Losing weight is a daunting task. This becomes all the more difficult for obese people. In many cases, the patient may be advised to undergo bariatric surgery. There are many types of bariatric surgery. Some surgeries address both the stomach and the small intestines while others address only the stomach. A gastric band surgery is one such procedure.

For this procedure, an adjustable band is placed around the upper half of the stomach. This creates a small pouch that can hold a limited amount of food. The band is connected through a plastic tube to a small device placed under the abdominal skin. Sterile fluid may be injected or removed from the band through this device. By injecting saline, the band is made tighter and by removing the liquid the band is loosened. This allows the band to be customized to improve weight loss.

The result of a gastric band surgery may vary from person to person. Band adjustment starts after the third week of surgery. Because the size of the stomach is reduced, the person will feel full faster and hence eat less. In most cases, a person can expect to lose 60 to 75 % of their excess body weight. This should not be confused with a person s total weight. The procedure can be reversed at a later date if need be.



Some people may develop side effects like nausea and vomiting after the procedure. But why this procedure has not gained acceptance compared to other bariatric procedures like gastric bypass and sleeve gastrectomy is because, the compliance with the band is not very good and complications like band erosion, band slippage, band migration are very high. Another dreaded complication following the band surgery in non-compliant patients who eat large quantities and overstretch the small gastric pouch above the band is severe GERD.

In severe cases, rarely, grains of undigested food is seen in the mouth on waking up in the morning. This could be life-threatening. Vitamin deficiencies are rare provided supplements are taken regularly during the weight loss period.  

Gradual band adjustment is required and regular follow up with the bariatric surgeon will yield good results. Over adjustment is not good at all and could lead to higher chances of complications like band erosion. However, proper dietary compliance can make the results of a band better. Ideally, a patient should get follow up checks every month after such a surgery.

All said and done, the percentage of excess weight loss in the gastric bypass and sleeve gastrectomy are far superior to the adjustable gastric banding. Even the compliance, and maintenance of weight loss over years is better in the other bariatric procedures compared to the band.

Gastric Band Surgery - Know How Competent Is It?

Ovarian cysts are fluid-filled sacs in the ovaries, often in multiples, which are very common in women. This is absolutely different condition from polycystic ovaries. Most of them are benign and not indicative of an underlying problem. They produce no specific symptoms and even if detected, can be watched over a period of time. Treatment may be required only if there are serious symptoms or there is higher possibility of cancerous nature of the cyst. Read on to know more. 

Types 

Functional: There are two types in this. The follicular variety is when the egg that is ready for fertilization does not completely shrink and stays for a few more days before it disappears. Another variety, the luteal ovarian cysts are formed when after the release of the egg, there is blood filling up in the corpus luteum. 
Pathological: There are many types here   dermoid, cystadenomas, endometriomas, cancerous cystadenocarcinomas etc. These are worrisome and need to be treated. Both varieties, once identified, should be monitored. The functional variety, though may not cause a problem, can cause infertility and so necessitate treatment. 
Symptoms 

Any ovarian follicle larger than 2 cm can be called as an ovarian cyst. They are usually benign and do not produce any symptoms. However, if they turn pathologic or grow in size, they can cause various symptoms such as: 

Irregular menstruation 
Heavy bleeding 
Intermittent spotting 
Painful and/or frequent urination 
Severe, recurrent abdominal pain 
Infertility 
Abdominal bloating 
Constipation or loose motions 
Nausea, sudden vomiting 
Fever, dizziness, and weakness 
While cysts are often quiet and do not produce any symptoms, they can cause intermittent, nonspecific symptoms like above. If there is a family history of ovarian cancers in mothers, maternal aunt, Sisters, Grandmothers etc then women should have regular Gynaecological checkups to have a check done for ovarian cysts. 

Why go for laparoscopic surgery? 

Laparoscopic surgery is considered to be one of the most effective ways of treating the condition of ovarian cysts. During the surgery, problem causing non-cancerous cyst can be removed without harming the ovaries. In the case of cancer, both ovaries along with uterus etc may have to be removed. This decision is taken by the operating surgeon depending upon age of the patient, characteristics and nature of the cyst and future fertility desires of the patient. 
The patient is given general anesthesia during the surgery. After the surgery, one is suggested to rest for a day and may be permitted to return to normal activities within a day s time. However, one needs to avoid any strenuous activity for almost a week. 
While some cysts can be watched for years, others need treatment. This would be specifically true in cases where the couple is facing infertility issues or if there is a higher possibility of cancerous cysts. Such cysts need urgent intervention and should be monitored by a gynecologist with an experience in oncology. There are few blood tests that are needed to be done to know the nature of the cyst if it is benign or cancerous.

