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Things you should know before your Bariatric (Obesity) surgery

Fighting obesity is a Herculean task. Many morbidly obese persons would eventually need bariatric surgery to win over obesity. The decision to undergo bariatric surgery is in itself a very big decision. A person goes through a lot of doubt and fact-checking before the final decision is taken. Here, I have attempted to help such a person by explaining some of their common doubts.   generic-bariatric

Do I really need bariatric surgery?

Bariatric surgery is advised if your body mass index (BMI) is 32.5-37.5 with a weight-related medical condition and if your  BMI 37.5 or greater even if they do not have any weight related medical condition. You should have tried to lose weight through a change in diet and lifestyle before considering surgery. If you fall in the above given BMI range, then you are less likely to lose and maintain weight with lifestyle changes. And hence need surgery.

If your weight is affecting your quality of life then surgery is even more justified. When obesity is leading you to have one or more medical problems like diabetes, blood pressure, swollen legs, breathing problems and infertility, then delaying surgery may be more harmful in the longer run.

Bariatric surgery is not a cosmetic procedure. We may hope to look better after losing weight, but the best reasons for undergoing this major surgery are to extend and improve our lives. In addition to improving quality of life, losing weight can reduce the risk of heart attack, stroke, diabetes, and cancer.

We must understand that it is not a surgery that is needed on an urgent basis. And the answer to the question “is it needed?” is never going to be a plain “yes” or “no”. It is always a conscious and well thought of decision, after understanding what are the benefits and the possible problems. And for most of the patients who finally undergo this surgery, the benefits outgrow the possible problems. 

Understand what are the reasons for you to consider bariatric surgery

Hence, you should understand what are the reasons for you to consider surgery. A consultation with a bariatric surgeon may help you in understanding that. To take into consideration your weight, BMI, age, lifestyle restrictions, possible future complications of obesity into consideration.

For example,

if you are a female aged 50 years with a weight of 95 kgs and a BMI of say 37 kgs, have varicose veins and swollen legs and knee and back pain. Unable to do physical activity properly and lose weight even with a proper attempt with diet changes. And you have observed an increase in weight of about 5 kgs in the past 2 years, you should consider surgery with thorough understanding. Else you are likely to cause more damage to your knee and spine and finally forced to go for weight loss surgery after a few years when your weight had increased to 105 kgs a few years later. This is so because you are less likely to lose and maintain weight loss with your knee and back problems and your age factor.

Another scenario

could be a patient with a BMI of 38 and with diabetes that is poorly controlled with medication or having significant breathing or sleep apnoea problems. For such patients, the possible problems of surgery are much less compared to the complication that are possible due to obesity and medical problems. For such patients, uncontrolled diabetes can lead to kidney problems, diabetic foot ulcers or heart problems. Or their sleep apnoea can lead to fatal accidents or can restrict their activity significantly.

There are a lot of such problems and scenarios where bariatric surgery will be a boon in spite of the possible complications. And with proper pre-surgery evaluation and a good follow up the complications can not only be reduced but can be effectively managed in case they occur. So you need to understand your own problems and to what extent obesity surgery will be helpful. What are the other options in case you do not undergo this surgery? 

Which surgery is best suited to me?

Once you decide you want to undergo bariatric surgery, the next step is the selection of a surgery. There are various options, broadly Laparoscopic and Endoscopic. 

Endoscopic procedures

  • Endoscopic Gastric Baloon placement
  • Endoscopic Gastroplasty (Gastric plication)

The commonly done surgeries among the above are Laparoscopic sleeve gastrectomy and both types of gastric bypass. They are the preferred ones because they have shown consistent good long term results. Selection of surgery depends on factors like your BMI, your age, whether your vegetarian and most importantly your metabolic problems. Metabolic problems mean your diabetes, need for insulin, your cholesterol levels and your pancreatic reserve as shown by C peptide levels. 

Bypass operations are little more complex surgeries but have a significant advantage for patients who have diabetes. While ileal interposition is for those patients who have diabetes and are not morbidly obese. It means it is a purely metabolic surgery, done to improve your diabetes.

