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Bariatric Treatment in India
Bariatric surgery, also referred to as weight loss surgery, is the procedure done for those people who are severely obese. Obesity is a chronic disorder that can lead to other health problems such as diabetes, high blood pressure, and obstructive sleep apnea. Because obesity can affect many organs, it may be difficult to treat. When other medically supervised methods of weight loss have failed, weight-loss surgery can be an effective way to lose weight and maintain that weight loss.Bariatric surgery (weight loss surgery) includes a variety of procedures performed on people who have obesity. Weight loss is achieved by reducing the size of the stomach with a gastric band or through removal of a portion of the stomach (sleeve gastrectomy or biliopancreatic diversion with duodenal switch) or by resecting and re-routing the small intestine to a small stomach pouch (gastric bypass surgery).

Who should consider Bariatric Surgery

You may be a candidate for weight loss surgery if:

  • You’re an obese adult, especially if you have a weight-related condition, such as type 2 diabetes.
  • You know the risks and benefits.
  • You’re ready to adjust how you eat after the surgery.
  • You’re committed to making lifestyle changes to keep the weight off.
  • You have a Body Mass Index (BMI) of over 40.
  • You have a BMI of over 35 and are experiencing severe negative health effects, such as high blood pressure or diabetes, related to being severely overweight.
  • You are unable to achieve a healthy body weight for a sustained period of time, even through medically-supervised dieting.

Types of Bariatric Surgery

Roux-en-Y Gastric Bypass

Gastric bypass is the current “gold standard” procedure for weight-loss surgery. A small stomach pouch is created using a surgical stapler. The remainder of the stomach is not removed, but is stapled shut. The pouch restricts food intake so you’re only able to eat small amounts of food at one time. The small intestine is divided and one end is raised and attached to the stomach pouch in a procedure called a gastrojejunostomy. The other end of the small intestine, still connected to the stomach remnant, is reconnected to another portion of the intestinal tract in a procedure called a jejunojejunostom

Advantages

  • Average weight loss is 70 to 80 percent of your excess body weight.
  • Average weight loss is greater than the average achieved by sleeve gastrectomy and gastric band surgery.
  • Studies show that gastric bypass surgery alters the metabolism of carbohydrates and increases insulin sensitivity, often eliminating the need for diabetes medications.
  • Medical conditions related to obesity — such as acid reflux, high cholesterol and high blood pressure, and sleep apnea — are improved or eliminated after surgery.

Disadvantages

  • Absorption of iron and calcium is decreased because the duodenum, or first part of the small intestine, is bypassed. Deficiencies of these minerals can lead to anemia and bone disease so you must take vitamins and other supplements.
  • Vitamin B12 supplements must be taken to prevent a deficiency.
  • A condition known as “dumping syndrome” can occur after eating too quickly or after eating foods high in refined sugars or carbohydrates or high in fat. Symptoms include nausea, skaing, sweating, light headedness, flushing and fast heart rate.
  • In some cases, the procedure’s effectiveness may lessen if the stomach pouch is stretched or if it is initially left larger than 15 to 30 cubic centimeters.
  • The bypassed portion of the stomach, duodenum and segments of the small intestine cannot be easily visualized using X-ray or endoscopy if problems such as ulcers, bleeding or cancer occur.

Adjustable Gastric Band

In this procedure, a band is placed around the upper part of your stomach, creating a small pouch that restricts food intake and creates a sense of being full after very small meals. The band can be adjusted to make the pouch outlet smaller or larger by injecting fluid into the band. A small “port” is implanted beneath the skin, and is connected to a catheter for the flow of fluid that adjusts the band.

Advantages

  • No stapling, cutting or removal of stomach tissue.
  • Slightly shorter recovery period.
  • Band is adjustable, allowing your surgeon to control the size of your pouch outlet.
  • If the band is removed, the stomach usually returns to its original form.

Disadvantages

  • On average, less weight loss than sleeve gastrectomy or gastric bypass.
  • Risk of band sllippage or erosion, which requires an additional operation to remove the band.
  • Risk of mechanical failure, such as port or tube leaking.
  • Follow-up adjustments required to the band and must be made by inserting a needle into the port.

Sleeve Gastrectomy

This operation involves only your stomach. A small sleeve, or narrow pouch, is created using a surgical stapler to separate the stomach. After the sleeve is created, the rest of the stomach — about two-thirds of the stomach — is removed. The sleeve creates a feeling of being full faster and decreases appetite. Only small amounts of food can pass through the sleeve at one time

Advantages

  • No foreign body implanted.
  • No rerouting of the intestinal tract.
  • Average weight loss is greater than gastric band, but slightly less than gastric bypass.

Disadvantages

  • Less long-term data available on the outcomes of sleeve gastrectomy.
  • Risk of leaking at the staple line of the stomach.

Laparoscopic or Minimally Invasive Surgery

Laparoscopic, or minimally invasive, surgery is a technique that involves a small video camera inserted into the abdomen. through several small incisions. The surgeon views images generated by the camera in the abdomen on a video monitor in the operating room. Laparoscopic surgery is considered minimally invasive because it replaces the need for one long incision to open the abdomen. Studies show that patients who undergp laparoscopic weight-loss surgery experience less pain after surgery, resulting in easier breathing and lung function.

