bariatric surgery
TRANSCRIPT
PRESENTPRESENTDESIGNATIONDESIGNATION
Senior ConsultantSenior ConsultantSurgical Gastroenterology & Minimal Access Surgical Gastroenterology & Minimal Access Surgery, Apollo hospital, Chennai.Surgery, Apollo hospital, Chennai.
PRESENT PRESENT AFFILIATIONAFFILIATION
Indian Society of GastroenterologyAssociation of Surgical GastroenterologyIndian Association of Gastro Endosurgeons International Hepato-Biliary-Pancreatic SurgeryInternational Federation Society of ObesityObesity Surgery Society of India
MAJOR MAJOR ACHIEVEMENTACHIEVEMENT
Started G.I endoscopic services in 1984 at Apollo Hospital, ChennaiEstablished GI Surgery & Minimal Access surgery departmentStarted Bariatric surgical servicesStarted FNB (MAS) & DNB (SGE)Adjunct Professor – The Tamil Nadu Dr.M.G.R. Medical UniversityAdjunct Associate Professor – University of Queens Land, Brisbane, Australia.
AWARDSAWARDS Prof. Nanjunda Rao Endowment Orations , MMC, ChennaiDr. Ranganathan Endowment lecture, RMMC, Chidembaram Prof. B. Shanmukeshwar Rao Memorial Oration, ASI-AP chapter, Hyderabad Dr. Karimulla Endowment oration, IMA, Nellore, AP
PUBLICATIONPUBLICATIONSS
26 National & International journals24 operative videos on Youtube (Prof. P K Reddy)
DR. PRASANNA KUMAR REDDYDR. PRASANNA KUMAR REDDYMB, FRCS (Eng, Edin, Glasg), FACG, D.Sc, D.lap (Fr)MB, FRCS (Eng, Edin, Glasg), FACG, D.Sc, D.lap (Fr)
SURGICAL OPTIONS FOR WEIGHT LOSS
Surgical management is the most effective method of treating morbid obesity. The weight loss is sustained for a longer period of time. Co-morbidities are resolved or improved in majority.
Like all other therapies weight loss surgeries should be combined with a change in dietary habits and life style.
INTRODUCTION
BARIATRIC SURGERY
INDICATIONS:1. BMI >40 kg/m2 or BMI 35-39.9 kg/m2 and life
threatening cardiopulmonary disease. Severe diabetes or lifestyle impairment
2. Failure to achieve adequate weight loss with nonsurgical treatment
CONTRAINDICATIONS:1. History of noncompliance with
medical care2. Certain psychiatric illness
personality disorder. Uncontrolled depression. Suicidal ideation substance abuse
3. Unlikely to survive surgery
CURRENT BARIATRIC SURGICAL PROCEDURES
Classification Procedure
Gastric Restriction Adjustable Gastric Banding
Sleeve Gastrectomy
Primarily restrictive andPartially malabsorptive
Roux-en-y-Gastric Bypass
Primarily malabsoptive and Partially restrictive
Bilio Pancreatic diversion with duodenal switch
Bilopancreatic diversion
Mini Gastric Bypass
Surgical treatment of obesity
MGB
LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING
• Silicone band placed around upper stomach to create a small pouch. Outlet diameter can be changed by infusing or withdrawing saline from port.
Mean follow-up was 35 +/- 2 months. Percentage of excess weight loss was 45.8% +/- 27.4 at 6 months, 66.7% +/- 30.3 at 1 year, 72.6% +/- 28.8 at 2 years, 75.9% +/- 27.4 at 4 years, 82.8% +/- 32.6 at 6 years, 82.3% +/- 25.1 at 8 years, and 82.7% +/- 4.2 at 10 years.
Obes Surg. 2008 May;18(5):573-7.
