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Bariatric surgery is a procedure that involves modifications to the digestive system so that the food intake can be restricted or the nutrients absorbed by the body is reduced. This surgery is recommended when exercise and diet may not cause the desired results with weight loss. Bariatric surgery is a group of surgeries that are procedure to reduce weight in the body.
The various types of surgeries that come under this category are:
- Gastric bypass: The most common bariatric surgery, gastric bypass is a procedure used to reduce the size of the stomach pouch in the body. Once the size is reduced, it leads to reduced consumption of calories. This procedure also causes alterations in the behavior of the gut hormones resulting in appetite reduction.
- Adjustable gastric band: This procedure involves placing an inflatable band around the upper stomach to make a small stomach area above the band. This causes one to feel full just after eating a small amount of food.
- Sleeve gastrectomy: In this procedure, almost 80% of the stomach area is removed surgically, resulting in a small stomach pouch being left. It reduces the stomach size, which cause an overall reduction in the amount of calories. Modifications also occur in the behavior of the gut bacteria linked with reduced appetite.
- Biliopancreatic diversion with duodenal switch: This procedure involves surgical removal of a large area of the stomach along with bypassing a major portion of the smaller intestine. This procedure may reduce fat absorption of up to 70%. The behavior of the gut hormones change resulting in a decrease in appetite and improved satiety.
Various complications may result from this surgery such as -
- May cause infections in the body
- Clots may form in the blood
- It can result in bowel problems
- Ulcers can form in the stomach
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.
Weight loss can be achieved through certain surgical procedures when all others methods seem to fail. These procedures called bariatric surgery,the most commonly performed are-
a) Laparoscopic Sleeve Gastrectomy
Where the stomach is converted into a thin tube of 100 ml capacity.
b) 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:
1. Diet and exercise have failed to help you lose significant amount of weight
2. 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) ).
3. 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.
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