Surgical Management of ObesitySandeep Malhotra, MBBS, FACS

Director Bariatric Surgery

Medanta - “The Medicity”

Impact of Obesity

Medical Costs

OBESITY

PrematureDeath

Comorbid Diseases

Disability

Reduced QOL

Medical Implications of Obesity Diabetes type II Hypertension Lipid disorders Heart disease Asthma Sleep apnea Gallstones NASH (non-alcoholic

steatohepatitis) Urinary incontinence Acid reflux Arthritis and gout

Infertility and menstrual problems

Obstetric complications Low back pain DVT & thromboembolism Depression Immobility Cancer (breast, colorectal,

prostate, endometrial, etc.) Venous/stasis ulcers Skin infections Intertrigo Accident proneness

Options for Weight Management

Medanta Weight Management Clinic Intragastric Balloon Bariatric Surgery

Medical Weight Management Endocrinologist – Evaluation of hormonal imbalance, basal

metabolic rate. Prescribe medicines if necessary. Dietician – Diet plan tailored to patient according to metabolic

rate, food preferences, hormonal balance and other factors Physiotherapist – Plans exercise regimen keeping in mind

patients current limitations with gradual increase over time Clinical Psychologist – Helps patients cope with stress by

means other than food

Intragastric Balloon

-For BMI less than 32.5

- Balloon placed in stomach via endoscopy

- Inflated to 400-700 ml

- Weight loss 10-12 Kg over 6 months

- Removed after 6 months

Who Is A Surgical Candidate?• Age 18-65 Years• BMI 32.5-37.5 with associated obesity related medical

problems• BMI>37.5• Waist to Hip Ratio >1 (Men) or >0.8 (Women)• Previous attempts at weight loss

Bariatric Surgery

Gastric Banding Lap Sleeve Gastrectomy Lap Gastric Bypass

Procedures

Percent 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. .

N Engl J Med. 2007 Aug 23;357(8):741-52. Effects of bariatric surgery on mortality in Swedish obese subjects.

Sjöström L, Narbro K, et al.Institute of Medicine, Sahlgrenska Academy, Gothenburg University, Gothenburg, Sweden.

CONCLUSIONS: Bariatric surgery for severe obesity is associated with long-term weight loss and decreased overall mortality.

N Engl J Med. 2007 Aug 23;357(8):753-61.                   

Long-term mortality after gastric bypass surgery.Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, Lamonte MJ, Stroup AM, Hunt SC.Cardiovascular Genetics Division, University of Utah School of Medicine, Salt Lake City, UT 84108, USA.

CONCLUSIONS: Long-term total mortality after gastric bypass surgery was significantly reduced, particularly deaths from diabetes, heart disease, and cancer.

Patients live longer………

Case Series

Total Cases: 955 ( Lap Band 112, Gastric Bypass 478, Sleeve Gastrectomy 365)

BMI Range: 33.5 – 84.0

Cost?

• Lap Sleeve Gastrectomy: 2.5 Lakh in twin sharing

• Lap Band: 2.75 Lakh in twin sharing

• Lap Gastric Bypass: 2.9 Lakh in twin sharing

Why Medanta?Facility - State of the art with most advanced equipment in

the World- Led by Dr. Naresh Trehan, leading Cardiac SurgeonSurgeon - Certified by American Board of Surgery- Fellowship trained in Bariatric Surgery- 10-year experience with about 1000 cases

Laparoscopic Surgery at Medanta

• Gallbladder Removal• Hernia Repair• Appendix• GI Cancer Surgery• Other Bowel Surgery• Acid Reflux Surgery• Obesity Surgery

Ask your questions on Bariatric surgery

Dr. Sandeep Malhotra: +91-9871727401Sandeep.malhotra@medanta.org