Other benefits of laparoscopy are fewer wound complications, such as infection or hernia. In addition, patients typically return more quickly to their normal activities after surgery.

Cost of Bariatric Surgery

India has the best medical facility and latest technology offering cost-effective Bariatric surgery. Specialized medical and diet plans are prescribed for long term effective results. Contact us to receive the best quote and treatment.

Gastric Banding (Lap Band Surgery) in India

The gastric banding procedure is one of the least invasive approaches for treating obesity. The surgeon uses laparoscopy (which involves small cuts in the belly) to place an adjustable silicone band around the upper part of the stomach. Squeezed by the silicone band, the stomach becomes a pouch with about an inch-wide outlet. After banding, the stomach can hold only about an ounce of food.

A plastic tube runs from the silicone band to a device just under the skin. Saline (sterile salt water) can be injected or removed through the skin, flowing into or out of the silicone band. Injecting saline fills the band and makes it tighter. In this way, the band can be tightened or loosened as needed to reduce side effects and improve weight loss.

Who should consider Gastric Banding

  • Candidates who have been overweight for more than 5 years.
  • Candidates who have a BMI (Body mass index) of 40 or higher.
  • Candidates who have made serious attempts to lose weight but had only short-term success.
  • Candidates who weigh at least 100 pounds more than their ideal weight.
  • Candidates who weigh at least twice their ideal weight

Benefits of Gastric Banding

Minimal Trauma

  • Least invasive surgical option
  • No intestinal re-routing
  • No cutting or stapling of the stomach wall or bowel
  • Small incisions and minimal scarring
  • Reduced patient pain, length of hospital stay and recovery period

Fewer Risks and Side Effects

  • 10 times less operative and short-term mortality than gastric bypass1
  • Low risk of nutritional deficiencies associated with gastric bypass
  • Reduced risk of hair loss
  • No “dumping syndrome” related to dietary intake restrictions

Adjustable and Reversible

  • Allows individualized degree of restriction for ideal rate of weight-loss
  • Adjustments performed without additional surgery
  • Supports pregnancy by allowing stomach outlet size to be opened to accommodate increased nutritional needs
  • Only surgical option designed to help maintain long-term weight loss
  • Removable at any time
  • Stomach and other anatomy are generally restored to their original forms and functions

Effective Long-Term Weight Loss

  • More than 550,000 Lap-band® devices placed worldwide
  • Standard of care for hundreds of surgeons around the world
  • #1 selling adjustable gastric band for weight loss
  • Academic publications with up to 10 years of follow-up

Adjustable Gastric Banding

Once placed around the stomach, tubing connects the band to an access port fixed beneath the skin of your abdomen. This allows the surgeon to change the stomach size by adding or subtracting saline or salt water, inside the inner balloon through the access port. This adjustment process helps determine the rate of weight loss. If the band is too loose and weight loss is inadequate, adding more saline can reduce the size of the stoma to further restrict the amount of food that can move through it. If the band is too tight, the surgeon will remove some saline to loosen the band and reduce the amount of restriction. The diameter of the band can be modified to meet your individual needs, which can change as you lose weight. For example, pregnant patients can expand their band to accommodate a growing fetus, while patients who aren’t experiencing significant weight loss can have their bands tightened.
LAGB (Laparoscopic adjustable gastric banding)

 

It is is the minimally invasive procedure for obesity.The surgery is done using a tiny camera that is placed in your belly. This type of surgery is called laparoscopy. The camera is called a laparoscope. It allows your surgeon to see inside your belly. In this surgery:

  • Your surgeon will make 1 to 5 small surgical cuts in your abdomen. Through these small cuts, the surgeon will place a camera and the instruments needed to perform the surgery.
  • Your surgeon will place a band around the upper part of your stomach to separate it from the lower part. This creates a small pouch that has a narrow opening that goes into the larger, lower part of your stomach.
  • The surgery does not involve any cutting or stapling inside your belly.
  • Your surgery may take only 30 to 60 minutes if your surgeon has done a lot of these procedures.

When you eat after having this surgery, the small pouch will fill up quickly. You will feel full after eating just a small amount of food. The food in the small upper pouch will slowly empty into the main part of your stomach.

Gastric Band Hypnotherapy

Gastric band hypnotherapy is a procedure used to suggest to the subconscious that you have had a gastric band fitted around your stomach. Many people report feeling fuller quicker after the procedure, as if their stomach has really been constricted.

Considered a last resort for people who are morbidly obese, gastric band surgery involves fitting a band around the upper part of the stomach. This limits the amount of food the person can eat, helping them to lose excess weight. This intervention is a surgical one and comes with potential risks and complications.

Gastric band hypnotherapy or having a ‘virtual gastric band’ fitted does not require surgery. It is a technique used by hypnotherapists to get the unconscious mind to believe it has had a gastric band fitted. The aim is that on an unconscious level, you will accept that you have had the procedure and that your stomach has reduced in size.

