Blog

I write this article for my readers who may also have visited me for the consultation for bariatric surgery but have opted out for various reasons. To clear the common misconceptions, read on ……

1.  Is Bariatric surgery risky ?

Bariatric surgery currently is very safe. 99% patients go home the next day without any problems. Those who have a complication such as leaks and bleeds are now managed very effectively. In a paper published earlier, bariatric surgery was found to be as safe as an appendicectomy.

2.  Will I feel weak after bariatric surgery since I will be unable to eat more ?

It is very common for patients who undergo bariatric surgery to feel energetic and vivacious. Patients regain a lot of confidence, are increasingly mobile and are off their drugs for diabetes, knee pain, blood pressure and are usually are at the top of the world.

3.  Can diabetes be actually cured by bariatric surgery ?

Yes, there are now enough successful patients and evidence to suggest that a surgery can remit diabetes in many situations. Millions of diabetics who were on insulin and drugs to control their blood sugar are off medications. In addition, these patients do not need to live in the fear of diabetic complications such as the kidney failure, heart disease, stroke, infections, eye complications and limb-threatening feet infections.

4.  Is life tough after bariatric surgery ?

Life doesn’t change after the surgery. It is the same as those individuals who value their life and practice moderation in their diet and lifestyle. Eating less come naturally after surgery. Making the food choices sensible is taught.

5.  Is the process of bariatric surgery painful and bothersome ?

Thanks to improved technique and technology most patients can be sent home the next day. They are back to work within a week. The pain is minimal thanks to keyhole technique. Patients start eating normal solid food after a week after newer procedures.

Know about Bariatric Surgery with our YouTube video.

I have anal fistula. I have taken various medicines prescribed by alternative medical practitioners but it has not healed. I am scared of surgery since I have heard it is painful and fail most often.

Anal fistulas can be cured only by surgery. So don’t waste time and money on pills and creams. The fistula surgery has improved in recent times due to better MRI scans, techniques like VAAFT, LIFT, Seton and Plug for complex cases. Most cases can be sent home after a single day hospital stay with minimal pain and wound. The failure rate for a simple fistula is rare and 15% for complex fistulas. Also in traditional surgery there is a chance of damage to anal muscle that can lead to inability to hold stool. This is least likely in modern surgery.

I am suffering from Piles since last 2 years and I have taken various alternative medicines but if I stop taking these, the problem starts within 2-3 days. How long do I have to take this?  Do I need surgery?

Most alternative medicines have no scientific basis or evidence. On the basis of scientific evidence, if there are smaller piles (grades one or two) they may benefit from injection or banding treatment. If you have grade three piles (piles that come out of the anus and bleed profusely), you need surgery. Surgery can be open or stapler. I recommend stapler since there is no pain or wound after the operation. It does not require any dressings and patients can return to their work within a day or two. If I needed surgery I would (having done both types of operation extensively) choose staplers any time.

I have pain when I pass stool for years. What should I do?

You should see a doctor immediately since it can be due to a simple correctable cause such as an anal fissure or it may be due to a sinister cause such as a rectal cancer.

A simple day care surgery can cure anal fissure forever.

My rectum pops out of my anus when I pass stool (Rectal prolapse). What is the modern treatment for this disease?

This popping out of rectum on straining for defecation is called rectal prolapse. If not treated early, these patients will develop permanent damage to their anal sphincter and may lose ability to control their passage of stool. Nowadays rectal prolapse can be treated by laparoscopic surgery without the need for cutting the abdomen. This means less pain, less wound and a hospital stay of 2-3 days only.

What is the recent advancement in the management of cancers of colon and rectum?

Early detection and surgery is the key to a successful management of these patients. The surgery can nowadays be done by laparoscopy and hence the patients are spared the trauma of open long incisions.

The combination of radiotherapy in rectal cancer and chemotherapy in colon cancer has improved outcomes too.

Watch the video of Anorectal Surgery on YouTube.

