Weight Loss (Bariatric) Surgery

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)


Agenda

• Obesity: Impact on Health• Weight Loss Surgeries• Post-Operative Care


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


Obesity Epidemic

Lack of Activity Over indulgence!

Thrifty genes


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


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


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


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


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

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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.


Surgical Options

• Restrictive– Stomach Capacity reduced– Feel Full More Quickly– Food/Calorie Intake Reduced– Weight Loss


Surgical Options

• Restrictive and Malabsorptive– Stomach Capacity reduced– Part of the small intestine is bypassed or rerouted– Reduced assimilation of food – Weight Loss


Adjustable Gastric Band (AGB)


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


Vertical Sleeve Gastrectomy (VSG)


Vertical Sleeve Gastrectomy (VSG)


• 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


Roux-en-Y Gastric Bypass (RYGB)


Roux-en-Y Gastric Bypass (RYGB)


• 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!


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!!!!!


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.


Life After Surgery

• Lifestyle Change• Diet Restrictions (Type, speed, Consistency, Volume)• Vitamins and Medication• Regular Follow-Ups• Exercise


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)


People who are successful

• Change lifestyle • Change eating habits• Are physically active• Exercise daily• Follow new diet• Follow up with their doctor as

advised


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

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Health & Medicine

Weight Loss (Bariatric) Surgery