The process doesn’t involve surgery or medication and is completely safe.

Vertical Gastric Banding

Vertical gastric banding, also referred to as sleeve Gastroplasty and stomach stapling, is a procedure where the amount of food consumed is decreased so that a person feels full before consuming more food. This restrictive weight loss surgery joins every aspect of gastric banding and stomach stapling procedure. Vertical banded gastroplasty (VBG) also involves a plastic band placed around the stomach. In addition, the surgeon staples the stomach above the band into a small pouch. Vertical banded gastroplasty is a restrictive bariatric surgery which uses a combination of non-adjustable bands and staples to create a stomach pouch that can hold only a limited amount of food without having to alter the normal digestive process. The goal of the surgery is to lose weight by making you feel full more quickly with less food, thereby limiting your calorie intake. The success of this procedure can only be achieved if the patient is intended to make radical changes in their lifestyle and food intake.

Cost of Gastric Banding

Compared to Europe and America, the cost of Gastric Banding in India is substantially lower due to its excellent health care facilities. A large number of patients travel from across the world as India has some of the best weight loss clinics in the world.

Gastric Bypass Surgery Diet in India

he aim of Bariatric surgery is to limit the consumption of food in order to facilitate the process of weight reduction. It is very essential to follow proper diet guidelines and lifestyle changes for achieving the maximum benefits. It is essential to minimize hair loss problem and to maintain hydration, skin elasticity and also lean body mass. These balanced meals help in preserving the muscle tissue and also prevents different nutrient deficiencies.

Benefit of Gastric Bypass Diet

  • It allows a patient to eat small amounts of food that can be easily digested.
  • A proper diet helps in eliminating all complications and side effects.
  • To allow the staple line in the stomach to heal without getting expanded by the food eaten.
  • To help lose weight and avoid gaining excess weight.

Diet Progression after Gastric Bypass Surgery

Your smaller stomach after gastric bypass surgery will lead to a couple of important changes in your diet:

  1. You will feel full much sooner than you did before
  2. If you eat too quickly, you may have difficulty swallowing. This is the result of food backing up into the esophagus after the stomach pouch has been filled. To avoid this, chew your food thoroughly, eat slowly and eat foods that are more easily digested. This should get better as your pouch stretches over time.

Diet Regime in the Hospital

A patient is required to follow a specific diet post surgery. The patient will be given broth, juices and Jell-O which are high in sugar content. The food portions after the surgery will be very small and the amount will be gradually increased after a patient gets the power to tolerate it.

Post-Op Dietary Guidelines

Once gastric bypass surgery is complete, a strict post-op diet plan needs to be followed. There is now a staple line in your stomach that must be allowed to heal. Certain foods can disrupt the healing process, put undue stress on the staple line, and lead to a leak.

The diet for a post-op gastric bypass patient consists of four stages:

Diet for First Two Weeks After the Surgery

For 1 to 7 days after gastric bypass surgery, only clear liquids are to be consumed at the rate of one to two ounces per hour. The patient’s dietician will decide how long this phase will last and suggest dietary guidelines.

Clear liquids recommended by the dietitian will probably include the following items:

  • water
  • fat-free milk
  • fat-free broth
  • sugar-free jello
  • Low-fat cottage cheese
  • Refined hot cereals that are low in fiber like cream of wheat or rice. Add extra liquid for creating a soup-like consistency
  • Optional low-calorie or high-protein liquid supplement drinks
  • Soy-based or lactose-free low-calorie drinks
  • Low-fat soups or blended broth-based soup
  • Also do not eat oatmeal

Diet for 2-4 Weeks Post Surgery

After 1 to 7 days of drinking clear liquids, you will be given permission to consume liquefied sources of protein. This stage of the post-op diet will usually last for one week (occasionally 2).

Because of the patient’s smaller stomach size, the individual should have several smaller meals throughout the day. Your daily intake should be about 60-70 grams of protein (protein shakes, egg whites, pureed meat/fish) and approximately 64 ounces (about 8 glasses) of clear liquids (as defined in stage one) not counting the fluid in the pureed foods.

Caffeinated and carbonated beverages should be not be consumed. Refined sugars and simple carbohydrates (including sugar alcohol) should be avoided as well.

Below is a list of the pureed protein sources that are typically allowed by the patient’s dietitian or surgeon:

  • Protein shakes
  • Egg whites
  • Non-fat soft cheese
  • Non-fat cottage cheese
  • Tofu
  • Hot cereals
  • Applesauce
  • Noodles
  • Yogurt
  • Mashed potatoes
  • Lean fish
  • Cottage cheese
  • Lean ground meats or poultry
  • Well-cooked, puréed vegetables

These food substances should be pureed with water, fat-free milk, or fat-free broth. Clear liquids (water) should not be consumed at the same time as the pureed foods. As a general guideline, it is usually suggested that the patient not drink any clear liquid 30 minutes before a meal and 60 minutes after a meal

