Obesity, Its Complications & role of Bariatric Surgery
What is Obesity?
Obesity is as a weight of 15 to 30 kgs over your ideal body weight. Morbid Obesity is a weight of 30 to 45 kgs over your ideal body weight. A BMI of 37 or greater, with or without any obesity-related illnesses, or a BMI less than 37 with the associated illnesses listed below. Most of which are known to reduce the life expectancy of the patient.
Relationship of obesity with other diseases
Type 2 Diabetes:
People who are obese become resistant to insulin (which regulates blood sugar levels). Over time the constant elevation of the blood sugars affects many organ systems in the body. Resultant damage can include kidney failure, heart disease, blindness, and susceptibility to severe infections.
High B.P / Heart disease
Obesity leads to elevated cholesterol/triglycerides and causes the heart to work under extreme conditions. These can result in inadequate pumping mechanisms or poor oxygen flow leading to heart failure, heart attacks, strokes, again kidney failure and poor circulation in the lower legs.
Additional weight or stress is placed on multiple joints and their support structures. These include the knees, hips, and back causing rapid degeneration leading to pain, inflammation, and lack of mobility.
Sleep Apnea / Respiratory problems
Fat deposits in the tongue and neck which can block the airway causing a person to temporarily stop breathing during their sleep, especially when sleeping on their back. This causes them to lose sleep and results in daytime drowsiness, fatigue and headaches.
Hiatal hernia and heartburn
Increased intrabdominal pressure weakens and overloads the valve at the top of the stomach, which then allows stomach acid to escape and irritate the esophagus. Approximately 10-15% of patients with even mild heartburn can develop Barrett’s esophagus, which is a pre-malignant change that can progress into esophageal cancer. Obesity related non alcoholic fatty liver disease may progress to cirrhosis and cancer liver.
People who are obese must deal with constant emotional challenges such as low self-esteem, lack of self-confidence, poor self-image due in part to social discrimination. This leads to social isolation, and occasionally suicidal tendencies.
Urinary stress incontinence
Increased intraabdominal pressure stresses the muscles of the pelvic floor compounding the effects of childbirth, which can lead to improper function of the bladder. This results in leakage of urine when coughing, sneezing or laughing or inability to hold the urine until the patient can reach a toilet.
Obesity can lead to faulty valves in the veins that promotes sluggish flow in vessels causing a clot in the lower limbs. The most feared problem is when one of these clots breaks away and floats into the lungs. This is called a Pulmonary Embolus and can be a fatal complication
OPTIONS FOR WEIGHT LOSS SURGERY
Laparoscopic Roux-en-Y Gastric Bypass
The gastric bypass (as it is commonly referred to) is a surgical weight loss procedure that was introduced in 1967. In recent years, a modified laparoscopic form of this procedure has been developed.
Gastric bypass is considered to be primarily a restrictive procedure, but it is widely believed that a small amount of decreased absorption also occurs. In gastric bypass surgery, a small 30 cc (1 ounce) gastric pouch is formed from the upper part of the stomach. A section of the upper intestine is connected to the small gastric pouch through a Y-shaped connection. As a result, patients eat less food, and somewhat less nutrients are absorbed. This surgery takes from 1 to 3 hours and most patients will be able to leave the hospital on the second or third day after surgery.
Potential surgical candidates should know and understand that in some people, this type of surgery can cause “dumping syndrome” in which eating sweet foods or drinking sweet drinks can lead to a dizzy, sweaty, queasy feeling. Patients who have this syndrome are therefore discouraged from eating sweets, which actually helps with weight loss because sweets are high in calories and usually low in nutrition.
Laparoscopic Sleeve Gastrectomy
The sleeve gastrectomy as a new procedure for weight loss that is particularly suited to those patients at highest risk for surgery, either because of their medical co-morbidities or their weight.
We offer this procedure as a first-stage, lower-risk surgical alternative that serves as a bridge to other bariatric operations. The procedure involves removing 85% of the stomach, leaving behind only a sleeve of stomach. This portion of stomach restricts the amount of food that a patient can eat and leads to significant weight loss (up to 50%-70% of excess weight). As a patient loses weight (over a 6-18 month period), their risk for subsequent surgery decreases dramatically. At the appropriate time, they can be safely offered a second-stage operation, either gastric bypass or duodenal switch.
It can be offered to the patients of obesity with high volume eaters as a prime procedure also, wherein it not only restricts but also decrease the harmones like Ghreline, thereby decreasing hunger and increasing satiety.No cutting of small intestine and no foriegn material like in Lap Band involved in this procedure, complication rate is less than 1%.
Laparoscopic Adjustable Gastric Band
Laparoscopic banding is a restrictive procedure. An FDA-approved (June 2001) inflatable silicone band is placed around the top portion of the stomach to create a small pouch just below the esophagus (or food pipe). The stomach is stitched over the band to prevent it from moving. This surgery takes about 1 hour and patients will usually be able go home from the hospital on the first or second day after surgery.
How does surgery help in reducing the intake of food?
Following this surgery, only a small amount of food can be eaten before the pouch is full. The food then passes through the small opening created by the band and is digested normally.
How often will patient need to visit the hospital after the initial procedure?
After the band is placed, patients will need to come back to the hospital for a band adjustment. The band has an adjustable “balloon” that is filled by injecting fluid into a port placed under the skin. Injecting fluid into the port will decrease the size of the opening. Extracting fluid from the port will increase the opening. The number of adjustments needed varies from person to person, but most need between 3 and 5 before the band is at its ideal tightness