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!

If you have taken the big decision to go ahead with bariatric surgery, one thing you need to prepare for well in advance is the additional effort that is required after the surgery to ensure it is a success. The results will be evident only after a few months post the surgery. This period requires your constant attention. 

Listed below are some after-care measures that are essential for the success of a bariatric surgery.

Hospital stay: Most patients are advised hospital stay for four days, during which the hospital staff will ensure the sleeve is working fine. No food is allowed for 48 hours. Diet is gradually advanced from water to clear liquids, about 50 ml to 100 ml and then to 150 ml.
Wound care: Depending on whether a laparoscopic or open surgery was done, the number and location of incisions will vary. However, the wound should be maintained clean and it should be ensured that there is no infection of the site. Wound care should be done by the nursing staff if required. Suture removal, if required, should be done as per doctor s advice.
Pain management: Finish the course of antibiotics and pain killers to ensure infection is completely gone. Pain would continue, if the infection is not completely controlled.
Diet: The first two weeks would be a completely liquid diet. The next two weeks will consist of a pureed diet. After these four weeks, solid foods will be introduced.
Foods to avoid after a bariatric surgery include anything with a higher protein content and anything that has too much oil as the stomach s ability to digest these is reduced. Refrain from:

Carbonated beverages
Hard meat
Nuts and seeds
Fried foods
Food items to include post bariatric surgery include those which are easy on the stomach, including:

Liquids such as soups, broth, juice, and milk
Pureed cooked vegetables and eggs
Soft mashed food including meat and vegetables
Adherence to this will reduce complications. While eating, the patient should also remember to chew nicely, eat and drink slowly, increase water intake throughout the day, and avoid fats and sugar. It is advisable to eat three proper meals a day and avoid snacking during the day.

Remember that the need for bariatric surgery arose in the first place due to uncontrolled eating of oily food. After undergoing a bariatric surgery, diet pattern is definitely going to move to a healthier side with reduced fat and sugars. It is not an easy shift, but definitely required, if the surgery is to be a success. Imagine the new you and you will be able to do it!

Bariatric Surgery - Aftercare Tips You Must Follow!

Are your regular exercises and the strict diet proving futile on your quest for a tighter and a flatter tummy? You can consider getting an 'abdominoplasty' or 'tummy tuck' done. This cosmetic surgery helps in flattening your abdomen by taking off the extra skin and fat and tightening up the muscles in the walls of your abdomen.

The procedure
1. The first step involves choosing a surgeon for consultation.
2. There are two types of  tummy tuck  surgery, both carried out under general anesthesia.  Complete abdominoplasty  whereby, your surgeon would dissect your abdomen from one hipbone to the other and then give an outline to your muscle, tissue and skin.  Mini or partial abdominoplasty  are recommended for people whose fat deposits are underneath their naval region.

Complete Abdominoplasty
 Complete Abdominoplasty  involves making a big incision around the lower part of the tummy from one hip to another, making a second cut in order to free the belly of the tissue that surrounds that region, separating the skin from the walls around the abdomen, re-aligning the muscles in the abdomen, removing the supplementary skin and fat and then pulling forth the skin remains and stitching them too.

Partial Abdominoplasty
Partial Abdominoplasty requires making a large cut on the lower belly, separating the skin from your abdominal wall, cutting out the excess fat, removing the additional skin and holding the remaining part of the skin together and finally stitching it in place.

Time taken for the surgery
The surgery may stretch from one to about five hours.

Pre-requisites

You will have to cut down on the consumption of alcohol and especially smoking; smoking leads to more complication and slows down the healing process.
It is recommended to have a well-balanced meal before the surgery.
After-care

You may suffer from swelling and pain in the days after the surgery, for which your doctor would prescribe pain-killers.
Regardless of the type of surgery conducted, the portion that was operated on would be stitched and bandaged. Therefore, it is very important to abide by the surgeon s instructions about how you should take care of the dressing in the days to follow.

Tummy Fat - Can Surgery Be Considered to Reduce it?

Obesity is a medical condition where the body accumulates excess fat to the extent that it adversely affects your health. People having a Body Mass Index (BMI) equal to or greater than 30 are considered obese. BMI is the measure of your body fat based on your height and weight. While some people may have a genetic background of being obese, others may gain excess weight due to underlying health conditions.