Meal Plan for 6 Months After Surgery and Beyond

  • Patients should avoid eating dried fruits, popcorn, raw vegetables, red and nut meats, breads and fresh fruits with skin.
  • High-protein liquid supplement drinks should be discontinued
  • 900-1000 calories should be consumed in a day
  • Increase the variety of low-calorie, low-fat and low-sugar foods
  • Eat only 2-3 snacks per day and also decrease to 3 meals in a day

Specific Guidelines After Gastric Bypass Surgery

  • Introduce one new food at a time; ideally not more than one new food a day so you can gauge your body’s reaction.
  • Eat slowly. Chew your food well, 15 seconds each bite. Use the timer on the Baritastic app.
  • Separate your food and water by at least 30 minutes.
  • Continue to drink at least 64 ounces of water a day.
  • Eat your protein first, vegetables second and carbohydrates third (ideally healthy grains and/or fruits, not processed foods).
  • Eat real nutrient dense foods. Stay away from pre-packaged and processed foods with a lot of ingredients.
  • Read labels. Focus on foods low in carbohydrates and a calorie to protein ratio of 10 to 1 or less (add a zero to the grams of protein and if the total calories are more than that then you may want to avoid that food – particularly if you are struggling to reach your protein goals).
  • The daily calorie intake should be in between 300-600 for the first two months.
  • Avoid eating fresh fruits, meats, bread, raw vegetables and rice. On the other hand, ground meats are generally better tolerated.

Protein Diet

Recommendations for the protein sources in this stage of the diet will probably include several of the following items:

Meat, Dairy, and Eggs

  • lean chicken
  • lean turkey
  • fish
  • egg whites
  • non-fat cottage cheese
  • non-fat cheese
  • tofu

Vegetables

  • potatoes
  • carrots
  • green beans
  • tomatoes
  • squash
  • cucumbers
  • bananas
  • avocados

Supplements Required

In order to avoid any kind of nutrient deficiency, a patient must take different supplements. It is required to cut the pills into 6-8 small pieces. Whole pills cannot pass easily from the new anatomy.

Calcium Supplement : A daily requirement of calcium is 1,200-2,00 mg so as to avoid any bone disease and calcium deficiency. It is important to divide calcium doses into 2-3 parts of the entire day.

Vitamin B12 Supplement : It is essential to take 500 mg of vitamin B every day.

Multivitamins : It is required to take high-potency daily chewable mineral and multivitamin supplement containing minimum of 400 mcg of folic acid, zinc, copper, 18 mg of iron and selenium.

Vitamin D Supplement : It is essential to take vitamin D with a quantity of 800-1,000 IUs (International Units) per day. The entire amount should be into different doses of 400-500 IUs twice a day.

Other Supplements : Additional supplements may be required for some patients that include iron or folic acid supplements. These supplements are especially for women who are still menstruating.

if You Don’t Take Your Bariatric Vitamins As Prescribed

  • Calcium deficiency – leads to osteoporosis.
  • Iron deficiency – can cause anemia (when your body does not have enough red blood cells to carry oxygen throughout the body), increased feelings of fatigue and hair loss
  • Folate (folic acid) deficiency – can also lead to anemia.
  • Protein deficiency – protein is one of the most important components of your body as it makes up most of your major organs. Not getting enough can lead to a myriad of problems, including muscle deterioration, organ failure, gallstones and even death.
  • Thiamin (Vitamin B1) deficiency – affects the heart, digestive system and nervous system. If not caught and treated quickly, learning and memory could be permanently affected. Ultimately, coma and death could be the result.
  • Vitamin A deficiency – can lead to night blindness and increases the risk of disease and death from severe infections. During pregnancy after weight loss surgery, it increases the risk of night blindness and child mortality.
  • Vitamin B12 deficiency –can cause fatigue and tingling in the hands and can eventually lead to anemia and neurological disorders
  • Vitamin D deficiency – can lead to liver and kidney disorders and bone softening diseases.
  • Vitamin E deficiency – causes neurological problems, anemia and can cause wounds to heal more slowly.
  • Vitamin K deficiency – increases the risk of osteoporosis and heart disease and can cause you to bruise more easily.
  • Zinc deficiency – will give you brittle nails and can lead to hair loss.

The only way to catch some of the above deficiencies is through regular blood tests. Symptoms that start to show are often confused with other bariatric surgery side effects, and even a physical exam from your doctor may not be enough for a diagnosis.

In short, take bariatric vitamins very seriously. If you’re not prepared stick to a strict regimen forever, don’t move forward with surgery.

Gastric Bypass in India

Gastric bypass surgery refers to a surgical procedure in which the stomach is divided into a small upper pouch and a much larger lower “remnant” pouch and then the small intestine is rearranged to connect to both. Gastric bypass surgery makes the stomach smaller and causes food to bypass part of the small intestine. You will feel full more quickly than when your stomach was its original size. This reduces the amount of food you can eat at one time. Bypassing part of the intestine reduces how much food and nutrients are absorbed. The procedure can improve the overall quality of life not only in terms of appearance but also reduce a number of health problems that overweight people are prone to suffer like heart problems and diabetes.