Ovarian Cysts - Ways Laparoscopic Surgery Can Help! 

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!

Gastric bypass is a kind of bariatric surgery, which helps in weight loss. This surgery aims to make changes so that your stomach becomes smaller than it used to be. This limits the amount of food you consume and effectively helps you to reduce weight.

Are you fit for the surgery?

Not everybody can go in for this surgery. Your doctor will recommend this surgery after careful evaluation. These are the parameters based on which your doctor will make a decision-

  Your medical history - If you suffer from sleep apnoea, heart ailments, liver diseases, kidney stones or if you have blood clots then you might have to undergo the surgery.

  Your psychological status - Sometimes obesity is the outcome of certain psychological ailments. A doctor will first ensure that these conditions are addressed before you go under the knife.

How is the surgery performed?

Gastric bypass operation is performed under general anaesthesia so you will be asleep for the entire duration of the surgery and it will be pain-free. The surgery is done laparoscopically. Tiny incisions are made through which scope and fine surgical instruments are introduced into the abdominal cavity. The camera guides the surgeon by providing live images from inside the body. Laparoscopic gastric surgery is advantageous because the wound heals faster and does not leave any marks.

Sometimes your surgeon might opt for an open surgery where she/he makes a large incision to reach the stomach.

There are two major steps to the surgery-

  The aim of the surgery is to make the stomach smaller so the surgeon divides it into two portions with staples. The food that you eat will go into the upper part (the pouch) of the stomach. The reduced upper stomach can hold at the most 28 grams of food so you are forced to eat less than usual. This will help you lose weight.

  The other step is the bypass surgery. After the pouch is created, the surgeon links it to the small intestine through the small hole in the pouch. This way, food will pass directly from the pouch to the small intestine. The surgery takes around 3-4 hours. You will be kept under observation for a couple of days and you will be released from the hospital in a week.

Gastric bypass operation is an effective and simple surgery that can help you reach your weight goals when you have a very high BMI and most other dietary restrictions have not been successful.

Gastric Bypass Surgery - Everything You Should Know!

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!

Once the reality of the positive pregnancy test sets in, dreaming about the yet-to-arrive begins. Curiosity about gender, options for names, ways to manage, shopping ideas, etc., begin to get discussed. And then totally out of the blue the news comes that there is a miscarriage. This is one of the most depressing phases. It is very important for the family to be around and support each other. While the entire family is upset and hurt over the news, the mother needs most care as there is just not emotional but a huge physical component also to the episode. On the other hand, remember that miscarriages are extremely common, and is no indication of a fertility issue.

The first step would be to diagnose and confirm the miscarriage. After that, depending on whether it was complete or incomplete, some medical intervention might be required. In most cases, medications like misoprostol are given to expel the uterine contents. These help by clearing out the contents in about a couple of days' time. In some cases, a D and C might be required if your doctor suspects that medication will not suffice. This also helps identify if there is any issue in the uterus that could have caused the miscarriage.

While the above take care of the physical part, the emotional component also requires cautious management. Needless to say, this is trickier than the earlier one.

Mourn to your heart's content - When you have nursed a life within you and have lost it, it is very normal to cry for its loss. There would be a mix of emotions - shock, denial, confusion, anger, grief, depression, etc. Take some solace from that fact that this is nature's way of removing unhealthy fetuses.

Get someone to talk to - Need not be your husband, but anybody whom you can talk to without having to watch words. A sibling, a good friend, a close relative - your choice. Make sure you don't pick ones who will judge and sympathize with you. More than sympathy, you need someone understanding and knowledgeable.

Socialize more - As you would have kept to yourself post your positive test, use this time to socialize more and meet friends whom you have not regularly been in touch with. Close family members, your children (if you already have), society groups, movie groups, etc., help to a great extent.

Formal medical counseling: If you are not able to cope with your regular circle of family and friends, try seeking professional advice from counseling.

Spirituality - Whether you believe in temple or churches, spend some time there. Involve in some religious activity if you would like, this helps very often.

As much as it is painful and traumatic, it is not very uncommon or unnatural. Get back on your feet, the sooner you do, the better.

Miscarriage - Ways To Recover

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