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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: [email protected]