bariatric surgery an overview
TRANSCRIPT
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Bariatric Surgery- An overview
Dr. Deep Goel, FACS (USA), FRCS (England)
Director
Department of Surgical Gastro Onco, Bariatric & Minimal
Access Surgery
Centre for Digestive and Liver Disease
BLK Super Specialty Hospital, New Delhi.
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Obesity in India5% population obese – rapidly increasing
63.5 million obese/ 1.27 billion
Prevalence is high in North India
Urbanization and Westernization major factors
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Obesity + Diabetes = Diabesity
World Capital of Diabesity
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Diabesity
Obesity and Type II DM strongly linked
‘Diabesity’- coined in 1970
44% of Type II -diabetic population is obese
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Impact of Diabesity on Society
7th leading cause of death
2.8 million deaths worldwide
Cardiovascular deaths in 50%
> 350 million US$ being spent at present & by 2030 500 million US$
Diabetes Cancer HTN CKD
CAD PCOD
Hyperlipidemia Infertility
Osteroarthritis
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Social Impact of Diabesity
• Depression childhood adult• Marital discord psychological physical emotional
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BMI Chart
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Bariatric Surgery
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Definition of Bariatric Surgery
• Bariatric surgery or weight loss surgery is a
spectrum of surgical procedures performed on
obese patients
• Types :
Restrictive : Sleeve & Band
Malabsorbtive : Bilo Pancreatic Diversion Mini Gastric BypassCombined : R&YGB
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Patient Selection Criteria
BMI ≥ 35 without any co-morbidities
BMI ≥ 32 with co-morbidities
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History of Bariatric Surgery1950
Intestinal Bypass(in dogs) 1963Open jejunoileal bypass by Payne & DeWind
1980Vertical banded gastroplasty
1994 Laproscopic gastric bypass
2000Laproscopic gastric sleeve
1978Gastric band
1986Duodenal switch
1997Open sleeve gastrectomy
2001Lap-band system approved by FDA2015
Gastric balloons approved by FDA
1970Open gastroplasty
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Bariatric Surgery in India
• The number of surgeries has increased by
almost 10 times in the last decade and almost
14000 bariatric surgery were performed last
year in India.
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Trends in No. of procedures Worldwide
2003 2008 2011 2013 20160
100000
200000
300000
400000
500000
600000
146301
344221 340768
468609
548677
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Sleeve Gastrectomy
• Stomach reduced without loss of function or change in anatomy• 75-80% EWL
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Roux-en-Y Gastric Bypass
• General Features– Pouch size: 1 oz– 70-80 % of excess weight
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Gastric Banding
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Intra Gastric Balloon
Indications• Patients who don’t want
surgery but want to loose weight.
Problems• Time period one year• Rebound hunger • Weight regain
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Medical Co-Morbidities Resolved after Bariatric Surgery
Type 2 Diabetes 95%
Hypertension 92%
Cardiac Function 95%
improvement
Osteoarthritis 82%
Sleep Apnea 75%
GERD 98%
Stress Incontinence 87%
Hypercholesterolemia 97%
Wittgrove AC, Clark GW. Laparoscopic Gastric Bypass roux-n-y-500 patients. Obes Surg 2000. And others.
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Complications
• Bowel obstruction
• Deep venous thrombosis/Pulmonary embolism
• Leak
• Bleeding
• Nutritional deficiencies
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Source: Direct Research, LLC, Center for Medicare and Medicaid Services, FY 2010 MedPAR, Medicare Fee-for-Service Inpatient Discharges with Selected Procedures
Risk of surgery
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Is Bariatric Surgery a cosmetic surgery ?
No• It is approved by Central Government • No service tax
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Insurance Coverage
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Weight Regain
“Procedure failed the patientor
Patient failed the procedure”
?
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• Realistic Expectation
• > 10% weight regain
- Re-surgery
Weight Regain
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Loose Skin after Bariatric surgery
Is a reality…
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Shape your own future
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Contouring Procedures
When to do?
• Minimum 12 months after bariatric surgery
• 3 months of stable body weight• BMI < 30• Staged procedures
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Lost 70 Kg in 12 months
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Our Results
• 760 cases from March 2006 – July 2016• Mortality:
• Within 30 days (2)BleedingPulmonary embolism
• After 30 days (2)Liver failureHyperammonemia
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Bariatric Surgery in News
Infertility
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Bariatric Surgery in News
OSA
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Bariatric Surgery in News
Diabetes
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Bariatric Surgery in News
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Lost 98 Kg in one year
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Lost 47 Kg in 8 months
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Lost 40 Kg in 14 months
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Lost 18 Kg in 3 months
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Lost 39 Kg in 6 months
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Pledge
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Surgical weight loss increases life span and it is an
effective means to achieve clinically significant,
permanent weight loss, which leads to significant
improvement in health risks associated with obesity
Take Home Message
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Take Home Message
• We believe that surgery in recent future would
be an important tool to resolve DM-2 not only
obese people but for people with normal BMI.
Indications of surgery are being relaxed at
rapid pace.
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“Treatment of morbid obesity should not
be deemed achieved unless plastic surgery
has been considered”
Obes Surg. 2013 Jan;23(1):24-30.doi: 10.1007/s11695-012-0735-8.
Take Home Message
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GIS Team