Dr. Premkumar Balachandran is a well known Bariatrician with a vast experience of 27 years. He completed his MBBS from PSG Institute Of Medical Science, Coimbatore in 1990. After which he pursued MS in General Surgery from Sri Ramachandra Medical College And Research Institute in 1997 and Master Of Minimal Access Surgery from Ninewells Medical School, Dundee UK in 2003. But his eagerness for learning did not stop there. He holds a Diploma in Minimal Access Surgery and has completed 5 fellowship programs- Fellowship in Minimal Access Surgery and Fellowship In Robotic Surgery from World Laparoscopy Hospital, Gurgaon, FICS from The International College of Surgeons, USA, F.I.A.G.E.S from Indian Association Of Gastrointestinal Endosurgeons and FARMASI from Association Of Minimal Access Surgeons Of India.
In his long career he has won prestigious awards like The Chikitsa Rattan Award and Gold Medal for Excellence in Medical Science by The International Study Circle, New Delhi. He is a member of various medical associations like Association of Surgeons of India, Indian Medical Association. He runs Gastro - Bariatric-Hernia Speciality Clinic in Chennai. He can be reached at his clinic on Monday to Saturday from 9 AM to 4 PM. He also provides online consultations.
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He is not just friendly, but also is very motivating. The interior of the Gastro - Bariatric Clinic was no nicely done, it was so clean. I had lost hope, but the diet chart given by Premkumar Balachandran has helped me regain my confidence and eliminate my obesity.
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The risk of developing heart problems has increased to a great extent and this is mainly due to obesity, which leads to other diseases. A gastric bypass surgery is a medical procedure, which is commonly known as Roux en-Y surgery. It aids in reducing the size of the stomach. The reduction in the size of the stomach makes an individual feel full even when they have eaten very little.
Gastric Bypass Procedure
The stomach bypass surgery is generally known as a bariatric surgery and it guarantees weight loss of about 30-40% within a year. For this procedure, the patient has to be in the hospital for 4-5 days and it takes about 2-3 hours for the medical procedure. It is through this procedure that the size of the stomach is reduced permanently and is performed laparoscopically.
Five small holes are made in the stomach under general anaesthesia. The procedure is conducted only after tests like ECG, blood and urine tests, chest X-Ray chest, abdominal scan and echocardiogram are carried out.
The patient can be discharged from the medical centre on the fourth day. However, it is necessary that calcium, vitamins and supplements are included in the diet plan, mainly to prevent malnourishment and tiredness. In the medical procedure, the surgeon divides the stomach into two sections using surgical staples. The sections are divided into a small upper pouch and a large remnant. The medical procedure makes use of surgical staples, which is why the procedure is sometimes referred to as stomach stapling.
The small intestine is re-arranged in a manner that the stomach pouches are connected to the intestine. The intake of food is reduced by the reduction in the functional capacity of the stomach and by the re-arrangement of the small intestine that causes food to go through the first portion of the small intestine. The procedure is mainly targeted for people with body mass index of 50 and above. It is important that the individual should not drink water for next 24 hours of surgery.
Benefits of Gastric Bypass Procedure
Results in reduced calorie absorption and helps in weight loss. It is generally advised for people who are unable to accomplish weight loss through diet and exercise.
Risks involved in gastric bypass procedure
- Inflammation of the stomach lining
- Nausea and vomiting
- Nutritional deficiency
- Development of gallstones. This occurs mainly due to loss of significant weight within a short span of time.
The procedure is a little expensive, but it is a reliable medical procedure for weight loss. It is always better to know about the risks involved in this surgery before opting for a weight loss program.
In case you have a concern or query you can always consult an expert & get answers to your questions!
Bariatric surgery is advised only in cases of morbid obesity, which has various severe health effects. Undergoing bariatric or weight loss surgery requires effort not just prior to surgery, but also after surgery to ensure its success. This includes significant diet and lifestyle changes, which often involves moving from one end of the spectrum to another end. However, for a person who is willing to do this, the long-term benefits are multiple.
Read on to know how bariatric surgery can turn your life around.
- Weight loss: Bariatric surgery is advised only for people who are obese. One of the first benefits they would see is weight loss. The tendency to eat less is one of the important ways to reduce eating. Nutrition planning should be meticulously done to achieve two things – avoid weight gain and promote weight loss.
