METABOLIC & BARIATRIC SURGERY
OVERVIEW

• Metabolic and bariatric surgery, the treatment of morbid obesity and obesity-related diseases and conditions, limits the amount of food the stomach can hold, and/or limits the amount of calories absorbed, by surgically reducing the stomach’s capacity to a few ounces
• Candidates for bariatric surgery have a body mass index (BMI) of 40 or more, or a BMI of 35 or more with an obesity-related disease, such as type 2 diabetes, heart disease or sleep apnea
• Bariatric surgery can improve or resolve more than 30 obesity-related conditions, including type 2 diabetes, heart disease, sleep apnea, hypertension and high cholesterol

TYPES OF BARIATRIC SURGERY PERFORMED

• Laparoscopic Roux en Y Gastric Bypass
  • Stomach is reduced from size of football to size of golf ball
  • Smaller stomach is attached to middle of small intestine, bypassing the section of the small intestine (duodenum) that absorbs the most calories
  • Patients eat less because stomach is smaller and absorb fewer calories because food does not travel through duodenum
• Laparoscopic Adjustable Gastric Banding
  • Silicone band filled with saline is wrapped around upper part of stomach to create small pouch and cause restriction
  • Patients eat less because they feel full quickly
  • Size of restriction can be adjusted after surgery by adding or removing saline from band
• Vertical Sleeve Gastrectomy
  • Emerging procedure
  • Approximately 85% of the stomach is removed, leaving a sleeve-shaped stomach
  • No published studies on long-term results

Dr.Radhakrishna’s special interest area is surgery for Gastro-intestinal bleeding in which he has immense experience.

GI Bleeding can present as an emergency with patients presenting with massive blood vomiting called haemetemsis. There are many causes, commonest being cirrhosis of liver and ulcer disease. Bleeding stops on its own in 90% of the patients. The rest will either require endoscopic treatment or sometimes surgery to effectively stop the bleeding. And emergency surgery in these patients is life saving.

Cirrhosis due to consumption of alcohol or chronic affliction of liver with hepatitis B or C infection hardens the liver leading on to increased portal pressure and portal hypertension. These patients present with bleeding from esophageal varices(swollen veins in the food pipe). Endoscopic variceal ligation is the treatment of choice and surgery is usually done as a last resort if all other measures fail. In view of the poor liver condition these patients are not good candidates for surgery.

Non-cirrhotics are the ones with portal vein thrombosis or non-cirrhotic portal fibrosis also form a large component of GI bleeding. These patients do very well after surgery because of their preserved liver condition.