Bariatric surgery is unlike other surgeries, as its effects are not instant but gradual and are seen over the months. Like any other surgery, it is not without complication. But again unlike all other surgeries, the complication rate can be negligible if a strict protocol is followed. Moreover, the factors like technology advancements, development in the field of advanced laparoscopy, enhanced skillset of the bariatric surgeon, dedicated management of bariatric and metabolic surgeries by bariatric surgeons, play a vital role in the reduction of complication rate which eventually results in safe surgery.

As the procedure is done laparoscopically, the pain is just for a day and is minimally managed by analgesics.

The fear of increasing incidence of incisional hernias while operating an obese patient is so negligible or nil, as the procedure is performed through tiny key holes and all precautions are taken to suture the sheath through which the ports are put to perform the surgery.

Reduced hospital stay and early resuming to work is one of the biggest benefits of this laparoscopic bariatric procedure.

Sometimes, problems that may be faced are:- 

Post-operative bleeding: Normally, this a nearly bloodless surgery involving 5 to 10ml loss of blood. However bleeding from the staple edges is known, but this can be managed well by the surgeon, by choosing the right size of the cartridge as well the right technique of application of the cartridge.

Dehydration: We are normally accustomed to drinking water at long intervals (a few hours) as we can consume nearly 200 to 400ml at one go. Following bariatric surgery, gulping or drinking water in one go is not possible in the first 2 to 4 weeks, due to reduced capacity of the gastric pouch. Hence, care needs to be taken to drink small quantities of water at frequent intervals to avoid dehydration. This is possible only if the patient is counselled about this prior to surgery and is fully aware of this. Also, the patient needs to be given good and clear post operative instructions regarding the quantity and frequency of liquid consumption, not forgetting the type of liquids. Coffee taken frequently could be another cause for dehydration. Family members and colleagues and friends at work play a major role in reminding tthe patient about consuming water frequently. Special care needs to be taken in people who are not accustomed to consuming adequate quantities of water prior to surgery as a general habit.

Vomiting/Fullness/ Discomfort/Indigestion: Following bariatric surgery, soft food is introduced in the diet in the third week, after the first 2 weeks of taking liquids. Due to the reduced capacity of the gastric pouch, the morsel size is significantly reduced and one has to chew the morsel well and eat slowly, giving a gap of 40 to 50 seconds between the morsels. This prevents distension or overdistension of the gastric pouch and thus avoids vomiting. This again requires good counselling prior to the surgery and on the follow up visit too before stating soft food. There is a subjective difference when we say small morsels and we cannot reach a standardization as the morsels size of each individual varies prior to the surgery itself. The best way to avoid this confusion is to make the person have the first soft food meal before you where in you can physically show the way food is expected to be eaten. However, by mistake, there is a chance that one can have a regular sized morsel as over years one is used to eating in that manner. If this happens, the person will vomit , and this will be a reminder to gauge the morsel size the next time the person eats. Following the vomiting, there could be a burning sensation in the stomach which will subside afer taking an antacid. If one follows the instructions of small morsel size, chewing properly and eating slowly, there is no chance that there will be vomiting. Another reason for vomiting could be keeping the stomach empty for a longer duration or having sicy food on an empty stomach. Avoid nuts, seeds, fried foods and processed foods. Very rarely vomiting could be due to reduced size of the joint between the gastric pouch and the small intestine. This could require an Endoscopy and necessary treatment.

Vitamin and mineral deficiency: It is seen that many of the obese patients are seen to have vitamin B12, vitamin D, iron and protein deficiencies in their blood tests that are done prior to surgery. With the significant reduction in the amount of food consumed after bariatric surgery, the existing deficiencies are bound to increase. Hence, it is necessary to do these tests, before surgery and rectify the deficit prior to the surgery.  

Gall bladder stones: Significant weight loss which is consistant over a short duration could lead to the formation of gall bladder stones, be it with or with out surgery in a small percentage of patients. To avoid this there are two schools of thought, one is have a prophylactic removal of the gall bladder along with the bariatric surgery and another is to put the patient on ursodeoxycholic acid (a tablet) for the first few months after surgery during which there is significant weight loss.