Bariatric surgery – a weight loss surgery- is becoming an increasingly popular option for patients who are obese and diabetic. It not only helps to reduce weight and resolve diabetes, it also helps patients with arthritis, snoring, infertility substantially. The dramatic results and benefits it produces is the major reason for its popularity. The method in which it achieves this outcome is based on the fact that it reduces the capacity of the stomach and hence eating less can satisfy the patients. The consequent calorie deficit drives the body fat to melt to supply calories. This fat meltdown translates into remarkable weight loss.

So far, the more popular bariatric procedures utilized this principle of food restriction that worked well with many patients.  Be it a Lap-band, Sleeve Gastrectomy or a Gastric Bypass, all worked mostly on this principle. The procedure like Lap- Band are simpler but less effective whereas a Bypass is more effective but technically more difficult.  A procedure with advantages of both would be the optimum surgery.

Recently, a procedure that is effective and simple has been developed that utilizes the principle of malabsorption (causes only part of the food to be absorbed). This has joined the armamentarium of bariatric surgery. It is called the Mini Gastric Bypass.

The Mini Gastric Bypass was developed by an American Surgeon, Dr. R Rutledge and has significant advantages. It is simpler to do, takes less time- less than an hour mostly and involves a single day hospital stay.

It is claimed that this surgery works even after a few years when most of other procedures have stopped their restrictive potential significantly. This is important especially in India, where patients cannot think of a second surgery because of the costs and risks involved.

Additionally, if patients wanted the procedure to be reversed for any reason, it is possible.

Since the procedure works on the principle of malabsorption and relies less on restriction, the patients can eat and drink more- an effect that may be more than welcome to many food-loving patients. Since we Indians have primarily a cereal-based diet, this may come real handy.

The surgery has been accepted widely by thousands of patients in the last fifteen years and has become the procedure of choice for many.

Watch video of Bariatric Surgery on YouTube.

What is a Hiatus hernia ?

In a hiatus hernia, a part of the stomach that should normally be in the abdomen protrudes through the diaphragm into the chest (See picture). This hernia allows food and acid abnormally to travel upwards and may produce symptoms.

What are the symptoms in Hiatus hernia ?

These individuals experience heartburn when acid produced in stomach enters the chest. They also experience the distressful symptom of regurgitation (feeling of food coming up in the throat) when food travels into the chest due to this wide defect. Some hiatus hernias can lead to dysphagia (difficulty in swallowing) too.

What causes a Hiatus Hernia ?

Most of the time, the cause is not known. A person may be born with a larger hiatal opening. Increased pressure in the abdomen such as from pregnancy, coughing, or straining during bowel movements may also play a role. Being overweight and obese is a definite risk factor for hiatus hernia.

How is a Hiatus Hernia Diagnosed ?

A hiatal hernia can be diagnosed with a specialized X-ray (using a barium swallow or with endoscopy.

What is the treatment of Hiatus Hernia ?

Most heartburns can be controlled by dietary changes and medicines. Surgery is required if these measures fail.

When Is Hiatus Hernia Surgery Necessary ?

Hiatus hernia surgery (laparoscopic fundoplication) is needed if symptoms of GERD and regurgitation cannot be controlled effectively by medicines or when there is complication of hernia.

Hiatal hernia surgery is performed as a laparoscopic procedure. It involves minimal pain and scars and one day hospital stay. The patient is spared the misery of life long treatment and therefore is the treatment of choice for many patients.

Watch video on YouTube on Laparoscopic Hernia Surgery.

A woman needs to preserve her beauty and health even more when she turns forty. This is because her body – and sometimes her mind as most partners would know- is changing at this age. She should be more informedand careful towards these changes taking place in her body because they affect her health in many ways. They are:

1.     The metabolism gets slower and she starts gaining weight especially at the areas she hates it most- the hips and the belly.Face it-  there is nothing worse for a woman under threat of progressive ageing to see her getting obese!

2.     There is decrease in the estrogen levels and consequently there is more fat deposit in the blood vessels. This means she gets    more prone to heart disease. Statistically, heart disease is the leading cause of death in females above forty years of age.

