Gastroplasty is a surgical procedure performed to decrease the size of the stomach.  This is another procedure that can be performed to reduce weight in obese patients.  In this procedure, the size of the stomach is reduced using stitches by about 60-70% of the existing size.    Gastroplasty aids in reducing weight as the reduced size of the stomach helps hold less volume of food.

Laparoscopic Gastroplasty

In Laparoscopic Gastroplasty, keyhole incisions are made at the abdominal wall to carry out the procedure.  A laparoscope is inserted through one incision and the stomach is stitched.  Laparoscopic Gastroplasty is much superior compared to Endoscopic Sleeve Gastroplasty and Intragastric Balloon as it is possible to do full length stitching of the stomach.  The cost of Laparoscopic Gastroplasty is also less compared to the endoscopic version.

In Sleeve Gastrectomy, part of the stomach is removed.  However, in Gastroplasty, stitches are used to reduce the size of the stomach.  As no cutting is involved, there is less chance of bleeding.  As the stomach is not resected, there is no chance for gastric leak.  It is also less expensive and the duration of anesthesia is also less.  The patient can return early to activities of daily living.  Gastroplasty is also reversible if the patient insists.

Compared to Intragastric Balloon Placement, which is another procedure for weight loss, the results from Gastroplasty are more sustained even after many years.  Intragastric balloon is placed for a period of 12 months, after which the balloon is removed.  The patient may gain weight after the intragastric balloon is removed.  Whereas in Laparoscopic Gastroplasty, the stitches can be retained unless and until the patient insists for removal.  Thus, there is sustained weight loss in Gastroplasty compared to Intragastric Balloon Placement.  Both costs the same only.

The success of all weight loss procedures and Bariatric Surgery also depend on the lifestyle modifications, which the patient has to adhere to.

Advantages

• Sustained results
• No chance of bleeding.
• No cutting involved (Keyhole Surgery)
• No Gastric Leak expected as the stomach is not resected.
• Less Expensive
• Less Duration of Anesthesia.
• Early return to activities of daily living
• Reversible

Other Weight Loss Procedures

There are different weight loss procedures that can be performed.  The doctor may advise the best procedure that suits a person depending on the weight of the patient and other medical conditions.  Other procedures are:

Laparoscopic Sleeve Gastrectomy – It is also known as Vertical Sleeve Gastrectomy or  Gastric Sleeve Procedure.   With Laparoscopic Sleeve Gastrectomy, the outer margin of the stomach that is responsible for the secretion of Ghrelin (hunger hormone) is removed.  The reduced stomach restricts the amount of food intake, and thus helps in reducing weight. 

Roux-en-Y Gastric Bypass – Roux-en-Y Gastric Bypass is also termed Gastric Bypass Surgery.  The stomach is divided into a small upper pouch and a large lower pouch and the small intestine reattached to the upper pouch creating a bypass.  The food thus bypasses the large pouch of the stomach, resulting in less absorption of calories and nutrients.

Mini Gastric Bypass – This is another weight loss procedure which is done laparoscopically. 

Intragastric Balloon Placement – Intragastric Balloon Placement is placing a balloon in the stomach.  A deflated balloon is placed endoscopically through the mouth, and once in the stomach it is inflated.  This helps in restricting the food intake, which aids in weight loss.  Swallowable intragastric balloon is also available, and can be performed based on the choice of the patient.

There are other body shaping procedures, which is effective for removing excess fat from the body.  These include:

Liposuction: Liposuction is a surgical procedure that is used to remove excess fat from specific parts of the body like abdomen, thighs, hips, buttocks etc.

Tummy Tuck:  Tummy tuck is also called abdominoplasty.  It is a procedure to remove excess belly fat from the abdominal area and used to treat hanging abdomen.

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Hanging abdomen with an apron is unsightly and uncomfortable for any woman. Not able to wear the dress of their choice is so depressing to anyone. The self esteem gets down with every morning seeing the self profile. But they can be happy that there is a sure way out.

Causes of hanging abdomen

Overweight or Obesity: General adiposity (excess fat) as part of increase in Body Mass Index can cause an increase in abdominal circumference. The ideal BMI is 18-23. Once it is above 23 till 27.5 it is overweight and 27.5 onwards is obesity. BMI is calculated as weight in Kg/Ht in M2 e.g. If a person has 100 kg weight and 2m height, BMI= 100kg/ 2m x 2m=25 Kg/M2

Truncal Obesity (Abdominal obesity): Increasing abdominal obesity is more dangerous than the overall increase in weight. Ideally, the abdominal circumference at umbilical level should be below 80 cm in women. The increase in BMI and abdominal circumference leads to various medical illness like Diabetes, hypertension (increase in blood pressure), dyslipedemia (increase in cholesterol), sleep apnea (breathing difficulty/ snoring with respiratory arrest), PCOS (Polycystic ovarian disease) and fatty liver. It also increase the risk of cancers of breast and ovary.

Divarication Recti (separation of muscles of abdominal wall) : This happens mainly and commonly following pregnancy when there is excessive stretch of abdominal wall muscles making it fall apart from the midline. This leads to bulging of abdomen and patient will have a state similar to pregnancy look. This is highly distressing to any woman. The abdominal bulge will be such that it projects out and comes anterior than breast level in a profile view.

Ventral Hernia : Ventral hernia muscle defect with herniation / projection of abdominal contents in to the sac formed at the muscle weakness. The intestines or omentum get trapped in this defect and can cause life threatening problems.