Types of Gastric Bypass Surgery

Four common types of weight-loss surgery are

Roux-en-Y gastric bypass

In Roux-en-Y gastric bypass, the surgeon creates a small pouch at the top of the stomach. The pouch is the only part of the stomach that receives food. This greatly limits the amount that you can comfortably eat and drink at one time.

The small intestine is then cut a short distance below the main stomach and connected to the new pouch. Food flows directly from the pouch into this part of the intestine. The main part of the stomach, however, continues to make digestive juices. The portion of the intestine still attached to the main stomach is reattached farther down. This allows the digestive juices to flow to the small intestine. Because food now bypasses a portion of the small intestine, fewer nutrients and calories are absorbed.

Laparoscopic adjustable gastric banding

In the laparoscopic adjustable gastric banding procedure, a band containing an inflatable balloon is placed around the upper part of the stomach and fixed in place. This creates a small stomach pouch above the band with a very narrow opening to the rest of the stomach.

A port is then placed under the skin of the abdomen. A tube connects the port to the band. By injecting or removing fluid through the port, the balloon can be inflated or deflated to adjust the size of the band. Gastric banding restricts the amount of food that your stomach can hold, so you feel full sooner, but it doesn’t reduce the absorption of calories and nutrients.

Sleeve gastrectomy

In a sleeve gastrectomy, part of the stomach is separated and removed from the body. The remaining section of the stomach is formed into a tubelike structure. This smaller stomach cannot hold as much food. It also produces less of the appetite-regulating hormone ghrelin, which may lessen your desire to eat. However, sleeve gastrectomy does not affect the absorption of calories and nutrients in the intestines.

Benefits of Sleeve Gastrectomy

  • The procedure can be performed laparoscopically.
  • The procedure increases the feeling of fullness and reduces the volume of the stomach.
  • The procedure is simpler than gastric bypass.
  • Allows normal functioning of the stomach and the food is eaten in smaller quantities.
  • The surgery involves less operative time.
  • There is a comparatively less stay in the hospital as compared to bypass surgeries.
  • The Ghrelin hormone is removed.
  • There is no use of foreign bodies as compared to bypass surgeries.
  • It does not require an intestinal bypass.
  • There is no dumping syndrome due to the pyloric portion of the stomach is left intact

Biliopancreatic diversion with duodenal switch

As with sleeve gastrectomy, this procedure begins with the surgeon removing a large part of the stomach. The valve that releases food to the small intestine is left, along with the first part of the small intestine, called the duodenum.

The surgeon then closes off the middle section of the intestine and attaches the last part directly to the duodenum. This is the duodenal switch.

The separated section of the intestine isn’t removed from the body. Instead, it’s reattached to the end of the intestine, allowing bile and pancreatic digestive juices to flow into this part of the intestine. This is the biliopancreatic diversion.

As a result of these changes, food bypasses most of the small intestine, limiting the absorption of calories and nutrients. This, together with the smaller size of the stomach, leads to weight loss.

Who should consider Gastric Bypass Surgery ?

  • Candidates who have a BMI (Body Mass Index) of 40 or more.
  • Candidates who weigh 100 pounds or more than their ideal body weight.
  • Candidates who have serious health problems of heart disease and diabetes due to excess weight and who have a BMI of 35 or more.

Procedure for Gastric Bypass Surgery

  • The procedure is performed under general anesthesia.
  • The procedure begins by making the stomach smaller. Staples are used for dividing the stomach into two sections- a larger bottom section and a small upper section. Pouch (top section) is that part where the food eaten is stored. This pouch can hold around one ounce of food and is of walnut shape.
  • A bypass is the next step. The small part of the small intestine is connected to a small hole in the pouch. The food will travel from this top section of the stomach (pouch) into the small intestine. Due to this entire process, the food will absorb less calories.

Mini Gastric Bypass Surgery

As the name suggests, mini gastric bypass surgery is a simplified form of Roux-en-Y gastric bypass surgery (RNY). A thorough review of the studies that specifically evaluated the effectiveness of MGBP shows that the procedure is shorter, easier, less expensive and has lower risk and equally successful outcomes as RNY .The mini-gastric bypass procedure is restrictive and malabsorptive. This means that the procedure reduces the size of your stomach, restricting the amount you can eat. The procedure also reduces absorption of food by bypassing up to 6 feet of intestines. Gastric bypass and the mini-gastric bypass are both malabsorptive and restrictive procedures. Gastric sleeve and the Lap Band are restrictive procedures. Mini-gastric bypass is a quicker operation compared to traditional laparoscopic gastric bypass surgery. Operating times are reduced, on average by 50 minutes.

Procedure for Mini Gastric Bypass Surgery (MGBP)

  • The stomach is divided with a laparoscopic stapler. Most of the stomach is no longer attached to the esophagus and will no longer receive food. Your new stomach is much smaller and shaped like a small tube.
  • Between 2 to 7 feet of intestines are bypassed. The surgeon will attach the remainder of the intestines to the new stomach.
  • Food now flows into your small tub-like stomach and then bypasses between 2 to 7 feet of intestines where it resumes the normal digestive process in you’re the remaining intestine.

