bariatric surgery in treatment of morbidly obese patients
TRANSCRIPT
ROLE OF BARIATRIC SURGERY IN TREATMENT OF MORBIDLY OBESE
PATIENTS
• Dr. Ashish AhujaDr. Ashish Ahuja• M.S (Surgery), Fellowship Bariatric Surgery, (Australia)M.S (Surgery), Fellowship Bariatric Surgery, (Australia)
• Consultant Surgeon & Asst. Prof. of Surgery,Consultant Surgeon & Asst. Prof. of Surgery,• Dayanand Medical College & Hospital, LudhianaDayanand Medical College & Hospital, Ludhiana
• BARIATRIC SURGERY IS NOT LIPOSUCTION
• BARIATRIC SURGERY IS A SAFE SURGERY
• DOES NOT CAUSE ANY SIDE EFFECTS
• RISKS OF UNDERGOING BARIATRIC SURGERY ARE FAR LESS THAN RISKS OF OBESITY
Obese patients who undergo weight loss surgery live longer,
studies suggest The Associated Press
Published: September 7, 2006 The Associated Press
Published: September 7, 2006
SYDNEY, Australia — Stomach stapling and other surgical procedures to help overweight people eat less may be radical, but they also could be safer than staying obese, new research suggests. ……………………..
Why Surgery for the Treatment of the Why Surgery for the Treatment of the Clinically Severe Obese?Clinically Severe Obese?
“Only surgery has proven effective over the long term for most patients with clinically severe obesity.”
- NIH Consensus Conference Statement, 1991
Surgery for the treatment of clinically severe obesity is endorsed by:
The National Institutes of Health
The American Medical Association
The National Institute of Diabetes and Digestive and Kidney Diseases
American Association of Family Practitioners
• Bariatric Surgical and Procedural Interventions
• in the Treatment of Obese Patients • with Type 2 Diabetes • A position statement from the • International Diabetes Federation Taskforce • on Epidemiology and Prevention
Types of bariatric procedures1. Sweedish adjustable gastric band
2. Gastric sleeve resection
3. Roux-en-y gastric bypass
4. Bilio-pancreatic diversion with duodenal switch
Adjustable Silastic Gastric Banding Adjustable Silastic Gastric Banding (ASGB): LapBand(ASGB): LapBand
– Inflatable balloon within the band orifice can be adjusted via a reservoir under the skin
Average Weight loss– 50% of excess weight
Gastric sleeve resection
• Restrictive procedure
• No complication rates
• Weight loss around 50-60%
Roux-en-Y Gastric Bypass Roux-en-Y Gastric Bypass (RYGBP)(RYGBP)
General Features– Pouch size: 15-20 cc– Pouch opening: 0.5 in– Roux-en-Y limb– Standard: 2 ft
Average Weight Loss– 70 % of excess weight
“The Pouch-Tool”
Procedure Swedish
adjustable Gastric band
Gastric sleeve
resection
Roux-en-y Gastric bypass
Laparoscopic
Hospital Stay X
Abdominal drain X
Operative time (<1 hour)
X X
Post operative supplements X X
Post operative adjustments
X X
Weight loss
Comparison of different procedures
Contra indications for obesity Contra indications for obesity surgery surgery
• Only be offered to patients suffering from morbid obesity who are willing, motivated and high level of intelligence.
• Patient unfit for general anesthesia, advanced cancer disease.
• Patients having underlined endocrine disorders and major psychiatric illness .
170 kgs with BMI-72, HTN, TYPE-2 DM, OSA, 170 kgs with BMI-72, HTN, TYPE-2 DM, OSA, AFTER 1 year 2 months 110 kgsAFTER 1 year 2 months 110 kgs
145 kgs with BMI, HTN, TYPE-2 DM,145 kgs with BMI, HTN, TYPE-2 DM,AFTER 10 MONTHS 90 kgsAFTER 10 MONTHS 90 kgs
128 kgs 128 kgs HTN & THYROID DISEASEHTN & THYROID DISEASEafter 9 months present weight 74 kgsafter 9 months present weight 74 kgs
130 kgs with HTN ,after 1 year 4 130 kgs with HTN ,after 1 year 4 months present weight 70 kgsmonths present weight 70 kgs
Morbid obesity with Blood Pressure, Morbid obesity with Blood Pressure, SugarSugar
BeforeBefore AfterAfter
117 kgs with HTN 117 kgs with HTN AFTER 12 MONTHSAFTER 12 MONTHS65 kgs and resolved HTN,D.M type 265 kgs and resolved HTN,D.M type 2
DM Type-2 with HTN,DM Type-2 with HTN,Before 127 kgs – Present 70 kgsBefore 127 kgs – Present 70 kgs
When we choose to live with When we choose to live with ObesityObesity
• Frequent hospitalization• High cost of medicine• Frequent visit to specialist doctors• Dependability on others,
– e.g. wearing socks, changing clothes, domestic works.
• Various diseases• Laughing stock