Your doubts on Bariatrics answered

13 Oct 2017

1. Which is considered the ‘gold standard’ of a weight loss surgery?

a. Gastric Sleeve

b. Gastric Bypass

c. Lap band

d. All of the above

Correct Answer: Gastric Bypass

The gastric bypass surgery, also known as Roux-en-Y Gastric Bypass, is considered the ‘gold standard’ of weight loss surgery as it works by several mechanisms. Similar to most bariatric procedures, there is a smaller stomach pouch created. It is created by dividing the top of the stomach from the rest of the stomach. In gastric bypass, a portion of the small intestine is also divided, and the bottom end of the divided small intestine is brought up and connected to the newly created small stomach pouch.

This newly created stomach pouch and intestine system is considerably smaller and facilitates significantly smaller meals, which translates into less calories consumed. Also, as the smaller stomach pouch digests lesser food, and there is a segment of small intestine that would normally absorb calories as well as nutrients but no longer has food going through it — because of the gastric bypass procedure — there is, to some degree, less absorption of calories and nutrients.

The most significant change is that the rerouting of the food stream by the gastric bypass surgery causes changes in gut hormones that promote satiety, suppress hunger, and reverse one of the primary mechanisms which causes obesity-related Type 2 diabetes.

2. Who is qualified to undergo a obesity surgery?

a. A person whose BMI is > 35

b. A person who is more than 45 kg overweight

c. A person whose BMI is > 32.5 and suffers from any obesity related diseases such as diabetes, hypertension etc.,

d. All of the above

Correct Answer: All of the above

For most bariatric surgeries, there is an acceptable range. This means that there is a minimum and maximum Body Mass Index (BMI) qualification required. Procedures such as gastric sleeve, gastric bypass and lap banding require a BMI over 40 — which means the person should be more than 45 kg overweight that the prescribed healthy limit and should not have any obesity-related health condition. In other cases, a person with a BMI of 35 or over is also qualified but if only the person also suffers from some an obesity-related health condition, such as Type 2 diabetes, hypertension, sleep apnoea and other respiratory disorders, non-alcoholic fatty liver disease, osteoarthritis, lipid abnormalities, gastrointestinal disorders, or heart disease.

Apart from that the surgery itself should happen at a centre that has a multidisciplinary team of experts for follow-up care, such as at Aster CMI.

After an obesity surgery, most patients are able to return to work within in two weeks. They might feel low in energy for a while after the bariatric surgery but the bariatric surgeon will always give clear instructions that need to be followed to the. 

3. What procedure lets you get back to exercise right away?

a. Gastric Balloon

b. Gastric Bypass

c. Gastric Sleeve

d. All of the above

e. Correct Answer: All of the above

Any bariatric surgery is the first step to losing weight, not the last. The good thing about a minimally invasive bariatric surgery is that the patient can get to exercise right away. You can take gentle, short walks even while you are in the hospital — the important thing is to start slow and maintain the routine.

Listen to your body and your surgeon: if you used to lift weights or do sports — remember to stay “low impact” for the first two months. Build up your stamina slowly over several weeks. If you are a swimmer, all your incision wounds — even from the minimally invasive bariatric surgery — need to be healed completely before you get back in the water.

Many patients are worried about getting hernias at incisions. That is almost never a problem from work or lifting — however be careful about doing too much of it. Hernias are more often the result of infection, so keep it clean too. You will not feel well if you do too much too soon.

4. How many days will I stay in hospital for bariatric surgery?

a. Two Days

b. Three Days

c. Four Days

d. A week

e. Correct Answer: Three Days

More often than not, the patients are asked to be admitted to hospital the night before the surgery. After that, there will be two more days of hospital stay, including the day of the surgery. Like any other under-anaesthesia surgical procedure, you will feel groggy and lethargic when you wake up after the surgery.

5. What kind of a procedure is a bariatric surgery?

a. Keyhole

b. Open Surgery

c. Robotic Surgery

d. Keyhole and robotic surgery

e. Correct Answer: Keyhole and robotic surgery

All the weight loss surgeries are performed under general anaesthetic using keyhole, laparoscopic — minimally invasive — surgery. Through keyhole surgery, a surgeon makes small cuts in the tummy and inserts a flexible viewing tube so they can see inside while they perform the operation. Laparoscopic bariatric surgery, or minimally invasive bariatric surgery, has replaced open surgery in most abdominal operations.

However, the most recent innovation in bariatric surgery is robotic surgery. The surgeon does the surgery using a master console, while the robotic patient cart puts tiny holes on the patient — similar to a laparoscopic surgery, but with much more precision. Robotic obesity surgery has definite advantages due to its 3D vision, and precise intuitive multi range instruments that are much safer for the patients. Robotic surgery also helps in better suturing skills, and reduces post-operative pain, and recovery time. Robotic surgery is, in fact, indicated for morbidly obese patients (more than 250 kg) which is more complicated and difficult to perform by laparoscopy due to heavy abdominal wall present in these kinds of patients.

This technology is available in limited hospitals across the world—Aster CMI is one of them—due to the capital expense in setting up the robotic surgery equipment.

6. Does a bariatric surgery require blood transfusion?

a. Yes

b. No

c. Maybe

d. Don’t know

Correct Answer: No

Nowadays, blood transfusion is not necessary in most surgeries, and especially in bariatric weight loss surgeries. The reason being there are several highly sophisticated energy devices being used by the medical industry to minimize blood loss. There are also advanced bipolar energy delivery devices that are designed to cauterize vessels and enable dissection without bleeding, minimizing surgical times and blood loss. These are specialized instruments used in procedures and are extremely effective in causing coagulation by sealing blood vessels and stem the bleeding. These are cautery devices, which are heat energy based devices.

At Aster CMI, surgeons also use harmonic scalpels that utilizes ultrasonic energy to dissect soft tissue and coagulate blood at the incision at the same time. The scalpel blade gets ultrasonic energy, which is transmitted from the resonant wave guide, which is excited by the hand piece, also called the ultrasonic transducer.