Sagging Fat and Skin : The lower abdominal wall fat and skin is redundant (extra) and hangs down in an unsightly manner. The skin sagging may be unrelated to the muscle weakness. The pulling down of the abdominal wall by the weight of this apron itself will be causing discomfort and muscle weakness. The disfigurement in these patients is unexplainable.

Hanging Abdomen can be Treated

Patients need to consult a surgeon who is well-versed with the problem and its corrective measures. Detailed physical examination with abdominal girth, height, weight, BMI, BP, Pulse, oxygen saturation to be checked. The co-existing problems like diabetes, hypertension, snoring, respiratory difficulty with walking, menstrual irregularities, stress incontinence and psychological problem (mainly depression).

Those who have increased BMI should be advised for weight reduction. To a good extend it is possible by diet regulations and exercise. There are some drugs available to reduce weight but it helps in reducing weight around 4-5 kg only. Those with higher BMI will be benefitted by intragastric balloon placement or by bariatric surgery of which sleeve gastrectomy is the best. Abdominal obesity also gets controlled to a great extent by these procedures.

Divarication of recti (the separation of muscle in the central abdomen), the ventral hernia and sagging skin with fat (the abdominal apron) needs tummy tuck (abdominoplasty). The exercises to tone the abdominal wall, weight reduction or application of any kind of solutions or application of slim devices like vibrators are not going to give any kind of benefit to these patients.

Abdominoplasty Procedure

Pre-hospitalization

The procedure of tummy tuck involves a pre-hospitalization checkup including blood tests. Ultrasound abdomen is performed to rule out any other surgical problem in abdomen like an ovarian cyst or gallbladder stones which can be talked at the same time. The necessary consultations will also be done with other specialists as needed.

Operation

The operation is done under anesthesia, either general or regional, so that patient will be comfortable. The incision will be made at the lowest skin crease of abdomen to give excellent cosmetic outcome. The skin and subcutaneous fat will be mobilized. The muscles which are far apart will be brought together. In case of hernia a net like material (mesh) will be used to give additional strength. The excess fat and skin will be removed and wound closed. The wound closure is also done in a careful manner with no stitches outside. This also will add to the perfect healing with very minimal scar. The scar will be completely hidden by the smallest of dress.

Post Surgery

Patient needs to be in hospital for 2-3 days and can resume normal activities after that. All kinds of job can be started within two weeks time. Wearing an abdominal binder during this period will give additional comfort.

Methods of Abdominoplasty

Tummy Tuck Before and After

Procedure Outcome

The outcomes are such great that patients get immediate results and regain self esteem. The profile changes and any modern dress will suit the person. The medical issues related to the divarication like dragging pain in abdomen and backache due to the abnormal posture and weight of ventral hernia will also get resolved. In those with higher BMI and sagging abdomen the procedure to reduce weight (sleeve gastrectomy) is done along with the tummy tuck thereby avoiding scars of the bariatric surgery and unnecessary second hospitalization. Combination of these procedures is an innovative method developed at our center to give maximal benefit for patient with superior quality of life.

Tummy Tuck for women

Women who have had several pregnancies find their muscles and skin stretched. They find this procedure useful to tighten those muscles and remove the excess belly fat. Divarication Recti (separation of muscles of the abdominal wall) commonly happens following pregnancy when the abdominal wall muscles are excessively stretched leading to a bulging of the abdomen. This can be rectified by tummy tuck surgery.

Tummy Tuck for men

Tummy Tuck can also be performed in men who has hanging abdomen.

Assessment

The psychological impact of these illness on the patient is very significant. They will be always worried about and other is depression seeing the bad body contour every day. Being not able to wear the dress they like and not able to move around comfortably also keeps them introverts and less sociable. Many jobs also demand people with normal BMI and body shapes. Even promotions are jeopardized by these abnormalities. The associated medical problems and the need for medication for the same will also be making patients uncomfortable and dissatisfied in life.

Tummy Tuck Surgery Cost in Kerala

Tummy Tuck Surgery cost in Kerala is cheap compared to Tummy Tuck Surgery cost in other parts of India. For an enquiry about the cost contact:

Tummy Tuck Surgery in India

Tummy Tuck Surgery in India is performed regularly by Dr. R. Padmakumar, one of the best Tummy Tuck Surgeon in India. He is also Dr. Padmakumar is hailed as one of the Best Bariatric Surgeon in India & UAE. He is renowned for new and improved treatment techniques and the first in the World to perform SCARLESS BARIATRIC SURGERY with Abdominoplasty.

Tummy Tuck Surgery Cost in India

Tummy Tuck Surgery cost in India is also cheap compared to other parts of the world. For an enquiry about the cost contact:

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Weight Loss Surgeries Performed in India

Laparoscopic Sleeve Gastrectomy

Laparoscopic Sleeve Gastrectomy is a surgical procedure that is performed for weight loss. In LSG, a part of the stomach is removed to restrict the amount of food intake and the stomach is left to a size of about 15% of the original size.

Sleeve Gastrectomy Surgery in India is very common and laparoscopic sleeve gastrectomy cost in India is very affordable compared to other parts of the world.

