Narayana Health Care

Over 30 million have now been diagnosed with diabetes in India. They do not pointlessly call India the diabetic capital of the world. The CPR (Crude Prevalence Rate) in the urban areas of India is thought to be 9%. In rural areas, the prevalence is approximately 3% of the total population.

What is weight loss surgery?

According to Wikipedia, Weight Loss or Bariatric surgery includes a variety of procedures performed on people who have obesity. The weight loss is mostly achieved by altering gut hormone levels that are responsible for hunger and satiety, leading to a new hormonal weight set point. This includes gastric bypass and other weight-loss surgeries.

When are weight loss surgeries recommended?

Such surgeries are recommended in cases that pose serious threats to your health that weight reduction becomes essential.

• Heart disease and stroke
• High blood pressure
• Nonalcoholic fatty liver disease (NAFLD) or nonalcoholic steatohepatitis (NASH)
• Sleep apnea
• Type 2 diabetes

Type 2 Diabetes is a situation where the pancreas produces enough insulin but the body is unable to use it. Diabetes is a syndrome leading to a number of diseases like blindness, heart, and blood vessel disease, strokes, kidney failure, nerve damage and in severe cases amputations. Contemporary therapies may not always be able to manage Diabetes. In that case weight loss surgeries are vital.

Who performs weight loss surgery?

A Bariatric surgeon is the one who performs the procedure. The team may include an endocrinologist, a general surgeon, a cardiologist, and a physician.

Preparing for the Procedure: Candidates are evaluated based on –

• Body Mass Index more than 35
• All methods of Diabetes and weight loss management have been tried but failed
• The final call needs to be taken by your team of doctors

When you are ready for the dietary and exercise commitment the procedure takes place.

How is the Bariatric surgery performed?

There are 2 types of procedures:

1. Gastric Bypass – Here a small stomach pouch is made by dividing the stomach. The food when eaten gets into the small pouch and bypasses the other half of the tied stomach and the top portion of the small intestine. This leads to more and early satiety and absorption of fewer calories.
2. Gastric sleeve (also called sleeve gastrectomy) – Here a large part of your stomach is removed reducing a hormone named ghrelin making you feel less hungry.
3. Adjustable gastric band – Like the name says an adjustable band is tied around the top portion of the stomach. The benefit is there is no cutting or moving of organs involved so the chances of complications post-surgery are limited. The band, however, slips or may wear later; you may need a surgery to fix it.
4. Biliopancreatic diversion with a duodenal switch – Here a large portion of the stomach is removed along with intestinal adjustments. A lot of cutting and moving may present severe complications.
5. Electric Implant Device – A device is implanted superficially over your stomach that interferes with the signals of vagus nerve reducing the feeling of hunger. It is a minor surgery.
6. Gastric balloon – An inflated balloon is placed in your stomach via mouth for up to 5-6 months. With all the space of your stomach taken, you can’t eat much.

Your team will help you decide which surgery is best indicated, gathering all your available personal information. Once the surgery is performed you will not be allowed to eat for 2 days giving your stomach time to heal.

What precautions do I need to take post-surgery?

• Strict exercise regimen
• Mandatory Diet Plan
• Eat smaller frequent meals
• Add more vegetable and protein to your plate
• Switch to low fat and calorie options

Risks involved with the bariatric surgery are:

• Excessive bleeding
• Infection
• Adverse reactions to anesthesia
• Blood clots
• Breathing problems
• Leaks in your gastrointestinal system
• Death (rare)

Longer-term risks and complications:

• Bowel obstruction
• Dumping syndrome, which leads to diarrhea, flushing, lightheadedness, nausea or vomiting
• Gallstones
• Hernias
• Low blood sugar (hypoglycemia)
• Malnutrition
• Ulcers
• Vomiting
• Acid reflux
• The need for a second, or revision, surgery or procedure
• Death (rare)

Gathering results from various centers in Indian set up have confirmed that up to 80% of people have shown no signs of diabetes after surgery. Apart from this, people usually lose 60% to 80% of their extra weight. Not to leave the part where it has improved the quality of life in leaps and bouts. Even six years after bariatric surgery, 62% have shown no signs of diabetes. They also had better blood pressure, cholesterol, and triglyceride levels. In comparison, similar people on medication only 6-8% have shown that kind of results. Let’s kick some diabetic — today….

Dr. Vikas Kapur, Senior Consultant – Gastroenterology – Surgical, General Surgery, Narayana Superspeciality Hospital, Gurugram