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Advanced TreatmentWith Utmost Care

At the Department of Bariatric and Minimal Access Surgery at Nanavati Super Speciality Hospital, we ensure that the RIGHT PROCEDURE IS SELECTED FOR THE RIGHT PATIENT, and best possible results are achieved.

Here, at Nanavati Super Speciality Hospital, we offer comprehensive care for all our patients, including detailed counseling sessions with our team of Bariatric surgeons, Bariatric Nutritionist, Endocrinologist and Bariatric Nurse. We also conduct monthly free Bariatric Support Group Meetings for all patients, to keep them motivated and on the path to fitness, lifelong!

Treatment & Surgeries

Obesity results from the excessive accumulation of fat that exceeds the body’s skeletal and physical standards. According to the United States National Institute of Health (NIH), an increase in 20% or more above your ideal body weight is the point at which excess weight becomes a health risk.

For every 10 extra kilograms above the stipulated body weight (measured according to height), life expectancy of a person reduces by three years.

What is morbid or clinically severe obesity?
Obesity becomes morbid when it reaches the point of significantly increasing the risk of one or more obesityrelated health conditions (also known as co-morbidities). This results either in significant physical disability or even death. Morbid obesity is a serious and chronic disease, and its symptoms build slowly over an extended period of time.

What are the risks of obesity?
Obesity is a risk factor for life-threatening diseases, including:

  • Diabetes
  • High Blood Pressure (hypertension)
  • Heart Disease
  • Obstructive Sleep Apnoea
  • Stroke
  • Heartburn or Acid Reflux Disease (GERD)
  • Cancer (in women: endometrial, gallbladder, cervical and uterine;
  • in men: colorectal and prostate)

Are you a suitable candidate for this surgery?
If you are someone for whom non-surgical procedures have failed to provide sustained weight loss, you can be evaluated for, and if appropriate, undergo life-saving weight loss surgery. This surgery is known as Bariatric Surgery (also known as metabolic surgery). Bariatric surgery is a major operation, and if you’re considering it, you must make a serious, lifelong commitment to lifestyle changes.

Our program follows WHO guidelines for the selection of Asian patients. These guidelines have also been endorsed by the Ministry of Health, Government of India. If you have a BMI (Body Mass Index) of 37.5 kg/m2 or more, or a BMI of 32 kg/m2 or more, with illness related to excess weight, and have not been able to sustain weight loss through diet and exercise, you probably are a candidate for weight-loss surgery. If you do not meet these guidelines, or we find that you are not eligible for surgery for health reasons, don’t despair. Through our intensive non-surgical weight management program, we can help you lose weight by helping you change your eating habits, modifying your behaviour and increasing your physical activity.

What are the types of surgeries?
IA variety of bariatric procedures have been described, all of which can be carried out laparoscopically or robotically. All of these involve the patient being under general anaesthesia, making 4-6 small cuts on the abdomen ranging from 5-12 mm in size, and lasting for about 1-3 hours.

Bariatric surgical procedures work on the principles of restriction, malabsorption or both. Restrictive procedures limit the intake of food, and malabsorptive procedures affect the absorption of food through the alimentary tract. In addition, these procedures cause a variety of hormonal changes in the body, thus reversing diseases like Type II Diabetes Mellitus, Hypertension, raised cholesterol, PCOS and infertility.

Studies show that the risk of death from these conditions drops significantly after weight loss.

The vertical sleeve gastrectomy, or sleeve gastrectomy, is a type of restrictive weight loss surgery. It causes weight loss by restricting the amount of food that a person can consume before feeling full. The conventional vertical gastrectomy surgery isolates a small section of the stomach for processing food, limiting the size of meals to approximately 90-100 ml after surgery. The surgery is typically performed on patients who are too heavy to have other types of weight loss surgeries with the expectation that a second surgery will be performed once weight has been lost, or on individuals who do not suffer from severe co-morbidities and are young.

This procedure has a restrictive as well as a malabsorptive effect. Physically, it restricts food intake; portions sizes after the RNYGB are drastically reduced by an early feeling of fullness. Over-eating may then cause abdominal discomfort and vomiting. While the majority of the reduction in a patient’s calorie intake is attributable to the restriction, initially there is also an element of malabsorption of fat. RNYGB also reduces a patient’s appetite. The mechanism by which this occurs is not fully understood, but is related to a change in the normal gut hormonal patterns. Bypassing the first part of a patient’s small intestine affects the production of hormones that control appetite. After RNYGB most patients feel far less hungry, often forgetting to eat. Bypass surgery also affects the hormones that control blood sugar and consequently many diabetic patients become non-diabetic soon after surgery.

The mini gastric bypass is also a restrictive and malabsorptive procedure. In this surgery, a stomach sleeve is created and separated from the rest of the stomach, which is retained in the body (like the RNYGB). The volume of the stomach sleeve is around 70-90 ml. The small intestine is then joined without disconnecting it (unlike the RNYGB) to the newly formed stomach sleeve. MGB is very successful (50-70% excess weight loss) as a primary weight loss procedure, especially in type II DM. It can be used on patients who have failed previous restrictive procedures, sweet eaters, and patients with heartburn. It has a lower complication rate than RNYGB, and is also completely reversible. In addition, it can also be converted to a RNYGB or a VSG at a later stage if required.

This is a new procedure, specifically designed for patients with Diabetes Mellitus and obesity. This combines the restrictive effect of a vertical sleeve gastrectomy, and also the malabsorptive effect of upper small intestinal bypass. In addition, it induces a variety of intestinal hormonal changes, all of which lead to lowering of blood sugar levels and resolving type II diabetes mellitus even in patients who are not obese.