Endoscopic procedures are not the ideal options for patients for BMI of more than 35. The gastric balloon has not shown good long term results. Endoscopic Gastroplasty is still a new procedure and looking at the poor results of laparoscopic gastric plication (which is already abandoned), I am not too optimistic about the long term outcomes on this procedure. Still, this can be considered in selected patients with BMI in the range of 30-32.5 and no metabolic problems.

What is the safest Bariatric surgery for me

The best and safest surgery for you may be differnet from the one for another obese person. Hence, a thorough discussion with a surgeon and understanding the outcomes of each procedure is advised before taking the decision. The surgeon will help you figure out the risk vs benefit ratio for differnt surgeries in your particular case. And then you both can make a joing decision about the type of surgery to be performed.

Have I understood the risk

Initial possible problems : How dangerous if weight loss surgery?

No surgery is 100 percent safe and without any problems, and so is Bariatric surgery. It is a major surgery, and has its share of problems. Some of the inital problems of concern are bleeding, leakage from the joints in the intestine and stomach, breathing problems and leg vein clots. Overall, there is a change of about 1-2% (means 1-2 in 100 patients undergoing this surgery) of having any of these problems. The above problems may need further treatment, longer hospitalization, another procedure to deal with the problem, and may add to the total cost of treatment. But if we are aware and allert about it, identify and treat them on time, major mishap can be avoided. Hence,  it is important to be aware of this problems. Apart form this there some other minor problems like wound infection, fever, vomiting which are not of a major significance.

Overall, for the right indication of bariatric surgery, despite these complications the benefit of this surgery is far more thatn the problems. When we follow proper protocols and with due to care, this problems can be kept at minimum and be managed efectively when they occur. Ultimately achieveing positive outcomes.

 

Long term possible problems: 

Long term problems are mainly nutritional problems and weight regain problems. There are lot of factors to be taken care of to prevent these problems. To a certain extent this also depends on the type of bariatric surgery one. A good follow up and an attitude to follow a healthy diet and lifestyle is very improtant to avoid these problems.

Protein and vimatin deficiencies are a common concern. So is anemia and trace elecment deficieny. Generaly they are being supplemeted during the wiehgt loss period. There a bit more likely to happen with bypass procedures compared to sleeve gastrectomy, and even more likely for malasbsorptive procedures where a larger intestinal part rendered disfunctional. A healthy diet helps in avoiding it, and a refular follow up helps in detecting it early. Early detection makes its management very simple, just by supplementing. Some of the deficiencies if not detected on time can cause more problems and will be difficult to manage.

Weight regain is another long term problem. Rather than it being a complication of the surgery, it is a problem of poor lifestyle on the part of patient. It is not at all wrong in saying that, weight regain happens as the patients not modified the primary culprit of their obesity, “the unhealhty lifestyle”. A poor follow up is an indicator of casual attitude towards lifestyle change. And so, majory of patinets who have nutritional deficiences and weight regain have a history of poor follow up after surgery.

 

What should I expect post surgery

Pain and recovery: Is Bariatric surgery Painful?

After the surgery, you will find that it is not as painful as you have expected. You will be out of bed and moving around in a few hours. Certainly, it not going to be totally pain-free. But considering that it is major surgery, the pain is much less. It is so because of the laparoscopic methods. In a couple of days, you can expect yourself to be moving around normally. Walking as much as you want, climbing stairs, etc. 

Adjusting to the initial diet

Initially, you will be on a liquid diet for 2 weeks. You will be able to a sip fo liquid at a time for the initial  few days. Hence you will be expected to have a sipper around so that you can continuously sip liquids every few minutes. This is important as you need to maintain hydration by taking about 2-3 liters of liquids per day. Soon, soft food will be added and progressed gradually. The transition to a normal diet will take about 4-6 weeks. This is the period that will need some planning and adjustments. Especially when you resume work.

Resuming work and normal activities

You can expect to return to work in about 8-10 days depending on the type of your work. Some motivated ones can resume work even earlier. The earlier you start moving around normally and resuming work, the faster is your overall recovery.

Initial weight loss

Initial weight loss is fast. About 40-50 % of the expected weight loss is seen in the initial 3 months. The rest will occur in the 12-18 months period. The total weight loss in the first month and the initial 3 months will depend on your excess weight. This initial weight loss is enough to make you feel lighter and more energetic. It will also boost your confidence. And hence, this is the time when you should gradually improve your physical activities to get the best outcomes.

