Introduction
- Obesity today is recognised globally as a lifestyle disease and has been labelled the worst pandemic of the 21st century.
- It is closely associated with diabetes (together they are referred to as Diabesity) and both conditions result in significant morbidity compromising the affected patients’ quality and longevity of life.
- Major lifestyle changes are mandated to help reduce and maintain weight loss. Surgery for obesity (Bariatric surgery) has developed to help patients adopt a healthier way of living for the rest of their lives
Signs and symptoms
- Morbid obesity literally means an excess of fat which adversely affects the health of an individual
- Patients with obesity come for treatment once obesity starts severely compromising their quality of life
- Common complaints are
- Breathing difficulty on walking/ climbing stairs
- Difficulty in lying down straight
- Snoring
- Headaches
- Diabetes
- High blood pressure
- Pain in leg joints, back
- Swelling in both legs
- Daytime somnolence
- Recurrent infections in skin folds
- Apart from the above, patients are also prone to heart disease, many cancers, liver disease progressing to failure and an early death
Diagnosis
- Obesity is defined using various criteria, but the most common is the body mass index or BMI
- BMI = weight (kgs) / height x height (m2) (to insert calculator)
- Patients with BMI more than 32.5 kg/m2 and diabetes are eligible to this form of treatment.
- Patients with BMI 27.5 kg/m2 and uncontrolled diabetes not responding to medication are also candidates for bariatric surgery
Laparoscopic gastric bypass (LRYGB) –
- This procedure is the most extensively practiced and evaluated procedure for treating morbid obesity and diabetes.
- It is performed through 5 or 6 access ports as shown in the fig,
- The procedure involves altering the digestive system by decreasing the stomach size and changing the path through which the food passes.
- As suggested by the name of the procedure, a large part of the stomach is bypassed by the food which reaches the small intestine quickly.
- This physical change in the machinery of the digestive tract results in activation of numerous chemical and hormonal mechanisms,
- This results in decreased appetite, decreased caloric absorption and normalisation of blood sugar levels.
- The patient loses weight and becomes either non diabetic or is able to control diabetes easily and completely on minimal medication.
- The duration of hospital stay is 3-4 days.
Laparoscopic sleeve gastrectomy (LSG) –
- The gastric sleeve operation is another surgical option for treating morbid obesity which is performed exclusively on the stomach.
- It is performed through similarly placed ports as the LRYGB.
- The stomach is the food reservoir of the digestive system. It has a large capacity which allows us to eat a good volume of food quickly. When empty it creates the feeling of hunger and once full, sends the signal to the brain of satiety.
- The food in the stomach is then churned and mixed with gastric juices and slowly pushed forward into the intestine over 3 to 4 hours.
- In the LSG, the volume of stomach is decreased by excising a large part of its body, modifying its shape into a tube like structure very similar to the rest of the intestines.
- This decreases its reservoir capacity and increases its emptying rate.
- Consequently the patients’ appetite decreases and satiety gets prolonged.
- The rapid transit of food to the intestine exerts a metabolic effect similar to that seen in the LRYGB on diabetes.
- Hospital stay is 3-4 days
Post operative recovery
- The patient has to follow a diet protocol, which can be broadly summed up as 10 days of clear liquid diet, 2 weeks of pureed diet, followed by soft diet gradually progressing to a normal diet over 4 weeks.
- Following bariatric surgery it is mandatory for the patient to take multivitamin, iron and calcium supplements to avoid developing deficiencies.
There is a support group meeting once a month for addressing dietary and other issues following surgery.