What causes obesity?
People who do not take part in physical activities or exercise on a regular basis are prone to excess weight gain. Those who have a family history of obesity are likely to be obese. Consumption of high-fat and high-calorie food like processed/fried food, pulses, rice, potatoes, red meat etc. Lack of sleep and sedentary lifestyle also play a huge part in unhealthy weight gain. As you age, your body undergoes many hormonal changes and loses muscle mass as a result of which metabolic rate becomes slower. This makes it easier for you to gain weight. A number of medical conditions like Polycystic Ovary Syndrome (PCOS), diabetes, hypothyroidism (underactive thyroid gland), Prader-Willi Syndrome etc also cause your body to gain excess weight.

What are the symptoms of obesity?
People who are obese, experience symptoms such as- tiredness, fatigue, exhaustion, shortness of breath, increased sweating, inability to keep up with physical activities etc. These symptoms, if not paid attention to, can lead to serious health issues such as sleep apnea, heart ailments, high blood pressure.

Role of homeopathy in treating obesity-
Homeopathy can proficiently manage the symptoms of obesity, and also prevent the condition from relapsing. Homeopathic remedies are extracted from different plants, herbs and natural substances that are absolutely safe for you. This branch of medicine attempts to improve your metabolism, correct your digestive system and easily eliminate waste products- which are the three basic prerequisites for weight loss. Homeopathic medicines, unlike conventional medications which restrict nutrient absorption and promote a feeling of fullness, aim to cure the symptoms responsible for excess weight gain naturally. The homeopathy component most commonly used to treat obesity is impure calcium derived from the middle layers of the shells. Homeopathic components like Clubmoss plant extract and sodium chloride are prescribed to those who have excess fat accumulated in the buttocks and thighs.

One major advantage of homeopathy is that they are non-addictive, and can be adopted by people even when they re on other conventional treatment medications.

Obesity - How Homeopathy Can Help?

Bariatric surgery is unlike other surgeries, the success is defined after 6-18months later. It is not without its complications. But complications managed well by Bariatric surgeons and the introduction of Laproscopy, it gives advantages of reduced post-op pain to less incisional hernias and less post-operative hospital stay. 

Sometime problems may happen like- 

Post-operative bleeding: Managed well by the surgeon. 
Dehydration: Chances of dehydration, therefore, one of the main post-op instructions, would be to increase water intake significantly, after the first week of course, when water is included in the diet. For someone who is not used to drinking lots of water, this can be difficult. 
Indigestion: Difficulty digesting food after the surgery is very common. There could be a burning sensation in the stomach. This is often managed by dietary changes like avoiding fatty foods, eating small frequent meals, avoiding too much sugary food items, etc. Too much fruits and vegetables should not be introduced early on, as fibre can be difficult to digest. Avoid fruits like nuts, seeds, fried foods, processed foods, etc. Gradually moving from water to pureed diet to semi-solids to solids can help in getting the stomach used to it. 
Vitamin and mineral deficiency: With the drastic cut in the amount of food consumption, there could be multiple problems including skin rashes, weak bones, dental issues, hair loss, gallstones, kidney stones, etc. All these are due to deficiency of various essential minerals like calcium, potassium, etc. This can be managed through minor diet modifications to ensure the body gets the required minerals and vitamins, even if they are in the form of supplements. 
Dumping syndrome: With a reduced size of the stomach, the food moves from the stomach into the smaller intestine much faster. Therefore, the sugar levels increase rapidly, producing various symptoms like bloating, diarrhoea, nausea, weakness, and anxiety. This is managed by eating less amount of sugars and fats and spacing out the meals through the day. Five to six small meals are preferred over 2 to 3 large meals. Some people also get relief from lying down after eating. 
Hernias: Less after laproscopic surgery but sometime it may happen. 
Diet changes: Whether it is medications or foods, some substances have to be knocked off your list. A detailed diet plan should be made with the doctor, as some can affect the stomach in an adverse manner. 
Altered bowel habits: Some people may have diarrhoea, others have constipation. Looking into one s diet and making suitable changes will help. Therefore, it is very important that you must keep regular follow-up and consultation with your surgeon, in order to avoid complications.

Bariatric Surgery - 8 Complications It Can Cause!

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!

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