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Gastric Bypass – Roux-en-Y

Gastric Bypass is a surgical weight loss procedure for treatment of morbid obesity. In this procedure the stomach is divided into a small upper pouch and a large lower pouch. The small intestine is then reattached to the pouch that creates a bypass for food, which results in absorption of less calories and nutrients. Gastric Bypass Surgery in India is performed at VPS Lakeshore Hospital by Dr. R. Padmakumar and team.

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Mini Gastric Bypass

Laparoscopic Gastroplasty

Laparoscopic Gastroplasty is another Weight Loss procedure. In Laparoscopic Gastroplasty the results are sustained even after many years. No chance of bleeding as there is no cutting involved. No leak as the stomach is not resected. Less expensive. Less duration of anesthesia. Early return to normal life. The procedure is reversible if patient desires.

Intragastric Balloon Placement

A Non-surgical Procedure for Weight Loss. This procedure involves using an endoscope to place a deflated balloon in the stomach. The balloon is then inflated to decrease the amount of intragastric space. The balloon is then left in the stomach for a period upto 6 months. Due to the restricted amount of food intake there is an average weight loss of 10-15 kg. This is highly effective in overweight people not classified as obese.

Read More

Abdominoplasty / Tummy Tuck

Abdominoplasty does not come under the category of Bariatric Surgery. Tummy Tuck is a surgical procedure which is performed to remove excess fat and skin from the abdomen and to tighten the abdominal wall muscle and fascia. It is also called Tummy Tuck

Read More

Best Bariatric Surgeon in India – Professional Excellence Awards

World Medical Council Award

Dr. R. Padmakumar receives World Medical Council Excellence Healthcare Award 2019 in recognition for his Professional Excellence and Outstanding Contribution to medical field especially Metabolic Surgery for Obesity (Bariatric Surgery) and Diabetes Resolution.

• Professional Excellence in Obesity (Bariatric Surgery) & Diabetes Surgery. Read More

100 most power Indians in the Gulf – Business.com (2012)

A specialist in obesity and diabetes, Dr. R. Padmakumar is presently exerting his considerable intelligence in a bid to help alleviate lifestyle diseases in the Gulf. Padmakumar is the first surgeon to win approval from the UAE’s Ministry of Health to conduct keyhole excess fat removal surgery.

Given the prevalence of diabetes in the Gulf – with some estimates claiming that the disease accounts for some 40 percent of the UAE’s healthcare budget alone – Padmakumar’s technique could make the difference for hundreds of patients in the region. He received his training in laparoscopy and cancer surgery from prestigious institutions including the All India Institute of Medical Sciences and Ram Manohar Lohia Hospital, New Delhi, Tata Memorial Hospital, Mumbai and Apollo Cancer Hospital, Chennai.

Business.com

Video Testimonials

Best Hospital for Bariatric Surgery in India

COEBMS (Centre of Excellence in Bariatric and Metabolic Surgery)

VPS Lakeshore Hospital under the leadership of Dr. R. Padmakumar was recognized as the Center of Excellence for Bariatric and Metabolic Surgery by the Obesity & Metabolic Surgery Society of India (OSSI) at the 21st National Conference of OSSI (OSSICON 2024 Kochi). Dr. R. Padmakumar and team (Dr. Madhukar Pai, Dr. Resen Rajan, Ms. Premna Subin, Ms. Nimmy) receiving the certificate of Center of Excellence from Dr. Shrihari Dhorepatil, Dr. Praveen Raj, Dr. K S Kular, Dr Gurvinder Singh Jammu, Dr. Vivek Bindal, Dr Raj Palaniappan.

VPS Lakeshore, also known as Lakeshore Hospital is a multi super-specialty Hospital in Kochi, Kerala. The Department of Bariatric Surgery is headed by Dr. R. Padmakumar and today is one of the Best Hospital for Bariatric Surgery in India. Dr. R. Padmakumar is listed among the top 10 Bariatric Surgeons in India and one of the Best Bariatric surgeons in Kerala.

India is considered to be one among the most preferred destinations for medical treatments as it is very affordable compared to other destinations. People from all over the globe, including US, UK, Kenya, Nigeria, United Arab Emirates, etc visit India and get their weight loss surgery performed in the Top Bariatric Hospitals in India.

Bariatric Surgery Cost in India

Compared to other parts of the world, the cost of Bariatric surgery in India is very affordable. The cost is really worth it, when we compare the benefits that the surgery offers. Again depending on the weight loss procedure performed, the cost of the surgery varies.

Bariatric Surgery Reviews

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Bariatric Surgery Before and After

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Diet and exercise, behavior therapy, and anti-obesity drugs are the first-line treatments for obesity and overweight. But for severe obesity this has limited success and long term success is very poor. Weight loss surgery or bariatric surgery results in greater weight loss than these conventional treatments. Weight loss surgery aids in improving the quality of life and brings improvement in obesity related diseases such as diabetes mellitus, hypertension, etc.

When is Weight Loss Surgery indicated?

Weight loss surgeries have proved effective and long term studies show that these procedures cause long term weight reduction, resolution of diabetes, improvement in cardiovascular risk factors and obstructive sleep apnea, etc.

According to a medical guideline published by the American College of Physicians, Weight Loss Surgery should be considered as an option for treatment in patients with BMI of 40 kg/m2 or above, who instituted an adequate exercise and diet regimen, but failed, and also in patients presenting with obesity-related comorbid conditions.