Benefits of Mini Gastric Bypass Surgery (MGBP)

  • Shorter operating time.
  • Less re-routing of the intestines.
  • One fewer anastomosis (connection of intestines), which in theory means less chance of a complication..
  • Similar weight loss and recovery.
  • High success rate up to 70%

Cost of Gastric Bypass Surgery

The cost of the gastric bypass surgery in India is the lowest as compared to other countires around the world. The surgeries  are performed by well trained surgeons in the clinics having latest medical facilities.

Laparoscopic Sleeve Gastrectomy in India

Gastric sleeve surgery, also known as the sleeve gastrectomy, Gastric Sleeve Resection, Laparoscopic, Vertical Sleeve Gastrectomy and Tube Gastrectomy has become a popular choice for patients seeking excellent weight loss in a straightforward procedure that doesn’t require the maintenance and long-term complication rates of a Lap Band. The surgery also removes the hormone Ghrelin which is responsible for causing hunger.  Super Obese individuals (people with a Body Mass Index over 45) have an increased risk during any surgery. And the longer the time under anesthesia, the greater the risk. Gastric bypass surgery can last over 2 hours. Duodenal switch surgery often takes over 4 hours. That’s a long time to be under anesthesia.So surgeons started breaking the procedure up into two stages. The first stage was to reduce the size of the stomach. The second stage would be done a year later after the patient lost some weight. The second stage of the procedure would include bypassing some of the intestines to reduce calorie absorption. Studies like this one started to emerge (Randomized clinical trial of laparoscopic Roux-en-Y gastric bypass versus laparoscopic sleeve gastrectomy for the management of patients with BMI < 50 kg/m2). Complication rates were low and weight loss was as good, if not better, than gastric bypass. And because the surgery took less time and was less complicated to perform. In the first year after surgery, the patient can lose about 45-55 % of excess weight.

Who should consider Laparoscopic Sleeve Gastrectomy Surgery

  • Candidates should have a BMI (Body Mass Index) of 40 or more.

Candidates having a BMI in between 35-39  are also eligible for this surgery who have obesity-related conditions such as high cholesterol, diabetes and high blood pressure.

Benefits of Gastric Sleeve Surgery.

Gastric sleeve surgery has the benefits below:

  • May reduce hunger.
  • The hunger inducing hormone ghrelin is reduced by removing a portion of the stomach largely responsible for its production.
  • Reduction of hunger occurs in most patients but not all.
  • Shorter operating time compared to gastric bypass.
  • Does not re-route intestines.
  • No dumping syndrome.
  • While dumping syndrome can be a tool to reinforce good eating habits, it’s very unpleasant.
  • The pylorus remains intact and sugars have time to digest since the intestines remain untouched.
  • No adjustments are needed. The Lap Band requires regular adjustments (doctor visits).
  • No foreign objects are left in the body. The Lap Band leaves a silicone band around the upper portion of your stomach.
  • Weight loss occurs over 18 months.
  • Gastric bypass weight loss is very quick. The majority of weight loss occurs in the first year.
  • Lap Band is gradual and requires major lifestyle changes for success. The majority of weight loss occurs over 3 years.

Recovery after Laparoscopic Sleeve Gastrectomy

Recovery from gastric sleeve surgery is painful for some and ‘not too bad’ for others. Each person experiences pain differently and different pain medications work better than others for different individuals.

Some sleeve procedures are outpatient (you can leave the same day as your procedure) and many require 1 or 2 days in the hospital to recover. Some surgeons prefer 3 days while others are comfortable letting you leave the day after surgery.

Below are some general guidelines after you are discharged from the hospital. You should have more specific guidelines to follow in your discharge instructions or post-op manual.

  • Sip your liquids constantly.
  • It’s easy to become dehydrated. You aren’t getting any liquids from food your first week post-op. Sip slowly, but makes sure you drink plenty.
  • Bowel movements
  • Bowel movements may be difficult or painful. This is normal.
  • However, don’t hesitate to call your surgeon if you are having issues.
  • Constipation is normal the first week post-operative. Your pain medications can increase constipation.
  • Medications
  •  Take your pain medication when you need them.
  • You may receive a prescription for Protonix to decrease the acidity in your stomach. This helps with heartburn and may reduce pressure on your healing pouch.
  • Unless otherwise advised by your surgeon, you can resume taking your medications. All non-time-released medications will likely need to be crushed. Any medication that is time-released should be switched, if possible, to non-time released. Do not crush time-released medications. Ask your doctor about your diabetes medication.
  • Activity
  • Walk, walk, walk.
  • Walk as much as you can. This helps the healing process and starts you on the path to include exercise daily.
  • Don’t lift anything heavy. This can put undue pressure on your stitches and torso which will be sore.
  • You will feel fatigued and tired for up to a month after surgery.
  • This is due to the reduced calorie consumption. Your body is adjusting.
  • Showering & Bathing
  • Don’t bathe or sit in a hot tub for the first 3 weeks after surgery.
  • Showering is typically OK.
  • Going back to work.
  • You can typically return in 2 to 4 weeks depending on the physicality of your job.
  • Most people return after 4 to 6 weeks at full strength.
      Diet After Gastric Sleeve Surgery

Your post-op diet greatly depends on how far out you are from surgery. The stages below are typical recommendations after gastric sleeve surgery. For a more detailed look what you can and can’t eat after surgery, we recommend this article.