Skin sagging: In the morbidly obese, when the skin is overstretched beyond a certain point, it tends to sag once significant weight is lost. This sagging is influenced by a number of factors like age of the patient, the BMI, pre existing sagging, pre-existing muscle tone and protein supplements taken during weight loss and exercises done during the weight loss period. Skin sagging is less if the age is less than 45, BMI less than 45, good protein intake during weight loss and good toning exercises done during the weight loss period.

Hairfall: Significant weight loss either by diet and exercise, aerobics, bariatric surgery, will entail hair loss. But this can be minimised to a greater extent by ensuring good protein intake during the weight loss period and adequate supplements in terms of vitamins and minerals.

Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. This causes the pancreas to release excessive amount of insulin, leading to very low blood sugar levels , producing various symptoms like abdominal cramps, bloating, diarrhoea, sweating, dizziness, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day, having four to five small meals compared to  2 to 3 large meals. Having a high protein diet and avoiding liquids during meals is also an option.

Bariatric Surgery - Know Problems Of It!

Adrenal gland cancer is a form of cancer which usually affects adrenals (tiny glands which sit above each kidney). The kidneys are situated inside the upper abdomen. The tumor usually develops in the outer part of the adrenal gland called the cortex. These hormones are called steroids and produce cortisol (hormone made in the adrenal gland) and sex hormones. 

Types of Adrenal Tumors:

Cancer in the outer part of the adrenal gland like adrenocortical carcinoma.
Neuroblastoma (usually affects children).
An extremely rare form of tumor called pheochromocytoma.
Symptoms of Adrenal Gland Cancer:

Low levels of potassium
High blood pressure
Panic attacks and anxiety can also occur
Nervousness
Throbbing sensation in the heart
Immense headache
Excessive amount of sweating
Pain in the abdominal area
Extreme fluctuation in blood sugar levels (diabetes)
Weight loss or weight gain for no reason.
Weakness and feelings of fatigue
Hair loss
Some changes in the genitalia.
Unusual occurrence of acne.
Changes in sex drive (libido).
Treatments of Adrenal Gland Cancer:

Surgery: This option can be considered in extreme cases. Surgery usually involves surgically removing the tumors. If the tumor is smaller than 5 cm, it might not be cancerous or dangerous. In this case a laparoscopic surgery is suggested.
Hormone Therapy: Adrenal glands might produce excess hormones during other treatments for curing adrenal gland cancer. The doctor might suggest drugs like metyrapone, streptozotocin, metyrosine and spironolactone to maintain your hormone levels.
Chemotherapy: This is the most common form of treatment to kill the cancer cells. Chemotherapy stops the cells ability to divide and grow thus destroying the cancer cells. During chemotherapy a patient is given a combination of different drugs at a time. The amount of adrenocorticoids which is produced by the adrenal glands during adrenal cancer is greatly reduced. The side effects of chemotherapy include nausea, vomiting, risk of infection, loss of appetite, hair loss, diarrhea and fatigue.

Adrenal Gland Cancer - 15 Tell Tale Signs You Must be Aware of

Like most things in life, the uterus also has both good and bad sides to it. It is a symbol of womanhood and also carries the developing baby. The bad side is that it brings with it (and its appendages) many problems including dysfunctional uterine bleeding, endometriosis, fibroids, pelvic inflammatory disease, uterovaginal prolapse, adenomyosis, a pelvic pain of unknown origin, cancer of the uterine cavity and other obstetric complications.

Hysterectomy is one of the most commonly performed procedures and ensures complete relief from these symptoms. There are however, multiple procedures, which can be used to manage these conditions without having to resort to removal of the uterus. This can help in preventing complications from hysterectomy including prolonged recovery, infertility in women of childbearing age and loss of womanhood.

Read on to know some of the emerging conservative alternatives to hysterectomy:

Myomectomy: Where there are fibroids, which are in the smooth muscles of the uterus and show symptoms like pain and discomfort. In these, it is advisable to go for a myomectomy. This removes only the fibroid, leaving the uterus in place. It can be done in one of the 3 ways traditional surgical process through an incision; laparoscopically through minute incisions; and then through vagina. In all these, only the fibroid is removed and sent for biopsy to confirm it is benign. It is less invasive, requires less recovery time and helps retain the uterus.

