Bariatric Surgery: A Path to Healthier Living
Bariatric surgery is a highly effective solution for individuals struggling with severe obesity and obesity-related health conditions. These procedures can significantly reduce weight, improve overall health, and enhance quality of life. The goal of bariatric surgery is not only to reduce the size of the stomach but also to help regulate hunger, metabolism, and nutrient absorption, ultimately leading to sustainable weight loss.
Types of Bariatric Surgery:
1. Laparoscopic Sleeve Gastrectomy (LSG)
Laparoscopic Sleeve Gastrectomy, or gastric sleeve surgery, involves the removal of a large portion of the stomach, leaving behind a small, banana-shaped sleeve. This limits the amount of food the stomach can hold and reduces hunger-causing hormones, helping individuals feel full with smaller portions.
2. Redo Laparoscopic Sleeve Gastrectomy
For patients who have not achieved the desired results or have regained weight after their initial sleeve gastrectomy, a redo sleeve gastrectomy may be performed. This procedure revises the stomach to provide a more effective outcome, and in some cases, it may involve additional modifications such as combining with other weight loss procedures.
3. Laparoscopic Gastric Bypass (Roux-en-Y)
Laparoscopic gastric bypass is one of the most effective bariatric surgeries. It involves creating a small pouch at the top of the stomach and rerouting a section of the small intestine to this pouch, reducing both food intake and nutrient absorption. This procedure leads to significant weight loss and is often recommended for individuals with severe obesity or obesity-related health problems.
4. Laparoscopic Mini Gastric Bypass
The mini gastric bypass is a variation of the traditional gastric bypass. It creates a smaller stomach pouch and connects it to a portion of the small intestine, bypassing a significant part of the stomach and small intestine. This less invasive procedure offers similar weight loss results with a shorter recovery time and fewer risks.
5. SASI (Single Anastomosis Sleeve Ileal Bypass)
SASI is a newer, combined weight loss surgery that merges the benefits of sleeve gastrectomy and gastric bypass. The procedure reduces the stomach's size like a sleeve gastrectomy and bypasses part of the small intestine, leading to significant weight loss through both food restriction and reduced nutrient absorption.
6. Laparoscopic Gastric Band
The gastric band is an adjustable band placed around the upper part of the stomach, creating a small pouch. This limits the amount of food the stomach can hold and increases feelings of fullness. Unlike other bariatric surgeries, the gastric band is reversible and can be adjusted over time. However, it is less commonly used now due to the higher risk of complications compared to other procedures.
7. Intragastric Balloons
Intragastric balloons are non-surgical weight loss devices that are inserted into the stomach. The balloon is inflated to reduce the stomach's volume, helping the individual feel full with smaller portions. This is a temporary solution that can help individuals lose weight and make lifestyle changes before considering more permanent weight loss surgery options.
Types of balloons have recently become many. Balloons are not considered an alternative to obesity surgeries for high body mass, and are not a treatment for metabolic diseases such as diabetes and blood pressure compared to surgical options in the long term.
Balloons are suitable for patients with a body mass of 27 and above. Each balloon has different properties than the other, but in the end the goal is one, which is to lose weight by filling the stomach and thus eating smaller quantities. Commitment to nutrition and exercise with the balloon is necessary for the desired weight loss.
Types of balloons in brief:
1. Traditional balloon (ORBERA): The most common and least expensive. Approved by the World Health Organization. It is placed and removed endoscopically as a one-day procedure with light anesthesia. It lasts for 6 months or a year and is filled with 400-700 ml of fluid depending on the size of the stomach. The expected weight loss is 12-15 kg.
2. Double balloon (Reshape Dual): It has recently received recognition from the World Health Organization. Placement and removal as a one-day procedure using an endoscope. Designed to fill the stomach more (900 ml) when inflated with liquid. Lasts for 6 months. Expected weight loss is 17.1 kg.
3. Annual balloon (Spatz): Placement and removal using an endoscope as a one-day procedure. Its size can be controlled using an endoscope as desired during its presence. Lasts for a year. Expected weight loss is 16-25 kg during the year.
4. Programmed capsule (Elipse): The latest currently. It does not require any endoscopes to place or remove it. The capsule is swallowed in the outpatient clinic and inflated with 550 ml of liquid inside the stomach. After 4 months, it dissolves and is expelled with the waste. Expected weight loss is 16.3 kg.
1. Smart capsule (Obalon): It only requires an endoscope to remove it. As for placement, the capsule is swallowed in the outpatient clinic and inflated with a special gas of 250 ml. 3 balloons can be placed over a period of 3 months and removed using an endoscope after the period ends. It is considered the lightest on the stomach. Expected weight loss is 8 kg.