- Emotional gains: For a person who is used to seeing an obese image in the mirror, it is a great morale booster to see that image changing to a slender version. This is a big boost to continue the effort towards diet and exercise, which will only improve the confidence and esteem levels.
- Overall health: Morbid obesity is not an isolated condition. It brings with it a host of medical issues including sleep apnoea, diabetes, hypercholesterolemia, etc. With obesity under control, these conditions also begin to improve and the person’s overall quality of life begins to improve. This in turn provides a big boost for the person to continue working at weight loss.
- Reduced healthcare expenses: Obese people often need to eat various medications to manage overall health. There could also be emotional health management issues. With this controlled, the patient spends less on overall health and feels good again.
- Social connect: Morbid obesity isboth a physical and an emotional blockage for a person to engage socially. Once it is controlled, the person is more confident in meeting people and participating in social activities. This further leads to increased overall happiness.
- Active life: With reduced weight, the person’s level of activity improves. What seemed difficult earlier is suddenly doable. A person who could not walk some steps is able to, and this is a big booster.
People who undergo bariatric surgery require quite a bit of effort to change their overall lifestyle. However, the benefits are for them to see for themselves, and that is the biggest motivator to continue working towards their goal. Support is definitely required both medically and socially to ensure that it works. The benefits are there for all to reap. If you wish to discuss about any specific problem, you can consult a Bariatrician.
A weight loss program is a marathon. While making up the mind to go for a weight loss program is the first step, there are other things to consider before plunging into the diet and exercise regime. Here is a list of 10 things to consider before a weight loss program--
- Not everything works for everyone- Just because a strict diet program helped someone to lose 5 pounds, doesn’t necessarily mean that it will work out for every single person. It is important to figure whether diet, exercise, workout or a combination of everything is required to lose weight.
- Make the environment conducive to match the goal- If the goal is to lose weight, it is essential to skip old habits. For instance, keeping a fruit bowl close by will refrain the thought of having a candy bar, skipping the idea of weekends parties for a while will help to stay away from few extra drinks, a leafy and salad rich lunch would help to stay away from the thought of fast food etc.
- The combination of exercise and diet is necessary- It is necessary to have a healthy mix of diet and exercise. This helps the body to lose weight fast while ensuring that the health is maintained at the same time.
- A plan comes handy- It is necessary to chalk out a plan to get into the weight loss program. For instance, 3 days of gym, 2 days of salad consumption for lunch, 3 days of walking after dinner etc. This will help to beat the monotony and keep the motivation going.
- Set a realistic goal- Losing too much weight in a short span of time is neither healthy nor realistic. It is, therefore, necessary to keep patience and work steadily towards the weight loss goal. An ideal time-frame could range from 3-6 months to attain the desired weight.
- Find the right reason- Since a lot will depend on the long-term discipline, it is, therefore, necessary to find the right reason to lose weight. Looking good or fitting into a skinny-jeans is not the right set of motivational factors to lose weight.
- It is necessary to have coping strategies- There should be a backup plan ready when a craving for chocolate, fast food or ice cream crops up. Healthy alternative such as custard, icy fruit salad, cool drinks can help to cope up with the craving face.
- A workout buddy can prove to be extremely beneficial- Since the process of losing weight is a lonely affair, it makes sense to find a workout buddy. This keeps the boredom of working out at bay and helps to get into a healthy competition.
- A food diary comes handy- While it is practically impossible to keep track all calorie consumption, a food diary will give a rough estimate of the calorie count consumed in a day. This will further help to design a diet for the week.
- Keeping many options open- It is not necessary to spend hours in the gym or only consume fruits to lose weight. Other alternatives such as cycling, swimming, adventure sport also help to lose weight. If you wish to discuss any specific problem, you can consult a bariatrician.
Weight loss surgeries or bariatric surgeries sound nothing short of miraculous. Research proves that they help you lose oodles of sticky fat and you are also able to toss away your type 2 diabetes medications just days after undergoing a weight-loss surgery.