3.     The obesity combined with poor bone strength seen at this age and the fact that a woman’s joints are more loose jointed than        men, leads to joint pains especially at the weight bearing ones such as the spine and the knee joint. This contributes to immobility    and creates a vicious cycle of producing more obesity. A catch 22 situation!

4.     The lower levels of estrogen and growth hormones together

with decreased metabolism leads to obesity and that is a great recipe for diabetes. In fact obesity accounts for 80-90% of diabetes in  menopausal females. The association is so strong that it is called diabesity.

So, if we were to point out only one area of concern for women above forty, it would be obesity.  And obesity has definite health consequences including increased risks of diabetes, heart disease, cancer, arthritis and sleep apnea as explained above.

Therefore it is imperative that women are aware of these changes and can take steps to prevent or treat them. The obvious tips would be:

• Avoid or quit smoking.
• Control Obesity.
• Exercise
• Follow a diet low in saturated fat and high in fiber.
• Treat and control medical condition

Although many women may be able to control their obesity through these measures, some- quite a few actually- may fail because either they are too obese to lose weight on their own or, their diseases (diabetes, heart disease, joint pains) warrant early intervention. It is particularly for these women that bariatric surgery comes very handy. This keyhole solution – a stapling procedure to ensure less dietary intake – has revolutionized the way we approach obesity these days. In the modern world, if the woman is unable to conquer her quest for weight loss on her own, she doesn’t have to live with it. A surgery can actually fix her. What’s more? It takes care of her diabetes, sleep apnea, heart disease, hypertension and arthritis. May I add here that we must not forget how they regain their beauty apart from the health from bariatric surgery!

So, if you are a woman above forty (that technically means a woman of 18 years of age with 22 years of experience) you need to be smarter- especially after reading this article. You need to be careful about your diet and your exercise and prevent obesity at all cost.  However if you are not lucky and you are obese, you need to fight the fat either by your own efforts or you may choose bariatric surgery if nothing works.

Watch the Video on YouTube for Bariatric Surgery.

In a recent research called the STAMPEDE trial– from Cleveland Clinic, USA,a comparison was done between diabetic patients managed on medicines versus bariatric surgery. The patients’ chosen were obese diabetics including the mildly obese. One group of patients was treated by drugs and diet under the intensive supervision of an expert team of physicians. The other group was treated by bariatric surgery. These patients were followed up for at least 3 years. It was seen that the post surgical patients lost more weight and were either off medicines or better controlled whereas the patients treated on diet and drugs did not match up at all with these targets. It was concluded that bariatric surgery worked better than medicines in the treatment of obese diabetics. They also observed that a particular bariatric procedure – gastric bypass was more beneficial than the other procedure called the sleeve gastrectomy. It was further seen that bariatric surgery worked very well even for the diabetics with mild obesity.

This research has thrown light upon how diabetes occurs. It is now known that there are chemicals in the body that are called incretins and antiincretins the balance of which dictates whether insulin will work satisfactorily or not. The gut and the fat cells are responsible for the release of these chemicals and hence addressing them leads to resolution of diabetes. It is worthwhile to remember that the blood sugar of the patient comes to normal immediately after the surgery much before any weight loss has occurred. This is evidence that the gut brings about the normalization of diabetes independent of weight loss by producing the incretins. More research is however underway to evaluate these incretins and study their effects. Future research in diabetes is exciting and holds promise for millions of diabetics in the world.

This is also great news for the seven crores diabetics in India. With the awareness spreading regarding bariatric surgery, many diabetics may now be able to resolve the disease once and for all instead of living in fear of complications. Diabetes kills patients through various complications such as heart attacks, strokes, hypertension, kidney failure, etc. In addition, the diabetic patients are under potential risk of blindness, infections and loss of leg. These translate into increased cost and morbidity. Preventing these complications by bariatric surgery will improve the quality of life, be cost effective and at times life saving.

Diabetes has always been considered an incurable disease that can be treated only by medicines. However research has eroded this notion and had mode this disease better understood and conquerable. The resolution of diabetes by bariatric surgery has therefore been hailed as the most important medical discovery of the last decade.

Watch video on Bariatric Surgery for Diabetes on YouTube.