Who Needs Bariatric Surgery?
For intragastric balloons the eligible Body Mass Index (BMI) is 27 or higher. Gastric Band can be applied from BMI 30 and above.
Bariatric surgery is typically recommended for individuals who:
• Have a Body Mass Index (BMI) of 40 or higher (severe obesity).
• Have a BMI between 35 and 40 with obesity-related health conditions such as type 2 diabetes, high blood pressure, sleep apnea, or joint problems.
• Have tried other weight loss methods (diet, exercise, medications) without long-term success.
• Are prepared for long-term lifestyle changes including diet and exercise.
Frequently Asked Questions (FAQs)
1. Who is eligible for bariatric surgery?
Candidates for bariatric surgery typically have a BMI of 40 or higher, or a BMI of 35 or higher with obesity-related health problems like diabetes or hypertension. Other factors, such as age, overall health, and commitment to lifestyle changes, are also considered.
2. What is the difference between gastric sleeve and gastric bypass?
The gastric sleeve involves removing a portion of the stomach to create a smaller, sleeve-like structure, which reduces the amount of food you can eat. The gastric bypass involves creating a small stomach pouch and rerouting part of the intestines, which limits both food intake and nutrient absorption.
3. How long does it take to recover from bariatric surgery?
Recovery time varies depending on the procedure, but most patients can return to light activities within 2-3 weeks. Full recovery may take 4-6 weeks. Adhering to post-operative instructions and attending follow-up appointments is key to a smooth recovery process.
4. Is bariatric surgery permanent?
Bariatric surgery is generally considered permanent, especially procedures like gastric sleeve, gastric bypass, and SASI. However, success depends on lifestyle changes. If these changes aren’t followed, some weight regain can occur. Reversible procedures, like the gastric band and balloons, can be adjusted or removed.
5. Will I need to make lifestyle changes after bariatric surgery?
Yes, bariatric surgery is a tool, not a quick fix. Successful long-term weight loss requires significant lifestyle changes, including a balanced diet, regular physical activity, and psychological support. Follow-up care and support groups can help you maintain your new weight and health.
Weight Loss Medication: Saxenda, Ozempic, and Mounjaro
For individuals struggling with obesity or overweight-related health conditions, weight loss medications can provide additional support to help achieve sustainable weight loss. These medications are often prescribed in conjunction with lifestyle changes such as a healthy diet and regular exercise. Among the most widely used and effective medications for weight loss are Saxenda, Ozempic, and Mounjaro. These injectable treatments have been shown to help individuals control their appetite, reduce food intake, and improve overall weight management.
Types of Weight Loss Medications:
1. Saxenda (Liraglutide)
Saxenda is an FDA-approved medication that is used for chronic weight management in adults who are obese or overweight with at least one weight-related health condition, such as type 2 diabetes or high blood pressure. Saxenda is a once-daily injectable medication that works by mimicking a hormone in the body called GLP-1 (glucagon-like peptide-1). This hormone helps to regulate appetite and food intake, leading to reduced calorie consumption.
How Saxenda Works:
• It helps regulate hunger, making it easier for individuals to reduce their calorie intake.
• It also slows gastric emptying, which helps people feel fuller longer after eating.
2. Ozempic (Semaglutide)
Ozempic is another GLP-1 receptor agonist, primarily used to manage type 2 diabetes, but it has gained popularity as a weight loss medication due to its effectiveness in promoting weight loss. Similar to Saxenda, Ozempic is injected once a week and works by reducing appetite, increasing feelings of fullness, and slowing gastric emptying.
How Ozempic Works:
• By mimicking the effects of GLP-1, Ozempic helps reduce appetite, leading to a reduction in food intake.
• It helps manage blood sugar levels, making it a valuable option for those with diabetes who also need help with weight loss.
3. Mounjaro (Tirzepatide)
Mounjaro is a newer medication approved for the treatment of type 2 diabetes. It works by targeting both GLP-1 and GIP (gastric inhibitory peptide) receptors, which are hormones that help regulate blood sugar levels and appetite. Research has shown that Mounjaro can significantly help with weight loss in individuals with type 2 diabetes or obesity.
How Mounjaro Works:
• Mounjaro targets both GLP-1 and GIP receptors to promote weight loss by reducing appetite and improving insulin sensitivity.
• It also helps with blood sugar regulation, making it beneficial for individuals who have diabetes or pre-diabetes.
Who Needs Weight Loss Medications?
Weight loss medications are typically prescribed for individuals who meet the following criteria:
• Obesity or Overweight: Individuals with a BMI (Body Mass Index) of 30 or higher or BMI of 27 or higherwith obesity-related health conditions like type 2 diabetes, high blood pressure, or sleep apnea.
