Professional Documents
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Bariatric Surgery
Dr. Sanjiv Haribhakti
MS,DNB,MCh(G.I surgery)
Chairman
Kaizen Hospital, Ahmedabad
What is Obesity?
Multifactorial disease of excess fat storage with a genetic
basis
Influenced by the environment
Lifelong and progressive
Associated with multiple serious medical problems
India 2015 !!
Patient Awareness
Health consciousness
Knowledge of complications
access to internet , reading
Availability of less painful, laparoscopic surgery , with
speedy recovery
Assesment of obesity
Assesment
overweight
BMI - 25 to 30
obese
BMI - 30 - 40
Morbidly Obese
BMI > 40
itself is a disease
FRIENDS TOGETHER
Metabolic Syndrome Syndrome X
Abdominal
obesity
M Type II
Dyslipidemia
Hypertension
Type 2 diabetes
Gaining as little as 4-5 kg doubles your chance of
developing type 2 diabetes
More than 80% of people with diabetes are classified as
overweight or obese
blood
pressure is twice
as common in
obese adults
High cholesterol
Overweight people often
have too much
cholesterol in their
blood.
High cholesterol is linked
to angina (a type of chest
pain), heart disease, heart
attack, and stroke
Arthritis
Breathing problems
Asthma and obstructive
sleep apnea are more
common in obese people.
Mechanical and
inflammatory reasons
Cancer
Obesity may increase the risk of endometrial, breast,
prostate, kidney, esophageal, and colon cancers
Women who gain more than 8 kg between the age of 18
and midlife have double the risk of developing breast
cancer after menopause
Gallbladder stones
Gastrointestinal Tract
GERD
Nonalcoholic
Pregnancy
complications
Infertility
Obesity increases the risk of diabetes during pregnancy,
delivery complications, and birth defects
Obese women have 10 times the risk of high blood
pressure during pregnancy
51%
50%
44%
41%
40%
32%
30%
28%
26%
23%
24%
18%
20%
15%
10%
16%
14%
10%10%
15%
7%
4%
3%
0%
0%
Diabetes
Asthma
BMI < 25
Arthritis
25 - 30
30 - 40
High Blood
Pressure
BMI > 40
Cancer*
Traditional Weight
Loss Therapies
Diet
Exercise
Lifestyle Habits
Key to success
Assesment of obesity
Target with timeline
Comittemnt
Consistency
Under proper guidence
Regular reassesment
??? Difficult
Surgery for
Weight Loss
Restrictive
Sleeve Gastrectomy
Laparoscopic Adjustable Gastric Banding
Malabsorptive
Duodenal Switch / Biliopancreatic Diversion
1. ASMBS, Position Statement on Sleeve Gastrectomy as a Bariatric Procedure. June 17, 2007.
2. Lee CM, et al. Surg Endosc (2007) 21: 18101816
Gastric-Bypass
Started in 1994
Long-term sustained weight loss
65 to 70 % of EWL
No protein-calorie malabsorption
Little vitamin or mineral deficiencies
Technically difficult procedure
Resolution of Comorbidities
% Improved
% Resolved
Diabetes
18
82
Hypertension
18
70
Osteoarthritis
47
41
High Cholesterol
33
63
Reflux Disease
24
72
19
74
Asthma
69
13
35.1%
55.7%
Average
90.8%
Improved or Resolved
Christou NV, Sampalis JS, Liberman M, et al. Surgery Decreases Long-Term Mortality, Morbidity, and Health Care Use in Morbidly Obese Patients. Annals of Surgery 2004;240(3):416-424.
Dzavik V, Ghali WA, Norris C, et al. Long-Term Survival in 11,661 Patients with Multivessel Coronary Artery Disease in the Era of Stenting: a Report from the Alberta Provincial Project for
Outcome Assessment in Coronary Heart Disease (APPROACH) Investigators. American Heart Journal 2001;142(1):119-126.
Placebo
46%
0%
812%
1.6%
(10 Years)
Drug Therapy
< 10%
10%
6585%
Up to 100%
4550%
56%
Sleeve Gastrectomy
50-60%
65%
Treatment
~ 15 years
Thank You