Obesity increases the risk of many diseases and health conditions. These include: Type 2 diabetes (Diabetes Mellitus), Coronary heart disease, Hypertension (High blood pressure), Cancers (endometrial, breast, and colon), Dyslipidemia (for example, high cholesterol), Stroke, Liver and Gallbladder disease, Obstructive Sleep Apnea and respiratory problems, Osteoarthritis, Infertility, Asthma

Frequently Asked Questions on Bariatric Surgery

What are the 4 Types of Bariatric Surgery?

Types of Weight loss Surgeries include:

•  Laparoscopic Sleeve Gastrectomy (LSG)
• Laparoscopic Gastroplasty
•  Roux-en-Y Gastric Bypass
•  Mini Gastric Bypass (MGB)

Laparoscopic Sleeve Gastrectomy – Laparoscopic Sleeve Gastrectomy is a surgical procedure for weight loss. Sleeve gastrectomy is also known as a vertical sleeve gastrectomy or gastric sleeve procedure. In this procedure, the outer margin of the stomach is removed to restrict the amount of intake of food leaving the size of the stomach to about 15% of the original size of the stomach.

Roux-en-Y Gastric Bypass – Gastric Bypass is a surgical weight loss procedure for treatment of morbid obesity. In this procedure the stomach is divided into a small upper pouch and a large lower pouch. The small intestine is then reattached to the pouch that creates a bypass for food, which results in absorption of less calories and nutrients.

Intragastric Balloon Placement for Weight Loss – Intragastric Balloon Placement involves using an endoscope to place a deflated balloon in the stomach. The balloon is then inflated to decrease the amount of intragastric space. The balloon is then left in the stomach for a period upto 6 months. Due to the restricted amount of food intake there is an average weight loss of 10-15 kg. This is highly effective in overweight people not classified as obese.

Which Bariatric Surgery is the safest?

Sleeve Gastrectomy is considered to be safer than Roux-en-Y Gastric Bypass and Mini Gastric Bypass as the anatomy is not altered in Sleeve Gastrectomy.

In Roux-en-Y Gastric Bypass, there is alteration in the anatomy as the stomach is divided into small upper pouch and large lower pouch and the small intestine is attached to the pouch (anastomosis) to create a bypass for food.  In Mini Gastric Bypass, the small intestine is connected by a single anastomosis, and thus there is an alteration in the anatomy.  Whereas in Sleeve Gastrectomy such anastomosis is not created and thus there is no alteration in the anatomy.

Gastroplasty on the other hand has the advantage of having no gastric leak.  There is less than 1% risk of Gastric leak that is possible in other bariatric procedures like Sleeve Gastrectomy or Gastric Bypass procedures and people could be afraid of such risks.    Gastric leak happens when digestive fluids leak through the staple line or incisions or anastomosis. Though Gastroplasty is considered safer than Sleeve Gastrectomy, Sleeve Gastrectomy is recommended is patients with high BMI as there is signification reduction of weight compared to Gastroplasty.  In Gastroplasty, 10 – 15 kg reduction is expected, where as in Gastrectomy or Bypass procedures there is much more significant loss of weight.

Which Bariatric Surgery is best long term?

Sleeve Gastrectomy is best long term because the portions of stomach which secretes Ghrelin and acid  in excess is removed.  Ghrelin is the hormone which is responsible for increasing appetite and cholesterol and the acid in the stomach is responsible for digesting the food.    As the part of the stomach responsible for secreting Ghrelin and acid is removed, appetite is reduced leading to less food intake.

Sleeve Gastrectomy is also considered best long term, because since there is no bypass created unlike Gastric Bypass procedures, the patient will not suffer from micronutrient deficiency.  No additional diet or vitamin supplements will be required and weight loss attained will be almost as equal to complex bypass procedures. Sleeve Gastrectomy is also best long term compared to Gastroplasty as the weight loss expected in Gastroplasty is around 10 – 15 kg, where as in Sleeve Gastrectomy there is a significant loss of weight.

Complications of Obesity

Obesity is a medical condition. Obesity occurs due to excess body fat accumulated in the body and is considered a serious medical condition due to the adverse health effect obesity has on the body. People with BMI (Body Mass Index) exceeding the normal range has much greater risk of medical issues. Medical issues include cardiovascular diseases, diabetes mellitus, OSA or obstructive sleep apnea, asthma, etc..

Obesity is a serious medical condition.  People who suffer with obesity and overweight, compared to people with normal or healthy weight, are more likely to develop a number of potentially serious health conditions.  These include:

Hypertension, also called high blood pressure. 

High Cholesterol (Dyslipidemia).

Heart disease:   High blood pressure, abnormal cholesterol levels and high sugar are risk factors for heart disease.  Obesity gives stress to the heart to send blood to all the cells of the body.

Stroke:   Stroke is a condition where the blood flow to a part of the brain stops, which causes the brain cells to die.  High Blood pressure and abnormal cholesterol levels increases the risk for stroke. 

Type 2 diabetes.   It is believed that obesity accounts for 80-85% of the risk of developing type 2 diabetes.  Obese people are 40 times more likely to develop type 2 diabetes than people with normal weight.

Gynecological and sexual problems. Obesity may lead to infertility and irregular periods in women and may cause erectile dysfunction in men.

Sleep apnea and breathing problems are more likely to develop in obese people.  Sleep apnea is a condition in which a person has one or more pauses in breathing during sleep.

Osteoarthritis.  Obesity increases the stress placed on weight-bearing joints.  This may cause damage to the cartilages.