Healthy problem benefits

Improvement in medical conditions is seen quite early. Diabetes starts improving from day one, even before the first kilogram is lost. This is the real magic of bariatric surgery, especially the bypass surgery. The blood pressure, knee problems, back problems, leg swelling, and infertility all start improving in the initial few months. And this will help you get back to a healthier lifestyle.

What are the main precautions that I should take after surgery

Although bariatric surgery gives consistent good long term results, the outcomes in an individual do depend on a lot many things. Patients, who understand this and follow the advice given by their surgeon get better outcomes. Here are a few factors that are very important and worth understanding.

Eating habits

The most important care is to eat slowly after chewing properly. This is important in the initial days, as eating fast may cause discomfort or even vomiting. Will the passing time you will be able to understand yourself, at what pace you are feeling comfortable eating.

Secondly, you also have to develop the habit of eating the right foods. As nutritional deficiencies are a possibility, you need to eat healthy food. Food rich in proteins, vitamins, and fibers. You need to avoid soda, coffee, and sugary liquids. You also need to avoid sweets, chocolates, and fried food. 

This change to healthier food needs to be done at a mental level. You need to understand and accept that this is the right way to eat and this habit should be lifelong. And it will be possible only if you are happily accepting it rather than forcing yourself. This is the single most important change that defines your long term outcome after surgery.

Physical activity

As already discussed, you should be able to resume normal activities in about 7-10 days time. And at this time, you need to focus on gradually increasing the physical activity levels. Being active will help you achieve maximum weight loss and also help maintain muscle mass. Sagging of skin also reduces if you are physically active. With increasing weight loss, doing exercise will be more and easier. 

Supplements

Protein and vitamin deficiency are a possibility and hence you need to follow the advice of your surgeon about the supplements. Protein supplements are generally required for the initial few months, till you reach a normal diet pattern. Vitamin supplements are needed for a longer-term, at least till you are losing weight. Further need for vitamin supplements will be suggested by the surgical team as per your needs.

Medications, alcohol, and smoking

After surgery, you need to careful with other medications. Always discuss with your surgical team before taking medications, especially NSAIDs and painkillers. Alcohol and smoking will also cause problems and hence need to be avoided. Smoking is very likely to cause ulcerations and may lead to major problems. 

Follow up

Follow up is the single most determinant of good long term outcomes. It is understandable that after a few months patients do not feel that they are patients. And hence they are very much likely to skip and avoid follow-ups. But this the time when your surgeon can pick up early nutritional deficiencies, pick up your unhealthy diet and inactivity. Suggestions are given during the follow up help you adhere to a healthy lifestyle. And hence those patients who keep good follow up are likely to have better outcomes.

Cost of Bariatric surgery in India?

The cost of surgery varies from place to place, hospital to hospital and surgeon to surgeon. Certainly, as it needs a lot of sophisticated instruments and disposable material, the overall cost is higher. Although it is not needed to spend an exorbitant amount of money, some of the basic necessities should not be ignored to cut costs. If you want to inquire about the packages at our center you can send your details by clicking here and we shall be happy to communicate to you.

Am I with the right surgeon?

The surgeon and the surgical team is your partner in your fight against obesity. Hence choosing a good surgeon is very important. Some of the attributes are very important and hence you should make sure that your surgeon has those. He must be experienced and qualified in performing these surgeries. Surgery should be performed at a hospital having all the needed equipment in operation theatre and should have an ICU backup facility. He should be willing to give you time to sort out your queries and give genuine advice. He should be available to you time after surgery for your small problems and concerns. If you can tick yes for all the above attributes then you are in safe hands.  

About ADROIT centre for Digestive and Obesity surgery 

We at ADROIT understand the problems of obese individuals. Not just what problems they are facing, but also why they are facing those problems. What are the challanges they are facing in fight against their weight, physical, psychological, emotional, familial, social, financial and professional. We also have a thoroguh understanding of the root causes of obesity. And have ability and willings to find the specific causes of each individual patient. This helps us guide them to achieve excellent long term results. We are a centre doing these surgeries regularly for a long time and can assure you of safe and smooth recovery. Our team also takes active participation in making sure you are back to your normal routine life soon after surgery. These are probably the reasons why our patients rate us among the best. 

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