Dr. Upendra Reddy Marreddy (MS, FRCS)Consultant Bariatric & Upper GI Surgeon
Weight Loss (Bariatric) Surgery
2www.upendrareddy.com
Dr. Upendra Reddy Marreddy
• Surgical Experience– Highly experienced Obesity and Gastrointestinal surgeon who worked as
consultant Upper GI surgeon in Greater London, with 10 years experience of more than 1500 bariatric operations and 10000 GI surgeries.
• Surgical Training– Senior Bariatric Fellow from Homerton Bariatric surgery unit (2years)– Specialist Registrar in Gastrointestinal, Bariatric & General surgery from London
Deanery hospitals (5 years), – All India Institute of medical sciences- New Delhi (Junior & Senior Residency-6 yr.).
• Research– Research fellow and Lecturer in Surgery from Barts and The London Medical
School– Presented Papers: 10 @ IFSO Hamburg Germany, 5 @ Bristol BOMSS, 10 @ IFSO
New Delhi, 3 @ DDW New Orleans (USA), DDW Washington (USA)
3www.upendrareddy.com
Agenda
• Obesity: Impact on Health• Weight Loss Surgeries• Post-Operative Care
4www.upendrareddy.com
What is Obesity?
• Obesity: Obesity is excess fat accumulation, 20% or more over an individual's ideal body weight. It is associated with increased risk of illness, disability, and death.
• Morbid Obesity: Overweight by over 30 kgs. Or using Body Mass Index (BMI) i.e. Weight(kg)/Height(m)2 of 37 or higher
Obesity in India
• Obesity has reached epidemic proportions in India, 5% of overall population is affected by Morbid Obesity
• They are GENETICALLY prone to waist circumference increase- scientists have discovered single nucleotide polymorphism named rs12970134s.
• Amongst the states, AP males are ranked as 5th most obese overall in India, as far as females they are rated 10th obese amongst the states
6www.upendrareddy.com
Obesity Epidemic
Lack of Activity Over indulgence!
Thrifty genes
7www.upendrareddy.com
Medical and Health Implications
• With BMI > 30– 70% increased chances of coronary artery disease– 75% increased chances of stroke– 400% increased chances of diabetes– 55% increased chances of mortality
8www.upendrareddy.com
Co-Morbidities with ObesityPulmonary diseaseabnormal functionobstructive sleep apneahypoventilation syndrome
Nonalcoholic fatty liver diseasesteatosissteatohepatitiscirrhosis
Coronary heart disease Diabetes Dyslipidemia Hypertension
Gynecologic abnormalitiesabnormal mensesinfertilitypolycystic ovarian syndrome
Osteoarthritis
Skin
Gall bladder disease
Cancerbreast, uterus, cervixcolon, esophagus, pancreaskidney, prostate
Phlebitisvenous stasis
Gout
Idiopathic intracranial hypertension
Stroke
Cataracts
Severe pancreatitis
9www.upendrareddy.com
What are the Options?
1. Diet, Exercise, Behavioral Changes up to 10% loss of excess body weight ineffective long-term, less than 5% sustain
significant weight loss2. Weight Loss Drugs
minimal sustained weight loss side effects prevent long-term use
3. Weight-Loss Surgery 55 to 75% loss of excess body weight
10www.upendrareddy.com
Who qualifies for weight loss surgery?
Normal Weight (BMI 18.5 to 22.9)
Overweight(BMI 23 to 24.9)
Obese(BMI >25)
Severely Obese(BMI 32.5 to 37 )
Morbidly Obese(BMI >37.5 )
BMI 18.5-22.9 BMI 23-24.9 BMI >25 BMI 32-37 BMI>37.5
11www.upendrareddy.com
Bariatric Surgery is an Option if:
• 20-30 kgs above your Ideal Body Weight• Body Mass Index:
– 32.5 or greater with co-morbidities– 37.5 or greater even without any co-morbidities
• Age of 18 to 65+ (assessed on individual basis)• Failed attempts at weight loss • Health complications related to obesity• No psychological contraindications• Understanding of the surgery/risks• Compliance with diet/exercise requirements
www.upendrareddy.com 12
Bariatric Surgery is NOT Liposuction
• Liposuction is purely cosmetic surgery that aims to produce an attractive body-shape.