Ten years experience with laparoscopic adjustable gastric
bandingBiagini J, Karam L et al
•Department of Surgery, Saint Joseph Hospital, Dora, Lebanon
Laparoscopic Adjustable Gastric Banding Produces Greater Weight loss than comprehensive Medical Therapy in Patients with Class I Obesity (BMI 30-35 kg/m2)
Dapri G,Himpens J,et al. Surgical Endoscopy 2006; 20(Suppl.):S46
Laparoscopic Adjustable Gastric Banding Produces Greater Weight loss than comprehensive Medical Therapy in Patients with Class I Obesity (BMI 30-35 kg/m2)
Obrien et al Ann Intern Med.2006:144-625-33
SLEEVE GASTRECTOMY
• Sleeve resection
• Mechanism
. Restrictive
. Hormonal
ACCELERATED GASTRIC EMPTYING
Melissas et al. Obesity Surgery 2007; 17.57.62
MECHANISM?
• Smaller volume capacity (less caloric
intake)
• Faster gastric emptying (earlier release
of GLP-1 and PYY? HindGut Theory?
• Decreased serum Ghrelin
• Higher and earlier Vagal stimulation
(Increased satiety)
• Other
EFFECTIVENESS ON CO-MORBIDITIES
• 42 patients had LSG 10-02 and 12-04
• 60% of major co-morbidities resolved, 24% improved
• Sleep apnea 56% resolution
• Diabetes 53% resolution
• Hypertension 67% resolution
Silecchia et at. Obesity Surgery 2005; 15(7):949
CO-MORBIDITIES AND LSGCo- Morbidity No. Of
patients6 months 12 months
Resolved (%)
Improved (%)
Resolved (%)
Improved (%)
Hypertension 12 16.6 83.3 66.6 33.3
Sleep Apnoea 10 100 -- -- --
Fatty Liver 38 -- -- -- --
Dyslipidemia 23 -- 60.86 -- 86.9
Osteoarthritis 14 -- 71.4 -- 71.4
Diabetes 30 -- 80 30 70
GERD 2 100 -- -- --
Asthma 8 -- 100 -- 100
Depression 1 100 -- -- --
GASTRIC BYPASS PROCEDURES
A small (10-30 ml) gastric pouch is anostomosed to a Roux limb of Jejunum. Increasing the length of the Roux limb increasesMalabsorption and weight loss.
LONG-TERM EFFECT OF GASTRIC BYPASS
SURGERY ON BODY WEIGHT
Pories et al.Ann Surg. 1995;222:339.
RELATIONSHIP BETWEEN SURGICAL EXPERIENCE AND PERIOPERATIVE MORTALITY IN GASTRIC BYPASS
SURGERY
BILIOPANCREATIC DIVERSION WITH DUODENAL SWITCH
• Sleeve Gastrectomy with rerouting of small intestine through nutrient limb and biliopancreatic limb.
• Digestion and absorption are limited to 100cm “common channel” of terminal ileum.
• Causes marked weight loss but can lead to significant nutritional deficicies.
Marceau P et al Wold J Sur.1998 2247;54
Effect of Different Bariatric Surgical Procedures on weight loss
Procedure
1. Laparoscopic gastric banding
2. Sleeve Gastrectomy
3. Gastric bypass procedure
4. Biliopancreatic diversion with duodenal switch
ApproximateLoss of Excess Weight
(%)
45-65
55-65
60-75
Klein et at. Gstroenterology;2002.123:882-932
ADVANTAGES
• Type 2 diabetes
• Hypertension
• Obstructive sleep apnea
• Obesity hypoventilation
• GERD
• NALD, NASH
• Pseudo tumor cerebri
• Depression
• Dysilipidemias
• Coronary artery disease
• Cardiac dysfunction
• Venous stasis disease
• Polycystic ovary syndrome
• Infertility
• Cancers
• Degenerative joint disease
• Quality of life
Major Obesity-related Co-morbidities that have
been improved by Bariatric Surgery
Long-term Survival: Canada
Christou et al. Ann Surg 2004;240:416-424
Endoscopic Bariatric procedures
CONCLUSION
Various surgical options are available to treat morbid obesity. Surgery sustains the weight loss for longer period of time. Metabolic complications related to obesity are resolved or improved. Like all other tharapies weight loss surgery should be combined with a change in dietary habits and Life style.
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