The advantage of this procedure is that the chances of frequent stools and esophageal reflux are less. Also, a single anastomosis is made, which can be examined via endoscopy. It is a partially reversible procedure, which works to its advantage in selecting this surgery especially for resolution of Type II Diabetes Mellitus.

Revision Bariatric Surgery is performed to alter or repair one of the many types of weight loss surgery for the treatment of morbid obesity. The two currently popular procedures, Roux-en-Y gastric bypass and Mini Gastric Bypass, while successful, also require occasional revision. Most commonly, revision surgery is needed for patients who have undergone LAGB (Laparoscopic Adjustable Gastric Banding), a procedure no longer performed for weight loss due to unacceptable side effects. In fact the revision rate for the Gastric Banding Surgery is more than 10% during the first two years for either device-related problems or unsatisfactory weight loss.

If you have had poor weight loss/weight regain or complications of the original procedure, e.g., ulcers for Roux en Y Gastric Bypass or slippage of the band, you may qualify for revision bariatric surgery.

The growing popularity of bariatric surgery.
Many obesity related health conditions may be improved or resolved completely following a gastric bypass surgery. These include Type II Diabetes Mellitus, High Blood Pressure/Heart Disease, Osteoarthritis of weight bearing joints, Obstructive Sleep Apnoea, Gastroesophageal Reflux Disease, Infertility in women, Stress Urinary Incontinence, etc. The lifestyle of these morbidly obese patient improves significantly especially in social/economic opportunities and physical functioning and appearance.

How do I prepare for this surgery?
Before the surgery, we provide a list of laboratory and radiological investigations to be done. Once our specialist anaesthetist gives the go ahead, you can plan your surgical procedure for a convenient date. For a period of 5 to 7 days before the surgery, you’re placed on a liquid diet. You’re admitted in the hospital one night prior to the surgery in a special room for bariatric patients.

What are the risks associated with it?
Risks are usually categorized as immediate risks which include bleeding, Deep Vein Thrombosis, injury to neighboring organs (like oesophagus and spleen), shoulder pain and delayed risks, such as Pneumonia, Abdominal Infections and Pulmonary Embolism. These risks are common to all abdominal laparoscopic surgeries. The risks associated specifically with bariatric surgery are chest pain, abdominal hernia, constipation or diarrhea, stomach obstruction, stretching of the stomach and re-operation for various reasons.

Is it a quick fix weight loss treatment? If not, why?
No, it is not a quick fix weight loss program, since this is not a cosmetic procedure (unlike liposuction, which involves sucking of fat cells for aesthetic reasons). This is a metabolic surgery, which helps not only to reduce weight naturally over a period of months, but also control or cure comorbid illnesses as mentioned above.

Tell us about the procedure and recovery time?
Since the procedure is done by a minimally invasive technique, recovery is faster than conventional surgeries. The patient is ambulatory on the day of the surgery itself, and oral feeds are started a few hours after the surgery. Feeds are increased stepwise in accordance with our dietician. Patients can usually be discharged 2-3 days after the procedure.

What long-term precautions do I need? Will I return to my old weight?
Since this is a metabolic procedure, the key to its long-term success lies in maintaining a healthy lifestyle. Dietary habits need to change, and exercise is a must. Certain vitamin and mineral supplements will be required lifelong, but these usually have no untoward effects.

Studies have shown that interacting with those who have undergone bariatric procedures helps one stay more focused and motivated to maintain the newfound weight. Attending support group meetings gives a great platform to share your experiences and adjust to life better.

How does this affect my social relationships?
As they see your body undergoing a change, the attitude of those around you may change. Getting healthier will boost your confidence and energy levels, and create a more positive environment around you.

In India, how popular are bariatric surgeries for weight loss?
In India, 5% of the total population is morbidly obese, of which, around 10-15% patients opt for surgery. The demand has been on the rise over the last decade.

Why should you select our team?
Our multidisciplinary team of bariatric experts will see you through the entire process. We will ensure that you are prepared for surgery, both physically and psychologically, and we will provide the most advanced and current procedures that are right for you. After surgery, we will assist you in committing to the lifestyle changes that will assure optimal success.

Our team ofBariatric Surgery

 

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Dr. Jaydeep H. Palep Director, Centre for Bariatric & Minimal Access Surgery

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Dr. Nidhi Khandelwal
MS, Associate Consultant, Dept. of Bariatric & Minimal Access Surgery

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About Nanavati Hospital

The iconic healthcare institution of Mumbai, Dr. Balabhai Nanavati Hospital, blessed by Mahatma Gandhi and inaugurated in 1950 by India’s first Prime Minister Jawaharlal Nehru, is now reintroduced as Nanavati Super Speciality Hospital.

Nanavati Super Speciality Hospital has been at the forefront of healthcare for 65 years. Today the 350 bed facility housing 55 speciality departments offers a plethora of services in practically every field of modern medicine and health care. Our well-equipped hospital rooms, state-of-the-art departments and technologically advanced systems are all backed by the expertise and reputation of over 350 consultants, 100 resident doctors, 475 nursing staff and 1500 employees.

The hospital’s state-of-the-art Imaging Centre, spanning over 10,000 sq. ft, houses 3 Tesla 32 channel wide bore Magnetic Resonance Imaging (MRI) scanner with MR guided Focused Ultrasound Surgery (MRgFUS) and High-Intensity-Focused-Ultrasound, 64 slice Positron Emission Tomography–Computed Tomography (PET CT) with cardiac capability. The Catheterization Lab at Nanavati Heart Centre which is the first of its kind in Mumbai, has a team of highly experienced and qualified faculty providing 24x7 Interventional Cardiac Services.

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