• Difficulty Losing Weight: Those who have struggled to lose weight through diet and exercise alone may be candidates for weight loss medications.
• Health Conditions Related to Obesity: Individuals suffering from obesity-related conditions such as high cholesterol, diabetes, or joint problems can benefit from weight loss medications as part of a broader health management plan.
Frequently Asked Questions (FAQs)
1. How effective are Saxenda, Ozempic, and Mounjaro for weight loss?
These medications have been shown to produce significant weight loss when used in combination with a healthy diet and exercise. On average, people using these medications can expect to lose 5-15% of their body weight over the course of treatment, but results vary from person to person.
2. Are these medications safe for long-term use?
Saxenda, Ozempic, and Mounjaro are generally considered safe for long-term use when prescribed by a healthcare professional and used according to the recommended guidelines. However, they should be used with monitoring for side effects such as nausea, headaches, and digestive issues.
3. How do I take these medications?
Saxenda is injected daily, Ozempic is injected once a week, and Mounjaro is also injected weekly. Each medication comes with detailed instructions on how to properly administer the injection. Your doctor will guide you on how to use the medication effectively.
4. Can I stop taking the medication once I lose weight?
While some people may achieve weight loss success with these medications, weight loss maintenance often requires continued lifestyle changes. Stopping the medication without adjusting diet and exercise may lead to weight regain. It’s important to work with your healthcare provider to develop a long-term plan for maintaining your weight loss.
5. Are there any side effects of these medications?
The most common side effects of Saxenda, Ozempic, and Mounjaro include nausea, vomiting, diarrhea, and headaches. Some individuals may experience digestive issues, but these often improve over time as the body adjusts. Rare but more serious side effects include pancreatitis or gallbladder problems. It's important to discuss potential risks with your doctor.
General Surgery: Essential Treatments for Common Health Conditions
General surgery encompasses a wide range of procedures used to treat a variety of conditions affecting the abdominal organs, soft tissues, and other body systems. These surgeries can be minimally invasive or traditional, depending on the nature of the condition and the patient’s health. General surgeries, such as hernia repair and laparoscopic cholecystectomy, are common and help improve quality of life by treating painful conditions and preventing serious complications.
Types of General Surgery:
1. Hernia Repair Surgery
A hernia occurs when an organ or fatty tissue pushes through a weak spot in the surrounding muscle or connective tissue. The most common types of hernias involve the abdominal area, including inguinal, umbilical, and femoral hernias. Surgery is typically recommended when the hernia becomes painful, enlarges, or presents a risk of complications like strangulation.
Surgical Approach: Hernia repair is usually performed through traditional open surgery or minimally invasive laparoscopic surgery. The procedure involves pushing the protruding tissue back into place and repairing the weakened area of muscle or tissue. In some cases, a mesh material is used to strengthen the wall and prevent recurrence.
2. Laparoscopic Cholecystectomy (Gallbladder Removal)
Laparoscopic cholecystectomy is a minimally invasive surgery to remove the gallbladder, often performed to treat conditions like gallstones, gallbladder inflammation (cholecystitis), or other gallbladder diseases. Gallstones can block the bile ducts, causing pain, infection, or other complications, making the gallbladder removal necessary.
Surgical Approach: During a laparoscopic cholecystectomy, small incisions are made in the abdomen through which a tiny camera (laparoscope) and specialized surgical instruments are inserted. This allows the surgeon to remove the gallbladder with minimal disruption to surrounding tissues. Recovery time is generally shorter compared to traditional open surgery.
3.Gastroesophageal reflux Disease (GERD)
Gastroesophageal reflux disease (GERD), commonly known as heartburn, can come with other symptoms, too, including chest pain, trouble swallowing, feeling like there's a lump in your throat, or even a cough. Life style modification and medical treatment can be successful in many cases. Surgical repair (laparoscopic Nissen fundoplocation) is an option if medical treatment fails.
4.Lumps and ulcers:
· Lumps: Skin lumps such as Lipoma, sebacious cyst, dermoid cyst.. etc can be excised under local anasthesia. Infected lumps can be managed fully before excition under medical supervision.
· Ulcers: skin ulcers like diabetic foot are treated with skin care, offloading, treatment of infection, and debridment in our diabetic foot clinic.
· Ingroin toe nail: toe nail growing wrongly under the skin can be treated surgically under local anasthesia with excision and daily dressing.
Emergency Consultation: The surgery clinic can be consulted for all general surgery emergencies including Acute appendicitis, acute cholecystitis, obstructed hernia, emergency bariatric conditions. The service is available at certain hospitals with supervision of a consultant bariatric and general surgeon.