• Although liposuction might seem attractive, it does not achieve the results in improved health and durable weight loss.
• Liposuction is performed by Plastic/Cosmetic Surgeons.
• Bariatric surgery, however, is a stomach operation which reduces caloric intake and the way fat is deposited.
• Bariatric surgery can achieve a sustained and lasting weight loss for the treatment of morbid obesity.
• Bariatric surgery helps improve health and increase the life-span.
• Bariatric surgery is performed by Bariatric Surgeons.
13www.upendrareddy.com
Surgical Options
• Restrictive– Stomach Capacity reduced– Feel Full More Quickly– Food/Calorie Intake Reduced– Weight Loss
14www.upendrareddy.com
Surgical Options
• Restrictive and Malabsorptive– Stomach Capacity reduced– Part of the small intestine is bypassed or rerouted– Reduced assimilation of food – Weight Loss
15www.upendrareddy.com
Adjustable Gastric Band (AGB)
www.upendrareddy.com 16
Adjustable Gastric Band (AGB)
Advantages Disadvantages
• Lowest mortality and complication rate
• Least invasive surgical approach
• No stapling, cutting, or intestinal re-routing
• Adjustable• Reversible• Low malnutrition risk• Shorter surgery
• Slower initial weight loss than Gastric Bypass
• Regular follow-up critical for optimal results: Need adjustments
• Requires implanted medical device
17www.upendrareddy.com
Vertical Sleeve Gastrectomy (VSG)
www.upendrareddy.com 18
Vertical Sleeve Gastrectomy (VSG)
Advantages Disadvantages
• No Malabsorption – No micronutrient deficiency
• No Strictures ? No Marginal Ulcerations ?
• Maintains oral access to GI and Biliary tract
• Creates restriction more than obstruction
• Lesser Follow up
• Non-adjustable• Irreversible
19www.upendrareddy.com
Roux-en-Y Gastric Bypass (RYGB)
www.upendrareddy.com 20
Roux-en-Y Gastric Bypass (RYGB)
Advantages Disadvantages
• Rapid initial weight loss• Time tested, proven efficacy • Best for metabolic
abnormalities such as diabetes, Hyperlipidaemia etc.
• Stomach cutting, stapling and intestinal re-routing required
• Portion of digestive tract is bypassed, resulting in nutritional deficiencies- easily managed by two pills a day
• “Dumping syndrome” can occur- sensible choice of foods and eating habits prevent this
• Non-adjustable• Difficult to reverse! Very
expensive!
21www.upendrareddy.com
How much Weight Loss?
• Depends on the surgery and the follow-up• 75% of excess weight with Gastric bypass at the end of one year• 45% of excess weight with Band but increases to 65% at 2-3 year
follow up with adjustments• Amount of weight loss varies from person to person• Must be compliant with follow-up!!!!!
22www.upendrareddy.com
Possible Risks and Complications
• These will be discussed during the first appointment.• With the experience and skill at hand, these surgeries post no more
risk in my hands than common surgical procedures, such as Gall Bladder removal surgery.
23www.upendrareddy.com
Life After Surgery
• Lifestyle Change• Diet Restrictions (Type, speed, Consistency, Volume)• Vitamins and Medication• Regular Follow-Ups• Exercise
www.upendrareddy.com 24
People who are not successful?
• Go back to old eating habits• Avoid exercise• Eat high fat diet• Eat High caloric diet• Graze, Snack• Drink “regular” soft drinks or
high calorie beverages (ex. Juice, alcohol)
www.upendrareddy.com 25
People who are successful
• Change lifestyle • Change eating habits• Are physically active• Exercise daily• Follow new diet• Follow up with their doctor as
advised
26www.upendrareddy.com
Good News
• Weight Loss• Improved Self Esteem• Improvement in co-morbidities
– Diabetes– Hypertension– Hyperlipidaemia– Sleep apnoea
• Improved Quality of Life
Thank You
Dr. Upendra Reddy Marreddy (MS, FRCS)Phone: +91 8790077333
Email: [email protected]: www.upendrareddy.com
Facebook: facebook.com/upendramarreddy