Just the idea of becoming svelte again after a lifetime of being obese is a good inducement to going under the knife, even if you are not a diabetic. But before you take this big risk- bariatric surgery is a major surgery with its own attendant risks- understand whether you are a good candidate for it, which type of bariatric surgery is most effective? And what are the long-term effects?
Rushing in for surgery without having complete knowledge about it could end up causing more problems than it is intended to solve.
Read on to get answers to the fundamentals of bariatric surgery-
Bariatric surgery is digestion redesigned
Bariatric surgery is a work in progress. The procedures are still being fine-tuned since the first bariatric surgery which was carried out in 1956 in America. There are at least seven procedures in bariatric surgery at this time, out of which four are very common. Let’s have a quick look at these four-
1. Gastric Bypass
This is the most frequently performed bariatric surgery. Most gastric bypasses are done laparoscopically in which your surgeon uses a laparoscope to see and work inside your body through just a small incision.
He leaves only a very small part of the stomach, the pouch after a bypass.
As it shrinks the size of the stomach by over 90 percent, from roughly the size of a fist to that of a thumb, a bypass reduces the amount of food you can eat at a time as you feel full faster because the pouch can't hold a lot of food. And also the food you eat bypasses the rest of the stomach, going straight from the pouch to your small intestine which means that lesser calories are absorbed. It also leads to dramatic and quick weight loss and diabetes mellitus reversal.
The re-routing of the food also hinders the absorption of vitamin and minerals, which is why you have to take vitamins to stop deficiencies after a bypass. About 1 out of 5 bypass patients also develop "dumping" syndrome, in which too much-undigested food goes into the small intestine causing diarrhoea and abdominal cramps.
2. Adjustable Gastric Banding
This surgery is also performed laparoscopically and here a fluid-filled belt is wrapped around your stomach. Tightening this belt divides your stomach into two pouches, a small upper pouch that receives food from the esophagus and a larger lower pouch that opens into the small intestine.
This belt's tightness can be adjusted by adding or subtracting saline solution by your doctor. If you tighten the belt, you eat less and lose more weight.
Banding can lead to gastrointestinal distress, such as nausea or bloating especially if you eat too much quickly. Complications with the band can also happen like it might slip out of place or become too loose, or begin to leak. You may have to undergo correction surgeries and infection is always a risk.
3. Sleeve Gastrectomy
This is another form of restrictive weight loss surgery and in this the surgeon removes about 75% of your stomach. What remains of your stomach is a narrow tube or sleeve, which connects to the intestines.
For people who are very obese or sick, this surgery is a heaven send opportunity to lose weight. It has fewer complications as compared to other weight loss surgeries.
It’s an irreversible surgery.
4. Maestro Rechargeable System
Electrical devices are implanted like pacemakers to deliver electrical pulses to the vagus nerve between the stomach and brain. Vagus tells your brain when the stomach is full. The electrical device is implanted in your abdomen and has a remote control that you can adjust from outside. It works by controlling hunger.
You can die of a bariatric surgery even though it’s considered a safe surgery. Death rates are higher for gastric bypass as compared to banding. Therefore, you must take the decision to have this kind of surgery after serious consultations with doctors.
You are an ideal candidate if-
- You're an extremely obese adult with a BMI of over 35
- If you have a weight-related condition like type 2 diabetes
- You have tried everything and failed.
After Bariatric surgery
Life changes forever after such a surgery. You have restrictions imposed on what types of food you can have and in what quantities. Like, you may only be able to have soft foods, less simple carbs than before and other such dos and don’ts which you have to follow for the rest of your life.
If you don’t obey these diet restrictions your operation can fail or you may not get any benefit. Other long-term side effect of weight loss surgery is nausea, vomiting and digestive distress. You also have to exercise regularly after this surgery to rep benefits. If you wish to discuss about any specific problem, you can ask a free question.
Diabetes is a gnawing problem that affects millions throughout the world. It is a disorder that if overlooked can lead to serious diseases; cardiovascular ailments, problems related to vision, kidney problems and many more. While medication tries to regulate your blood sugar levels, it is not always unfailing. Medication along with changes in your diet and lifestyle can still not improve your condition in certain cases. At times it is hard to increase the insulin production in a person's body even after administering medicines solely known for their efficacy. Such kind of diabetic patients can therefore benefit from a Bariatric surgery.
What is a Bariatric surgery?