Stage 1 – The first week after surgery

  • Clear liquids only. These include:
  • Water
  • Decaf Tea
  • Sugar-free Posicles
  • Broth

Stage 2 – Week 2

  • Full liquid diet with protein shakes.

Stage 3 – Week 3

  • Soft-pureed foods. These include:
  • Soups
  • Scrambled Eggs
  • Cottage Cheese

Stage 4 – Week 4

  • Soft foods.
  • Boiled chicken.
  • Fish
  • Cereal
  • Mashed potatoes.

Stage 5 – Week 5 and beyond

  • Introducing real foods.
  • Introduce small amounts of foods.
  • Chew well and eat slowly.
  • Eat 3 small meals a day.
  • Eat a small, healthy, nutrient dense food as a snack if needed.
  • Get your protein but don’t forget vegetables and fruit.

Daily Vitamins & Supplements

You’ll need to ensure you are getting enough vitamins after gastric sleeve surgery

A decent option for a non-bariatric specific multivitamin is below:

  • Centrum Adult Daily Chewable – you can find this at your local pharmacy Iron – Iron may be recommended. It’s important to talk to your doctor and follow his or her recommednation.
  • Check with your surgeon when to start iron post-operatively.
  • Take on an empty stomach.
  • Ferrous Fumarate 29mg – NOT the more typical ferrous sulfate (ferrous sulfate is not absorbed well after bariatric surgery).
  • Do not take with your Calcium Citrate.

Calcium Citrate – Taken 3 times daily.

  • Begin 1 month after surgery.
  • Liquid or chewable form and should be taken in 500 mg doses with at least one hour in between doses.
  • Do NOT take Calcium at the same time as Iron.
  • Wait at least 2 hours between taking your multivitamin/iron and your calcium.
  • 1500 to 2000 mg daily.

Vitamin B12 – May be recommended. Check with your doctor.

  • Typically taken once per week.
  • 5000 to 7500 mcg.
  • Available in sublingual (under the tongue), injection, or nasal spray.
  • Should NOT be taken in pill form after surgery.

Protein Supplements

Protein is important after gastric sleeve surgery. It’s recommended that you get at least 60 grams of protein per day after surgery.

Duodenal Switch Surgery

Duodenal switch surgery is a combination of a gastric sleeve and gastric bypass surgery. It is one of the more rare primary treatments for morbid obesity The procedure can reduce the number of calorie intake as well as the quantity of food. It unites the formation of a moderately sized stomach pouch through bypassing a part of the small intestine. As a result of this, a patient loses weight without making changes to their eating habits. In this procedure, the stomach can hold 5-6 ounces of food as compared with other procedures that can hold 1 half to 1 full ounce.. The procedure is occasionally done as a secondary procedure after a failed gastric band surgery. You will lose weight. It may reduce hunger. You may have nutritional deficiencies.

Stomach Stapling Surgery

This type of procedure is meant for severely obese people who have made countless unsuccessful  efforts in order to reduce their weight such as dieting, proper eating plans and regular physical exercise. The candidates for this procedure are those who have a BMI (Body Mass Index) of 40. Sometimes this surgery is the only option for morbid obesity. This procedure can also be combined with a malabsorptive operation where the food is diverted from the stomach that passed much of the small intestine. This leads to rapid weight loss.

Cost of Laparoscopic Sleeve Gastrectomy

The cost of Laparoscopic Sleeve Gastrectomy in India is substantially  as Compared to the surgical costs in Europe and America lower  due to its excellent health care facilities.

Duodenal Switch in India
Duodenal switch surgery is a combination of a gastric sleeve and gastric bypass surgery. It is one of the more rare primary treatments for morbid obesity. Duodenal switch, also known as biliopancreatic diversion with duodenal switch, or vertical gastrectomy, is an effective weight loss procedure. This procedure provides long-term weight loss for those people who are severely obese. The procedure is occasionally done as a secondary procedure after a failed gastric band surgery.

  • You will lose weight.
  • It may reduce hunger.
  • You may have nutritional deficiencies.
  • You will have to take vitamins for the rest of your life.
  • You will not get dumping syndrome if you eat sugar like a gastric bypass.
  • Many bariatric surgeons do not offer this procedure.
  • It can require more than 6 hours of operating time.
  • You will have to change your diet to get enough healthy calorie foods.
  • You will likely improve or cure most or all of your obesity related comorbidities

Candidates for Duodenal Switch

  • Insulin-dependent diabetic or poorly controlled diabetic has the highest cure rate with duodenal switch.
  • Candidates who have severe diabetes or has BMI (Body Mass Index) of 60 kg/m2

Procedure of Duodenal Switch

Duodenal Switches are done by stapling about 70% of the stomach off and leaving the rest of the stomach connected as it normally does to the first part of the intestine (the duodenum). Then before the intestine reach the appendix the intestine is cut and then re-attached at a lower area of the intestine. This prevents the bile and digestive juices to only start processing the food when it gets further down the intestine resulting in less caloric absorption. Because of this longer period between eating and digestion of food, the food passes to the colon faster, and the patient doesn’t process the full amount of calories he or she normally would have.