Who Needs General Surgery?
• Hernia Repair Surgery:
o Individuals with painful or enlarging hernias in the abdomen, groin, or other areas.
o Those at risk for complications like strangulation, where blood flow to the hernia is cut off, causing severe pain and potential tissue death.
o Patients experiencing symptoms such as nausea, vomiting, or discomfort related to a hernia.
o Individuals who wish to avoid the long-term complications of an untreated hernia.
• Laparoscopic Cholecystectomy:
o Patients diagnosed with gallstones that are causing pain, blockage, or infection.
o Those with a history of chronic gallbladder inflammation or recurring gallbladder attacks.
o Individuals suffering from conditions such as cholecystitis, where the gallbladder becomes inflamed due to infection.
o Patients whose gallbladder disease is interfering with their daily life or leading to serious complications, such as jaundice or pancreatitis.
. Laparoscopic Nissen Fundoplication:
If lifestyle modification and medical treatment failed, surgery can be a treatment for GERD. Usually, hiatal hernia (stomach migration to the chest) and GERD is usually repaired surgically after investigation of the disease by upper GI scope, manometry and pH study, and contrast study.
Frequently Asked Questions (FAQs)
1. What is the recovery time for hernia surgery?
Recovery time varies depending on the type of hernia surgery. For traditional open hernia repair, patients may need 4 to 6 weeks to fully recover. Minimally invasive laparoscopic hernia repair typically requires a shorter recovery time, around 1 to 2 weeks, but full recovery can take a few months.
2. Can a hernia be repaired without surgery?
No, the only effective treatment for a hernia is surgery. While a hernia can sometimes be managed with lifestyle changes (e.g., avoiding heavy lifting), surgery is necessary to repair the weakened tissue and prevent complications.
3. How long does laparoscopic cholecystectomy take?
Laparoscopic cholecystectomy typically takes about 1 to 2 hours to perform, depending on the complexity of the case. Since it is minimally invasive, the procedure generally has a shorter recovery time compared to traditional open surgery.
4. What are the risks associated with laparoscopic cholecystectomy?
Like any surgery, laparoscopic cholecystectomy carries risks such as bleeding, infection, injury to surrounding organs (such as the bile ducts), or complications related to anesthesia. However, it is considered a safe and routine procedure with a low complication rate.
5. Will I need to make dietary changes after gallbladder removal?
After gallbladder removal, some patients may experience digestive changes. While the body adjusts to the absence of the gallbladder, a low-fat diet is often recommended to help with digestion. Most patients can return to a normal diet after a period of adjustment.
Laparoscopic/Minimally Invasive Abdominal Surgery for Diastasis Recti with Small Hernia
This procedure is a type of minimally invasive laparoscopic surgery used to treat diastasis recti (separation of the abdominal muscles) along with a small hernia. Through small incisions, this surgery allows for the repair and tightening of abdominal muscles, improving appearance and alleviating symptoms like pain and discomfort. The minimally invasive nature of the procedure results in less pain and faster recovery compared to traditional open surgery.
Types of Procedures:
- SCOLA: This is a laparoscopic surgery to repair the abdominal wall and diastasis recti with or without a paraumbilical hernia. It involves three small openings, through which the surgeon repairs and strengthens the abdominal muscles using sutures while addressing the hernia. SCOLA is typically an outpatient procedure, allowing for quicker return to daily activities.
- MELA: MELA combines SCOLA with liposuction of abdominal fat. This approach not only repairs muscle separation and hernia but also restores the abdominal skin to a more contoured appearance, reducing excess fat for a smoother, firmer abdominal profile.
Who Needs This Procedure?
This surgery is beneficial for people experiencing diastasis recti with or without a small hernia, including:
- Postpartum women with visible abdominal muscle separation.
- Individuals with a small hernia due to a weakened abdominal wall.
- People with abdominal muscle weakness or bulging from diastasis.
5 Frequently Asked Questions (FAQs)
- Is
laparoscopic surgery painful?
Laparoscopic surgery is generally less painful than open surgery, with most patients requiring only mild pain relief after the procedure. - What
is the recovery time after surgery?
Most patients can resume light activities within 1-2 weeks, with faster recovery times for SCOLA and MELA due to their minimally invasive approach. - Will
there be scars after the surgery?
Small incisions used in both SCOLA and MELA result in minimal, often inconspicuous scarring. - Can
the hernia recur after surgery?
Recurrence is rare when following post-surgery instructions provided by the surgeon. - When
can I resume exercise?
Patients are generally advised to wait 4-6 weeks before resuming intense exercise, though light activities may be started earlier per the surgeon’s advice.