Uterine endometrial ablation: In cases of dysfunctional uterine bleeding or menorrhagia with no fibroids, the lining of the uterus could require removal. In these women, thermal balloon ablation, cryoablation, and radiofrequency ablation can be used. A small amount of extreme heat or cold or radio frequency waves are used to remove the uterine lining, thereby managing symptoms.

Uterine artery embolization: In women with fibroids, the feeding arteries could be cauterised to ensure blood supply is stopped so that fibroid growth is stopped. With very promising success rates, this is gaining popularity as a conservative method.

Laparoscopy and endometriosis excision: In endometriosis, where the uterine tissue is growing in areas outside the uterus, it could be removed laparoscopically after identifying the area of growth on ultrasound and laparoscopy.

Vaginal pessary: In women with uterine prolapse, the uterus drops from its normal position, pushing against the vaginal walls. This can be due to vaginal childbirth, age, smoking and obesity. Vaginal pessary is where a removable device is placed into the vagina to prevent it from falling down. It is a temporary solution, but very useful in holding the uterus in place and relieve symptoms partially or completely.

In all these, medical management (painkillers and hormone replacement), stress and weight management, quitting smoking, reducing alcohol are also essential.

Hysterectomy - Know the Emerging Conservative Alternatives to it?

Ovaries are a part of a woman s reproductive system. The primary function of ovaries include producing  ova  or eggs and secreting hormones such as progesterone and estrogen. Cysts are fluid filled sacs that form the ovaries; they usually do not cause any symptom and are not painful.

There are primarily two types of ovarian cysts:

1. Follicle cysts: During a woman s menstrual cycle, the egg develops in a sac known as the follicle. Under normal circumstances, the sac breaks open and releases the egg. When this doesn t happen, fluids start accumulating in the follicle to form a cyst.

2. Corpus luteum cysts: Follicle sacs dissolve after releasing the egg, but in some cases, these sacs remain and the opening of the sacs gets sealed. It again results in fluid accumulation, leading to the formation of corpus luteum cysts.

Symptoms

Usually, cysts do not cause any symptom. If the size of the cysts increases, they may cause symptoms such as stomach pain, pain during bowel movements and sex as well as pelvic floor pain. The breasts may become tender and one may experience rapid breathing. Other symptoms of ovarian cysts are fever, nausea and dizziness. Usually, rupturing of a cyst leads to these symptoms surfacing; hence you would know when exactly to call the doctor.

Treatment

The treatment options for ovarian cysts are:

Laparoscopy: Laparoscopy is carried out if the cysts are small in size. An incision is made close to the navel, through which an instrument is inserted to get rid of the cyst.
Birth control pills: For chronic ovarian cysts, oral contraceptives are prescribed to stop the ovulation process in order to arrest the formation of cysts.
Laparotomy: In case of large cysts, this procedure is recommended. A relatively bigger incision is made in the abdomen, through which the cyst is removed.
Ovarian cysts, if left untreated, can certainly cause infertility. Pre-menopausal women and who suffer from frequent hormonal imbalances in the body are the most vulnerable to this condition.

Ovarian Cysts - 3 Ways it Can Treated

Cholecystectomy is an operation performed to remove the gallbladder. The gallbladder is a kind of a small sac found just below the liver, on the right hand side of the abdomen. The gallbladder stores a liquid known as bile. Bile is made in the liver and it gets released into the intestine along with the meals. The importance of bile lies in the fact that it helps to digest the fat in foods.
As gallbladder is not really an essential organ, so a child would do well after cholecystectomy. Once the gallbladder gets removed through this pediatric surgery, bile will continue to get released from the liver right into the intestine along with meals.