Cancers.  Obesity might increase the risk of cancer of the cervix, uterus, endometrium, ovary, breast, rectum, colon, esophagus, liver, pancreas, gallbladder, kidney and prostate.

Digestive problems.  Obesity increases the likelihood that you’ll develop heartburn, gallbladder disease.

Fatty Liver disease.  This occurs when fat builds up in the liver.   This disease often affects people who are overweight or obese and/or diabetic patients and also in middle aged people.

Polycystic ovarian disease or PCOD.

Pregnancy:  Obese women who are pregnant is at increased risk for developing gestational diabetes, high blood pressure during pregnancy that causes problems for both mother and child.

Depression and anxiety.

Low quality of life.

Bariatric Surgery may help in lowering the risk of Stroke and Heart attack. Bariatric Surgery helps in lowering the risk of stroke and myocardial infarction (heart attack) in patients suffering with type 2 diabetes and severe obesity according to a study published in the Journal of the American Medical Association (JAMA). The study was conducted to investigate the relationship between bariatric surgery and incident macrovascular (coronary artery disease and cerebrovascular diseases) events in patients with severe obesity and type 2 diabetes. This observational study concluded that patients with type 2 diabetes and severe obesity who underwent bariatric surgery, compared to those who did not undergo surgery, bariatric surgery was associated with a lower risk of macrovascular outcomes.

Related Links

• Bariatric Surgery Gallery – Before and After
• Video Gallery
• About Bariatric Surgeon – Dr. R. Padmakumar

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I had undergone Bariatric Surgery under Dr. Padmakumar on December 4, 2018. I was 85 Kg, had high cholesterol, had pain in my legs, had trouble walking, and was troubled emotionally and physically due to my weight problem. I got the contact number of Dr. Padmakumar from my friend and underwent Bariatric Surgery. I had no side effects even after the surgery. I got discharged after 2 days and followed the advise of the doctor. It is almost 1 year, and I have reduced from 85 kg to 60 kg. Cholesterol is normal now, stopped cholesterol medications. My leg pain has resolved. And I thank Dr. Padmakumar for the surgery.

Bariatric Surgery. I had no side effects even after the surgery. I got discharged after 2 days and followed the advise of the doctor. It is almost 1 year, and I have reduced from 85 kg to 60 kg. Cholesterol is normal now, stopped cholesterol medications. My leg pain has resolved. And I thank Dr. Padmakumar for the surgery.

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Video Talks on Bariatric Surgery

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What is Metabolic syndrome?

Metabolic Syndrome is a condition in which excess body fat is accumulated to such an extent that health may be negatively affected and the life span is shortened. It is a group of diseases where increased abdominal girth more than 90 cm in males and more than 80 cm in females generally associated with increased BMI, diabetes, dyslipidemia, hypertension, polycystic ovarian disease, sleep apnea and non-alcoholic steatohepatitis.

Obesity and Infertility:

How is Obesity related to Infertility? Obesity makes it difficult for women to get pregnant. If they get pregnant, then there is higher risk of losing it. Hormonal levels are also altered in obese women. Obesity related complications in pregnancy (BMI >35): Preeclampsia (5 times), stillbirths after 28 weeks gestation (3 times), early neonatal death (3.5 times), large-for-gestational-age infants (4 times), gestational diabetes (8 times). The infertility treatment including IVF also has lesser success in obese people.

Management of Obesity:

By lifestyle and medical methods weight loss is modest and rarely sustained. We had only few medicines to take care of Obesity. Leucine 2.25 gm with B6 30 mg per day increases fatty oxidation by 30 percent which may help to lose weight to some extent.

Obesity and Infertility – Treatment Options

Non-Surgical treatment: Intragastric Balloon (IGB):

It is placing a deflated balloon in the stomach using endoscope and then filling it to decrease the amount of intragastric space. It can be left in the stomach for a maximum period of six months. It results in average weight loss of 10 to 15 kg. It may be used in patients with overweight who are not suitable for Metabolic Surgery

Surgical Treatment (Metabolic Surgery):

The term “bariatric” surgery is derived from the Greek word baros for weight; defines surgical procedures designed to produce substantial weight loss. Metabolic Surgery – Metabolic changes occurring cannot be explained completely by their effects on body weight alone; hence procedures which induce metabolic improvements come under the category of metabolic surgery.

Laparoscopic Sleeve Gastrectomy (more than 30 BMI patients) :

The portion of stomach which secretes Ghrelin and acid in excess is removed. This leads to reduction in food intake and also alteration in hormonal milieu which leads to usage of stored fat for caloric requirement. This has got very good results without significant nutritional deficiency and hence most preferred.

Modified Sleeve Gastrectomy with Ileal Interposition (BMI 25 – 30):

In this after a modified sleeve gastrectomy ileum is brought near the stomach by interposing proximally. The jejunum is connected after ileum. This ensures early entry of food to ileum but jejunum is not kept out of its route. There is significant increase in GLP1 hormone and resultant increase in timely secretion of insulin. There is no dumping or vitamin deficiency in contrast to bypass procedures.

Patients will be initially on liquid diet and later on changed to semi solids, gradually changed to solid diet in a month’s time. Patients will be on vitamins for a month or so, Pantoprazole for 2 months; Calcium will be optional. Biotin is advised if patient has significant hair loss. There is no need for long term vitamins.

