Bariatric Surgery

Laparoscopic Gastric Banding

A laparoscopic adjustable gastric band, commonly called a lap-band, A band, or LAGB, is an inflatable silicone device placed around the top portion of the stomach to treat obesity, intended to slow consumption of food and thus reduce the amount of food consumed.

Least invasive among the other bariatric procedures
Technically a reversible procedure ( Removal of band causes weight gain)
Good % of excess weight loss (EWL) (40-50 %)
Does not create any major disturbance in anatomy as in other bariatric procedures
Ideal for young patient who does not want to undergo a Major (Malabsortive) procedure and is ready to exercise
Definite improvements in associated co-morbities

Precautions

To be done with caution in patients who have bread, pasta, refined flour as in Maida
High liquid calorie consumption Alcohols and colas
Older patients unwilling to exercise
Gastric outlet obstruction
Large hiatus hernia
Manometry studies showing esophageal dysmotility

Laparoscopic Roux En Y Gastric Bypass

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.

An excellent procedure for patients with higher BMI, type II diabetes and other morbidities, excellent results in the low BMI type II diabetics
A good procedure for sweet eaters, low volume eaters
Procedure of choice for patients with hiatus hernias
A good procedure for band failures and VBG and sleeve with inadequate weight loss
Excess Weight loss up to 70-80 %

Precautions

Smokers - Risk of ulceration of Gastro - jejunal anastomosis
Patients with inability to take lifelong multivitamin supplements
To be avoided in patients with small bowel conditions like Crohn's disease

Laparoscopic Sleeve Gastrectomy

Sleeve gastrectomy is a surgical weight-loss procedure in which the stomach is reduced to about 10-20% of its original size, by surgical removal of a large portion of the stomach along the greater curvature.

A good effective procedure as a sole choice of procedure in patients who are

Volume eaters
Stomach volume is reduced, but it tends to function normally so most food items can be consumed in small amounts
Eliminates the portion of the stomach that produces the hormones that stimulates hunger (Ghrelin)
No dumping syndrome because the pylorus is preserved
Minimizes the chance of an ulcer occurring
By avoiding the intestinal bypass, the chance of intestinal obstruction (blockage), anemia, osteoporosis, protein deficiency and vitamin deficiency are almost eliminated
Very effective as a first stage procedure for high BMI patients (BMI >55 kg/m2)
Limited results appear promising as a single stage procedure for low BMI patients (BMI 35-45 kg/m2)
Appealing option for people with existing anemia, Crohn's disease and numerous other conditions that make them too high risk for intestinal bypass procedures
Can be done laparoscopically in patients weighing more than 500 pounds

Absolute Contraindications

Gastric outlet obstruction
Large Hiatus Hernia
Manometry showing a lax esophageal sphincter

Disadvantages Of LSG

Potential for inadequate weight loss or weight regain. While true for all procedures, it is theoretically more possible with procedures without intestinal bypass
Higher BMI patients will may need to have a second stage procedure later to help lose all of their excess weight. Two stages may ultimately be safer and more effective than one operation for high BMI patients. This is an active point of discussion for bariatric surgeons
Soft calories from ice cream, milk shakes, etc., can be absorbed and may slow weight loss
This procedure does involve stomach stapling and therefore leaks and other complications related to stapling may occur
Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure
Considered investigational by some surgeons and insurance companies

Intra-Gastric Balloon

The Intra Gastric Balloon is a non-surgical procedure available for weight loss. A soft, expandable, silicone balloon is placed inside the stomach via a camera that enters through the mouth. Once inserted into the stomach, the empty balloon is filled with sterile saline, occupying a large part of the stomach, creating a feeling of fullness.

Placement of the intragastric balloon takes approximately 20 minutes. Because the balloon is inserted and removed in a day clinic and does not involve surgery, it is considered to be a minimally invasive procedure.

The Intra Gastric Balloon is completely reversible, and effective in temporarily reducing hunger, controlling food intake, initiating behavioural change, and achieving target weight loss of 5 to 30 kg.

The Intra Gastric Balloon remains in the stomach for a six-month period, where it is then removed the same way it was placed.

As a one stage procedure for a weight loss of 5-30 kgs in low BMI with or without co-morbidities in patients not warranting any other bariatric surgery
As an initial procedure in the super super obese category BMI > 60 to gain weight loss of 20-40 kgs before planning definitive surgery
As an initial procedure for patients unfit for anesthesia to loose weight
Laparoscopic Foregut surgeries Like Fundoplication, Cardiomyotomy
Laparoscopic Colorectal Surgeries Like Anterior Resection, APR etc.
Laparoscopic Hernia surgeries Like TEP, TAPP, Ventral Hernia repair
Laparoscopic Gynecology surgeries Like TLH etc.
Basic Laparoscopic surgeries like Appendectomy, Cholecystectomy, Diagnostic laparoscopy