What is the necessity behind cholecystectomy?
The necessity for performing this surgery of Cholecystectomy can be outlined as follows:

The main reason behind the surgery is gallstones and pain.
Gallstones are small rocks, which form inside the gallbladder
These stones prevent the release of bile out from the gallbladder.
This blockage results in pain as well as jaundice
If a child comes across these problems, he or she would be recommended by his or her primary doctor to visit a paediatrician.
A paediatrician can get rid of the gallstones by removing the gallbladder through performing the surgery if Cholecystectomy.
How is the surgery performed?
The surgery is performed in the following manner:

A Cholecystectomy is performed on most of the occasions by way of laparoscopy.
A small telescope and tiny instruments are placed through very small incisions made on the abdomen.
The surgery normally gets completed within two hours.
When a child gets hospitalized, he or she receives intravenous fluids, antibiotics as well as pain medication.
As and when a child feels well, he/she would be allowed to eat, drink and also take pain relievers through mouth.
Cholecystectomy surgery involves very less loss of blood. Only in a rare case, when there is an emergency, a child needs to receive blood.
Children are released from hospital, one or two days after the surgery as and when they are able to eat, drink and be comfortable about themselves.
Homecare needed after the surgery
There are certain guidelines which parents must follow when their children get back home after the surgery. They include:

Pain management: The pain medication prescribed by the paediatrician is not required at a routine basis after discharge from the hospital. Most of the children only require Acetaminophen (Tylenol) or Ibuprophen once they are at home.
Healing ridge: Once the small incisions get healed, children would be able to feel a firm ridge just below it. It would last for few months, slowly get softened and then disappear.

Cholecystectomy - Know More About It!

What are Different Types of Bariatric Surgeries? 

Bariatric Surgery is one of the most popular options for obese people looking for a way to control their weight. To get bariatric surgery, one has to qualify for certain criteria like BMI (Body Mass Index), associated comorbidities like Diabetes, Hypertension, sleep apnea, infertility, hypercholesterolemia etc. There are many kinds of bariatric surgeries or weight loss surgeries, different surgeries work differently in order to give the desired effect, which is why it is important to understand these surgeries thoroughly. 

Weight loss surgeries are divided into different categories like - 

  Restrictive surgeries: Some bariatric surgeries are focused on limiting the amount of food that can be stored in the stomach. This allows a person to eat less than they used to, because of the limited capacity of the stomach. Sleeve gastrectomy, Adjustable gastric banding, Gastric imbrication, Gastric balloon surgery are examples of restrictive procedures. In sleeve gastrectomy, the stomach is divided into two halves first, then one half of the stomach is completely removed. The remaining part of the stomach is formed into a tube-like structure. This tube-like structure cannot hold enough food and restricts excessive food intake. It also limits the secretion of an appetite hormone called Ghrelin which limits the desire of a person to eat. 

  Malabsorptive procedures: In this procedure, a large segment of the small intestine is bypassed i.e the food is not allowed to enter a large segment of the small intestine and hence malabsorption will be there. Duodenal switch is a malabsorbtive surgery. 

To Summarize: The weight loss procedures that suit our Indian population are the Roux en Y gastric bypass and the sleeve gastrectomy. We do not come across any sign of malnutrition in patients who have undergone these procedures. For successful outcomes, vitamin, calcium and protein supplements are required. 

There are certain myths about bariatric surgery --- life will never be normal after the surgery, pregnancy is a problem after this surgery, one will never be able to eat after this surgery, marriage is a problem after this surgery etc. All these are incorrect as one live a better life after the surgery as one has shed the extra kilos, one is cured of existing problems like diabetes, high cholesterol, hypertension, obesity induced infertility and sleep apnea extra. IN FACT, the quality of life is phenomenal after this surgery. CHOICE of surgery depends on the existing BMI, existing associated problems and results of the investigations that are done prior to the surgery. Your surgeon is the best to decide the right procedure for you. As the procedure which your friend has undergone might not be good for you. Choice of procedure and proper follow up are the key points for a successful surgical outcome. 

  Combination of restrictive and Malabsorptive surgeries: In these procedures, the surgery is done on the stomach as well as the small intestine. It involves creating a small stomach pouch which is attached to the small intestine, thus bypassing a small segment of the small intestine to get the desired effect if the person has diabetes associated. The rest of the stomach produces important digestive juices and is also connected to the intestine so that it can transfer these digestive juices in it. As a part of the stomach and few centimetres of the small intestine are bypassed i.e food does not enter this part, the surgery is called the gastric bypass. The Roux en Y gastric bypass and the Mini Gastric bypass surgeries are examples of these combination procedures.

Bariatric Surgeries - Know Forms Of Them!

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