain hydration and good urine flow. From third week, pureed foods are started for two weeks. From 5th week soft diet is consumed finally after 6 weeks regular foods are permitted. Bypass patients will be required to take a multivitamin twice a day, calcium supplement and iron once a day and vitamin B-12 for life.
WHAT ARE THE RISKS ASSOCIATED WITH WEIGHT LOSS SURGERIES?
These can include:
- Excessive bleeding.
- Infection.
- Adverse reactions to anesthesia.
- Blood clots.
- Lung or breathing problems.
Leaks from the cut edge of the stomach
Longer-term risks and complications can include:
- Vomiting.
- Gastrointestinal blockage.
- Gastro esophageal reflux.
- Hernias.
- Malnutrition amongst others.
WHAT ARE THE LIFE STYLE CHANGES REQUIRED AFTER WEIGHT LOSS SURGERY?
- Since the stomach pouch is small, the patients should eat slowly to avoid vomiting, chew the food well as the stomach is small and will not be able to handle big bites.
- Food choices have to be proper. Avoiding simple carbs like sugar, juices, sodas and fat (which yields twice the amount of calories than protein) are essential for good weight loss. The diet should mainly consist of protein with fresh fruits and vegetables.
- Other lifestyle changes include walking / exercising every day to promote weight loss and build up muscles.
- Regular physical activity is essential to burn fat and prevent muscle loss and minimum is walking 3 kms per day. Gradually exercises should be started and the best option is a sport of choice or swimming. The weight loss reaches a plateau at 18 months and life style changes must be continued to maintain weight.
- Smoking and alcohol are completely forbidden.
- Regular medical checkups to monitor health are essential for the first several months after weight-loss surgery, which include laboratory testing, blood work and various exams.
- Sometimes one may experience changes as the body reacts to the rapid weight loss in the first 3 to 6 months after weight loss surgery including:
Feeling tired, as if you have the flu.
Dry skin.
Hair thinning and hair loss. This indicates protein intake is insufficient and needs to be increased.
The weight loss is maximum in the first month and significant till 3 months and then slowly reaches a plateau at 15 to 18 months. To achieve optimal weight loss it is essential to follow the life style changes.