Bariatric surgery doesn't refer to a single operative method. It involves a host of surgical procedures conducted on a person to rid him or her of obesity. Obesity in combination with diabetes can make a person's life miserable. The treatment of one can come in the way of curing the other. A diabetic patient who also suffers from obesity usually finds it hard to lose weight in spite of exercising or being on diet. Surgery comes to their rescue. This kind of surgery should be fallen back upon as the lender of last resort that is to say when other solutions have not helped. Bariatric surgery is always performed under skilled supervision. It might include reduction of the size of your stomach, removal of a portion of the stomach, or even gastric bypass surgery.
How does Bariatric surgery help reduce Diabetes?
Diabetes can be of three basic kinds;
Type 1 diabetes in which the body produces no amount of insulin.
Type 2 diabetes in which the body produces an insufficient amount of insulin or Gestational diabetes that pregnant women tend to contract.
Bariatric surgery proves to be very advantageous for patients of Type 2 diabetes:
1. Surgery lowers blood sugar levels considerably. Research shows people with acute diabetes made huge improvements after having undergone a Bariatric surgery. Their blood sugar levels dropped by a noticeable percentage and they felt healthier. Reduced blood sugar is an almost immediate effect in some while for others it does take some time.
2. Bariatric surgery exercises a control over cholesterol, blood pressure and triglyceride levels.
3. The impressive benefits of this operation for a Type 2 diabetes patient are not superficial or temporary. If the patient adheres to the lifestyle prescribed by a doctor, takes medication regularly and follows the basics of post- operative care he or she is likely to remain beyond the ambit of this metabolic disorder.
4. It successfully takes care of ailments resulting from diabetes.
5. Bariatric surgery can eliminate the need for medication or it can reduce the dosage of medicines you take. If you wish to discuss about any specific problem, you can consult a Bariatrician.
Are you overweight and thinking about undergoing a weight loss surgery? If yes, then you can opt for a gastric bypass surgery in which certain changes are made to your digestive system. Due to these changes, the amount of food you consume gets limited and the absorption of nutrients also gets reduced. Hence, weight is lost due to a reduced appetite or stomach capacity. This surgery is undertaken by people who face severe health difficulties because of being overweight. Gastric bypass surgery is a very common form of weight loss surgery associated with fewer complications.
Why is it carried out?
A gastric bypass surgery is carried out to help you lose excess weight. This reduces the risk of several weight related health problems such as heart diseases, hypertension, severe sleep apnea, strokes, type 2 diabetes and gastroesophageal reflux disease. This surgery is undertaken when a person fails to lose weight after following several other methods.
Who is it for?
You can undergo a gastric bypass surgery only when your body mass index or BMI is 40 or higher, or when your BMI is between 35 to 39.9 and you also have a severe condition such as type 2 diabetes or high blood pressure. This surgery is not for all people who are overweight and several criteria have to be fulfilled before deciding on getting a gastric bypass surgery.
This surgery has to be carried out at a hospital and the patient is given general anesthesia. The surgery depends on the individual situation of the patient and on the surgeon who will perform the surgery. Most bariatric or gastric bypass surgeries are carried out laparoscopically. A laparoscope, which is a small, tubular device with a camera attached to it, is inserted into the abdomen via small incisions. The camera allows the surgeon to see the inside your abdomen and perform the procedure. A laparoscopic surgery is efficient and the patient recovers faster than other modes of surgery. The surgery takes several hours to be successfully completed. The patient may have to stay at the hospital for five days.
Gastric bypass surgery or bariatric surgery provides long-term weight loss. The amount of weight that will be lost depends on the surgical procedure and the patient’s new lifestyle and habits. It is possible to lose more than 50% of the pre-surgery body weight within a span of two years. Along with weight loss, the surgery also improves and resolves various conditions related to obesity.
A gastric bypass surgery also improves a patient’s ability to undertake regular activities. This improves the quality of life and the patient gains confidence and self-esteem. A successful gastric bypass surgery can change your life. If you wish to discuss about any specific problem, you can ask a free question.