RESULTS:

Around 85 to 90 % of diabetes patients treated by these surgeries get complete resolution of diabetes. Whereas, the rest of them get significant control of diabetes with reduced dose of medication. In addition to diabetic control the other benefits are loss of excess weight and control of triglyceride levels. Sleep apnea, arthritis, cardiac episodes, kidney disorders and cancers are also reduced significantly. Studies show that metabolic surgery is cost-effective and safe. IFSO Global Registry studied more than 1 lakh bariatric surgeries over 18 countries and has reported a mortality of 0.03%. SOS – Swedish Obese Subject Study (prospective matched cohort study with 15 years follow up) showed excellent results of metabolic syndrome resolution which is sustained even after many years.

When can pregnancy be planned?

Patients can conceive after 6 months of Bariatric Surgery. Generally, there is no need for any special nutrition or vitamin supplementation to these patients other than what is recommended for a pregnant lady routinely. Bariatric surgery might be effective in young infertile obese women who wish to become pregnant. Weight-Loss surgery resolves PCOS. Most of the improvement in PCOS symptoms occurred during the first 12 months after bariatric surgery.

Conclusion:

Metabolic surgery has emerged as the most preferred, highly effective, and safer means to achieve long term resolution of type 2 diabetes and excellent improvement in fertility status.

Video Talks on Bariatric Surgery

Video Testimonials

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Body Mass Index (BMI) is an estimate in relation to the weight and height of a person; it is calculated as weight in kilogram divided by height 2 times (BMI =Weight in Kg/ height in M2). BMI of 20 to 25 is considered normal. 26 to 30 is over weight. Above 30 is obesity and above 37 will be considered as morbid obesity. If overweight is a predisposition for illness, obesity is a disease itself and needs treatment. Like in developed countries obesity is increasing in India also. On one side when nation is trying to reduce poverty related illnesses it is undesirable to see that people are getting illness due to over eating and resultant obesity related illness; and it is a thing to be strongly discouraged. It’s more problematic to have abdominal obesity like what we see in Kerala.

Obesity: Reasons:

• Hereditary factors
• Food habits
• Life style.

Though hereditary can be contributing factor for obesity, it is usually due to excessive food intake. Food rich in fat and low in fiber is the main culprit for obesity. Meat, sweats in excess quantity and repeated intake of food: causes obesity. Soft drinks, instead of ordinary water also contribute as they are energy sources, though people don’t consider it as food. One gm fat gives nine calories where as protein and carbohydrate gives four calories only. Sedentary life style with no exercise is another important factor which accelerates obesity.

Weight Loss Treatment – Why a necessity?

When weight increases, it directly affects heart and respiratory system. Heart when made to pump in greater force and to larger area will definitely weaken it. This will induce heart attack to a very early age. Cholesterol deposition causes reduction in lumen of blood vessels leading on to high BP (Hypertension). Chances of vascular events like heart attack and stroke are very very high due to blockage of vessels in these patients. Requirements for coronary angioplasty and cardiac bypass are 3-4 fold compared to persons of normal weight. Obesity also leads to sleep disorders and respiratory problems called as sleep apnoia. Excess fat causes damage of pancreas and induce insulin resistance. This in turn result in high blood sugar (diabetes mellitus). Increased weight damages joints and bones leading into early arthritis necessitating joint replacements. Women with increased body fat suffer from polycystic ovarian disease (PCOD). It is an important cause for infertility and is mostly reversible if persons loses excess weight. The loss of body image is a significant contributor for mental disease like depression. Morbidly obese people find it difficult to move around and use common facilities, commuting and seeing the response of the society at sight of the morbidly obsess person puts them down

Solutions:

Control of diet and increasing exercise are two things which an overweight person can do himself to counter the problems. There are drugs available in the market which may reduce the appetite. There are some drugs which can induce malabsorption of fat so that the calorific value of the diet is reduced. But these things can reduce weight to a minimum extent only. The permanent solution for obesity and related illness is surgery. Measures like reduction and size of stomach or diversion of food from the stomach to the distal part of the intestine have proved highly effective in causing dramatic reduction in fat and weight. As these procedures are done through laparoscopy, it is a thing which makes it comfortable, safe and simple for a patient.

Laparoscopy for Weight Loss Treament

Lapro means abdomen and scopy means to see. Surgeon makes one cm incision in the abdomen and puts a telescope which is connected to the monitor outside. Surgeons see the picture of the abdominal organ on the monitor and operate. Operating instruments are less than a pencil size which is introduced through 5 mm incision. In open operation a big wound is made for surgeon to visualize organs and for putting his hands for performing surgery. These big wounds were causing severe pain, increase risk of infections and chance for hernia due to poor healing. Keyhole surgery is very advantageous as no significant wound is made and hence patient will be going home very early and resume normal activities in few days time. As the images are magnified 20 times the precision of surgery is very much high. Even small blood vessels can be seen as big and equipments like harmonic scalpel seals these vessels perfectly so that the blood loss in significantly less. This avoids need for blood transfusion to tune 1 % of open surgeries and patient is saved of the associated illnesses like Hepatitis, AIDS, and Malaria. In obsess patients open surgery is extremely difficult opening these kind of patients will cause respiratory distress, blood clots in the vessels, slowing of the intestinal motility (Ileus). Laparoscopic surgery avoids such problems greatly and patients will be ambulant within few hours and there will not be a need for long term rest.