  • It is both restrictive and malabsorptive.
  • This procedure uses staples to reduce your stomach size to about 30% of its normal size. This limits the amount of food that you can eat in one sitting.
  • Food still passes through the stomach to its normal entry into the intestine. It is then re-routed and reconnected farther down the intestine. This creates significant malabsorption of calories.

Duodenal Switches typically create the longest bypass of the intestine which is why a surgeon must be careful to not bypass too much intestine. Duodenal Switch typically results in more weight loss than other bariatric procedures.

Benefits of Duodenal Switch

Here are some of the benefits of Duodenal Switch Surgery:

Unlike gastric bypass, Duodenal Switch procedure leaves the patient with a larger stomach. This helps the patients to enjoy more satisfying portion sizes. Because of its ability to reduce the body’s need for insulin, this type of surgery is effective for treating Type 2 diabetes. According to some studies, Duodenal Switch surgery is effective in curing Obesity related comorbidities show the following cure rate after DS surgery:

Type 2 Diabetes – 98% cured

Hyperlipidemia – 99% cured

Hypertension – 83% cured

Sleep Apnea – 92% cured

  • Most recipients of the Duodenal Switch procedure experience 60 to 85 percent excess weight loss after 18 months. This is higher than that seen in other weight loss surgeries.
  • The surgery is just a 3-4 hour procedure with a 1-2 night hospital stay.
  • Stomach resection may reduce hunger by eliminating hunger-causing hormones.
  • Recovery time ranges from a few days to several weeks.
  • Approximately 200-400 calories may be lost through malabsorption.
  • Ghrelin (a hunger hormone) is significantly decreased as there is a removal of a large section of the stomach.
  • ·  Duodenal switch is a very effective weight loss procedure for those patients who have a BMI (Body Mass Index) of 50 or more.
  • Pyloric valve is kept intact in order to avoid any incidence of stomal ulcers and dumping syndrome which can happen by gastric bypass surgery.

The Laparoscopic Sleeve Gastrectomy with Duodenal Switch

The Laparoscopic Sleeve Gastrectomy with Duodenal Switch procedure, sometimes known as the Biliopancreatic Diversion with Duodenal Switch, combines restriction (eating less because you feel full more quickly) with malabsorption of fat to give you a very powerful bariatric surgery procedure. The laparoscopic sleeve gastrectomy with duodenal switch combines two bariatric surgeries. First, a sleeve gastrectomy wil be peformed. The new pouch, referred to as the “sleeve”, can hold between 3-5 ounces. This restricts the amount of food that can be eaten at any one time and reduces hunger. Next, the small bowel is rearranged, bypassing a significant portion of the small bowel, which results in malabsorption. This is referred to as the “duodenal switch” portion of the surgery.

The laparoscopic sleeve gastrectomy with duodenal switch results in a dramatic weight loss of 80-85% of excess body weight. This surgery is especially good for people who have a great deal of weight to lose or have significant comorbid conditions requiring quicker resolution. A sleeve gastrectomy patient will now be able to eat a cup of food in three times a day and will feel more full and satisfied after eating small amount of food. A patient will now be able to control his/her cravings and hunger.

Benefits of Sleeve Gastrectomy with Duodenal Switch surgery

Most individuals experience additional health benefits from gastric sleeve surgery. In 95% of patients the quality of life improved and obesity-related health conditions (called “comorbidities”) were resolved or improved. In addition mobility and energy are usually greatly improved.

  • Rapid and large weight loss
  • Quicker resolution of comorbid conditions related to obesity
  • Increased chance of sustained weight loss
  • Patients do not experience dumping syndrome, common with Roux-en-Y gastric bypass surgery, because the pyloric valve between the stomach and small intestine is kept intact
  • It preserves Pyloric Valve which regulates the emptying of the stomach while preserving certain centimeters of the duodenum.

Duodenal Switch Success Rate

A patient who undergoes duodenal switch surgery can expect to lose about 29-37% of excess weight in the first three months.

  • About in 90% of the patients, the condition of sleep apnea has completely disappeared.
  • There could be 51% weight loss in first three months, 55% weight loss in 6 months and 80-90% of weight loss at the end of second year.
  • The problem of hypertension in about 85% of people has completely disappeared.
  • The problem of asthma in about 60% people has completely disappeared.
  • Duodenal switch also helps in resolving about 47% of arthritis issues.
  • This procedure has received 97% success rate in resolving the problem of diabetes.
  • 96% success rate is also achieved in resolving the problem of high cholesterol.

Cost of Duodenal Switch Surgery

India is considered as a preferred healthcare destination for many international patients that offer cost-effective duodenal switch surgery. Low-cost surgeries along with latest medical facilities have attracted many national as well as international patients to India.