A hernia occurs when an organ or fatty tissue pushes through a weak opening in the muscle that holds it in place. Hernias are common in the abdomen, but can also develop in the upper thigh, belly button and the genitals. The common types of hernia are the ones that occur in the groin viz (inguinal, femoral, obturator) around the belly button (umbilical), incisional (after a previous surgery) and hiatal (causes acid reflux) and are caused by muscle weakness. This weakness or increase in pressure in the abdomen can be triggered by lifting heavy objects without stabilizing abdominal muscles, diarrhea or constipation and chronic coughing (smokers and asthmatics) or straining to pass urine.
How can you treat hernia?
As hernia is a mechanical defect in the abdominal wall, the only definitive treatment is surgical repair of the defect. The type of surgery required depends on the size of the hernia and the severity of its symptoms. The defect may be repaired with stitches but the best option with least recurrence is to use a mesh. The Hernias that are small and don't cause discomfort can be observed and managed conservatively with regular follow up with the surgeon. All hernias have the risk of intestines getting trapped and strangulation.
Avoiding heavy meals, not bending over immediately after a meal and managing your body weight can reduce the incidence of hernias. Also, you should avoid foods causing heartburn and quit smoking. If these dietary changes do not relieve your discomfort, you may need surgery to treat hernia.
Prescription medication given by your doctor that reduces stomach acid can relieve your soreness and improve the symptoms.
So when do you need surgery?
If your hernia is gradually growing in size, looks unsightly and is causing pain, you should seek help and the doctor may advice you to effectively treat it through surgery. But with a hernia, there is always a risk of bowel obstruction and strangulation which may need an emergency operation.
A hernia can be repaired using two different surgical methods - open surgery or laparoscopic surgery.
In case of an open surgery, an incision is made in the skin near the bulging area. It requires a longer recovery process.
Laparoscopic surgery uses a camera and miniaturized surgical equipment to repair the hernia by making two to four small incisions in the abdomen. This method is less damaging to the surrounding tissue and has a much shorter recovery time.
Almost all of the hernias can be treated Laparoscopically, but as many surgeons are not well trained in Lapsroscopic hernia repair they do not recommend the procedure. So it's imperative you seek out a good minimally invasive surgical specialist.
Is there an alternative to surgery?
There is no other treatment apart from surgery for a hernia (imagine you have a hole in a cloth, the only way to repair it is with a thread (darning) or a patch).
Exercising regularly, losing weight or taking medications will not eliminate a hernia. Some patients feel that wearing a hernia belt will help ease the discomfort, but it will not help your hernia go away. It will only provide temporary relief. Only surgery provides a permanent and effective solution. If you wish to discuss about any specific problem, you can ask a free question.
- Laparoscopic Sleeve Gastrectomy: Where the stomach is converted into a thin tube of 100 ml capacity.
- Gastric bypass surgery: This process involves dividing the stomach into 2 portions and connecting the top end directly to the middle portion of small intestine with the food you eat going directly from the top part of the stomach to the intestine.
This class of surgery works in two ways to bring about weight loss – firstly, through surgical changes made to your digestive system, it strives to limit your food intake; and secondly, it also controls your nutrient absorption capability.
There are certain conditions that you need to meet before you can opt for weight loss surgery and these are:
- Diet and exercise have failed to help you lose significant amount of weight
- You’re extremely obese and have a body mass index (BMI) of 37.5 kg/m2 or more. (BMI or body mass index is a ratio of your weight (kg) / height (m2) ).
- Your BMI is above 32.5 kg/m2 along with associated health problems like type 2 diabetes, sleep apnoea (a common sleep disorder wherein you snore excessively and experience pauses in breathing or shallow breathing instances while sleeping), high blood pressure, high cholesterol levels, osteoarthritis or joint pains.
- You will need to be evaluated thoroughly by a Bariatric Surgeon who would advise you some tests to do a whole body evaluation before surgery. He might ask you to meet the different specialists as per your co-morbid conditions in order to optimize your clinical condition. This ensures a safer surgery.
Weight loss through surgery shouldn’t be looked upon as a shortcut to losing weight. It is a powerful tool to aid you to become healthier, but remember. "With Great Power comes Greater Responsibility", because after the surgery you’ll be required to make some changes to your eating and lifestyle habits to ensure a long, healthy and satisfying life. If you wish to discuss about any specific problem, you can consult a bariatrician.