Weight Loss Treatment – 3 Types of Laparoscopic Procedures

• Sleeve Gastrectomy
• Banding
• Gastric bypass

Sleeve Gastrectomy:

Using staplers a portion of stomach is removed and their by reduces the quantity of food patient take additionally. This reduces appetite, stimulating agents and acid secretions so that patient will be comfortable with small quantity of food. This is sure to bring down the weight of the patient drastically with desirable effects on con existing illness.

Banding:

In this an adjustable band is placed around the stomach so that stomach size at the area of food entry is reduced. Patient can adjust the size of stomach and quantity of food.

Gastric bypass:

In this the stomach is connected to a distal part of the intestine so that the absorption is reduced and thus causes weight reduction.

Many studies have shown that surgery as a weight loss treatment in addition to causing dramatic weight loss improves or resolves the conditions associated with obesity. The requirement for insulin is reduced to 90% and hypertension medication can be discontinued by almost 80% of persons. The joint problems, sleep apnea improve and quality of life will be very good.

Patient may require procedures like liposuction, lipectomy or abdominoplasty for cosmetic purpose. So it is advisable for everyone who has obesity to resort to the above mentioned procedure. So that they will be back to normal life with good quality.

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If you suffer from Metabolic Syndrome and have tried various treatments without results, metabolic surgery may be indicated. At present, surgery combined with behavioral changes is the only documented method for achieving long lasting weight loss for patients with morbid obesity.

A silicon balloon is placed in the stomach, under endoscopic guidance. A gastric balloon aims to reduce feeling of hunger and helps to feel fullness of stomach. The intragastric balloon device is not considered a permanent weight loss procedure. There are different types and sizes of balloons in the market. All balloons are temporary and need to be removed after a period of time (6-12 months).

Indications for Intragastric Balloon Placement or IGB

• More than 30 BMI – obesity class I (BMI 27.5 – 32)
• Class II obesity (BMI 32-37) in whom surgery is not possible due to medical conditions or patient’s dislike for surgery.
• In Morbidly obese (BMI > 37) as a procedure before bariatric surgery to reduce surgical morbidity.
• Any patient with an excess weight of 10 -20 kg (BMI 23-27.4), with failed dietary measures especially in cases with PCOD (Polycystic Ovarian Disease) and infertility.

Multidiscipilnary Approach – Bariatric Team for Intragastric Balloon Placement

The insertion of balloon does not require surgery. You will be supported by a multidisciplinary team that includes a bariatric surgeon, a gastroenterologist, a dietician and an anaesthesiologist.

Doctor consultation helps in

1. Assessment
2. Guidance
3. Discussion about various procedures. You may ask any questions that you feel are necessary.
4. The team confirms that intragastric balloon is a good option for you.

After this you may be advised investigations and consultations that are felt necessary for the assessment of your health condition.

Intragastric Balloon Placement – Preprocedural Evaluation

• Hemogram, RBS, HbA1C
• Liver function test, Lipid Profile, Thyroid function test, Renal function test
• S. Calcium, S. Magnesium
• S. Cortisol, Blood Group
• Hbs Ag, HIV I & II, Anti HCV, VDRL , Urine RE
• C peptide fasting, C peptide 1 hr pp, Insulin fasting
• GAD Antibodies , IA2 Antibodies (in diabetic patients)
• ECG, X-Ray Chest PA, USG abdomen, Dexa Scan.

Consultations:- Anesthesia, Cardiology, Counseling, Diabetology, Dietician

Swallowable Gastric Balloon

The balloon is placed in the stomach by swallowing a vegetable-based capsule that contains the deflated balloon. We generally use the Allurion Swallowable Gastric Balloon. The balloon is connected to a long, thin tube. Once the capsule has entered the stomach, an X-ray is used to confirm the correct position of the capsule.

The doctor then uses the tube to fill the balloon with liquid and then a second X-ray will confirm the balloon is correctly filled. Once the balloon is filled, your doctor will gently remove the tube.

Endoscopic Placement of Intragastric Balloon

Your doctor does an endoscopy under mild anesthesia with a flexible tube equipped with a camera to see the inside of the stomach. If there is no local disease during endoscopy he sets up the intragastric balloon in the stomach. We regularly use ORBERA365 weight loss balloon, which is placed and removed endoscopically. It lasts for one year. The gastric balloon consists of a silicon elastomer based material, which is soft and pliable. The balloon is inserted uninflated through the mouth and taken down the esophagus. It is coated with a local anesthetic to facilitate the passage.

Once the balloon is in the stomach, it is filled with a sterile saline solution colored in blue (BIB system) or air (Heliosphere system), through a catheter attached to the balloon. When a balloon is filled, the doctor gently pulls on the inner end of the catheter to remove it. The balloon has a self-sealing valve that prevents the leakage of liquid or air. The balloon floats freely in the stomach. The procedure time is about 20 minutes. You will be monitored in the hospital for a few hours before returning home (Generally overnight).

Medications

During the initial days of the insertion of the balloon, nausea, vomiting, abdominal pain, acid reflux are common. Your doctor would prescribe medications to minimize gastritis. Medicines for nutritional supplementation/ multi-vitamins may not be generally needed. You can contact the doctor during the following days. You have to have food as prescribed by the dietician. It is important to drink more water to avoid dehydration. Some patients take a light meal. A radiograph of abdomen or abdominal ultrasound is rarely indicated for persistent abdominal pain. Nutritional assessment is done after one month and three months. A consultation (in person or by phone) every month will be scheduled. The consultations help to assess the progress of weight loss.

Dietary Counseling

The first consultation is scheduled a week later. Nutritional and behavioral modification is the key to loose weight and keep it off after removal of the balloon. Your physical activity is evaluated and diet is adjusted to your body needs and profession. A psychological treatment may be necessary in case of eating disorders.

Gastric Balloon Withdrawal

Intragastric balloon is removed when:

• Weight loss is adequate.
• 6-8 months time
• Spontaneous rupture
• Patient not tolerating

Removing the balloon is carried out after 6 months. The balloon is no longer effective because the stomach has adapted to it. The gastric secretions make it porous and then it can deflate. The gastric balloon is removed the same way it has been introduced – through the esophagus and mouth – without surgery. The removal is performed under mild general anesthesia under endoscopic control. The removal lasts around 15 minutes. The balloon is punctured and the fluid or air is removed and then the empty balloon is brought outside.

Complications:

No major complication. Nausea and vomiting during the first week in 7.4 % which settles itself

Frequently Asked Questions

How much weight can I lose with gastric balloon?

The balloon is an effective aid for losing weight in combination with diet and eating behavior modification program. Dietary counseling is done monthly and sometimes more frequently if needed. The weight you lose will depend on your motivation and the quality of diet. The balloon is not an appetite suppressant. This an effective aid for the modification of habits and eating behavior. The weight loss is between 10 and 20 kg for 6 months when the balloon is in place. After its removal the weight maintenance and prevention of weight regain will depend on how you adapt long-term lifestyle changes in eating and exercise. It is therefore important to continue the diet plan after removal of balloon.

Our Result

Average weight loss:- 15 to 20 kg

1. Diabetes, Hypertension, Dyslipidemia
   • Complete resolution: – 50%
   • Reduction of medicines: – 50%
2. Rate of PCOD resolution with positive pregnancy is excellent
3. Sleep apnea (Snoring) very good control

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Ghrelin or the “hunger hormone” is also called lenomorelin. Ghrelin is secreted when the stomach is empty and when the stomach is stretched the secretion of Ghrelin stops. Ghrelin acts on hypothalamic brain cells to increase hunger and to increase the secretion of gastric acid and motility of gastrointestinal tract to prepare the body for intake of fodd.

Sleeve Gastrectomy leads to reduction in food intake and also alteration in hormonal milieu which leads to usage of stored fat for caloric requirement. Thus, by natural way, weight gets reduced and in few months’ time major portion of excess weight is lost. There is no need for taking medicines continuously and the weight loss will be sustained. Studies show this as the best method.

Laparoscopic Sleeve Gastrectomy (more than 30 BMI patients): Laparoscopic Sleeve Gastrectomy (LSG) is a well established bariatric procedure of treatment for people who are obese and having type 2 diabetes, not achieving desirable control with medical and dietary therapies, especially when there are other major comorbidities.

Indications for Laparoscopic Sleeve Gastrectomy

• Obese class II and obese class III patients
• Obese class I patients with obesity related comorbidities that could not be controlled with medicines.
• Patients who failed to lose weight with conservative modalities

Contraindications for Laparoscopic Sleeve Gastrectomy

• Patients with age group <15 and >65 years
• Chronic liver diseases
• Major cardiovascular diseases that cause a high risk for anesthesia
• Drug or alcohol abuse currently
• Uncontrolled psychiatric illness and lack of comprehension of the risks-benefits

The portion of stomach which secretes Ghrelin and acid in excess is removed. This leads to reduction in food intake and also alteration in hormonal milieu which leads to usage of stored fat for caloric requirement. Thus, by natural way, weight gets reduced and in few months time major portion of excess weight is lost. There is no need for taking medicines continuously and the weight loss will be sustained. This has got very good results without significant nutritional deficiency and hence most preferred.

It is safe and effective in weight reduction as well as resolution of associated comorbidities especially diabetes mellitus in obese class II and obese class III categories. LSG is generally recommended in patients with BMI>35 kg/m2. The study conducted by Dr. R. Padmakumar et al. shows that laparoscopic sleeve gastrectomy is effective in obese class I group as well (resolution of diabetes is 86.6% in patients with obese class I) and the resolution of type 2 diabetes achieved is sustained.

Other Bariatric Surgeries

Other Bariatric Surgeries for treatment of Obesity include:

Roux-en-Y Gastric Bypass – In Roux-en-Y Gastric Bypass, the stomach is divided into a small upper pouch and a large lower pouch. The small intestine is then reattached to the pouch that creates a bypass for food, which results in absorption of less calories and nutrients.

Laparoscopic Gastroplasty – In Laparoscopic Gastroplasty, the size of the stomach is reduced using stitches by about 60-70% of the existing size.

Mini-Gastric Bypass

Other Weight Loss Treatments

Intragastric Balloon Placement – Weight loss about 10-15 kg can be achieved with Intragastric Balloon Placement, which is placing a balloon inside the stomach. Intragastric Balloon is placed endoscopically through the mouth. Swallowable balloon insertion is also done based on patient preference.

Body Shaping Procedures

Tummy Tuck – Tummy Tuck is also called abdominoplasty and is performed to remove excess belly fat from the abdomen and to tighten the abdominal wall muscle.

Liposuction – Liposuction is another fat removal procedure.

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