This document discusses various surgical procedures for treating obesity, including restrictive, malabsorptive, and combination procedures. It provides details on laparoscopic sleeve gastrectomy, gastric bypass, adjustable gastric banding, and intragastric balloons. Complications of bariatric surgery are also outlined. The document recommends bariatric surgery for patients with a BMI over 40, or over 35 with obesity-related health conditions, when more conservative weight loss methods have failed.

1. SHANTI MEMORIAL HOSPITAL PVT LTD
A MULTI SPECIAILTY MEDICAL CENTRE

2. SURGERY TO COMBAT OBESITY
(BARIATRIC SURGERY)
DR. SREEJOY PATNAIK
LIFE MEMBER , SAGES, OSSI & IFSO
MINIMAL ACCESS , BARIATRIC & METABOLIC
SURGERY

3. IFSO 2010, LONG BEACH, CALIFORNIA

4. IFSO , 2011 HAMBURG

5. IFSO-2011 HAMBURG, GERMANY

6. HIS HOLINESS DALAI LAMA AT IFSO 2012, NEW DELHI

9. MENSTRUAL DISORDERS
INFERTILITY
HYPERANDROGENISM
METABOLIC SYNDROME

11. TREATMENT OF OBESITY:

12. Surgical Treatment of Obesity:
Bariatrics is the branch of medicine that deals with the causes,
prevention, and treatment of obesity.
Bariatric surgery (weight-loss surgery) includes a variety of
procedures performed on obese.

13. Surgical Treatment
of Obesity:
• According to the NATIONAL INSTITUTE OF HEALTH
(NIH)
• BARIATRIC SURGERY IS THE PERMANENT
TREATMENT OF CHOICE AND THE ONLY
TREATMENT THAT HAS BEEN PROVEN TO BE
SUCCESSFUL IN THE LONG TERM ( MORE THAN 10
YEARS).

14. BARIATRIC SURGERY GUIDELINES
THE CONSENSUS GUIDELINES ON BARIATRIC SURGERY
CALIFORNIA ASSOCIATION OF HEALTH PLANS OBESITY INITIATIVE
WORKGROUP (CAHP) JUNE 2006
THE U.S. NATIONAL INSTITUTE OF HEALTH
THE AMERICAN GASTROENTEROLOGICAL ASSOCIATION (AGA)
CLINICAL GUIDELINES DEVELOPED BY THE NATIONAL
HEART, LUNG, AND BLOOD INSTITUTE EXPERT PANEL
SOCIETY OF AMERICAN GASTROINTESTINAL &
ENDOSCOPIC SURGEONS

15. Recommends bariatric surgery for obese people:
BMI > 40 without co morbidities
BMI >35 with 1 or more co morbidities.
or
BMI of 30 to 35 with significant or serious co morbidities.
or
When less invasive methods of weight loss have failed and the
patient is at high risk for Obesity-associated morbidity and mortality.

16. Patient Criteria for surgery
1. A Body Mass Index (BMI) ≥ 40 or a BMI ≥ 35 with obesity related co-morbid
conditions.
2. Age – 16 to 65 yrs
3. Screening for mental or behavioral disorders that may interfere with post-
operative outcomes (e.g. eating disorders, depression, and substance abuse).
4. Counselling and advise to stop using tobacco products & alcohol, 4 weeks prior
to surgery.
5. No absolute contraindication to major abdominal surgery

17. 6. Should have completed a weight loss program is recommended but not required.
eg: dieting, nutritional counseling, an exercise program and commercial/hospital based weight loss
programs.
7. Received counseling by a credentialed expert on the risks and benefits of the procedure and the
potential complications of the surgery (including death) and the realistic expectations of post-
surgical outcomes.
8. To adhere to post-surgical attention to lifestyle, an exercise program and dietary changes and

18. SPECIAL POPULATIONS
criteria
• Over 65 years of age– Careful consideration on a case-by-case basis, due to the potential for
increasing risk of complications with advanced age.
• Under 16 Years of Age (adolescent obesity)– Careful consideration on a case-by-case basis,
due to the unique needs of adolescent patients.
– Benefits of performing the surgery on the adolescent patient
outweigh the benefits of waiting until the patient reaches
adulthood.

19. – Need for family inclusion in pre-assessment and counseling
.– Attainment of skeletal maturity and Tanner Stage IV
• Girls ≥ 13 years of age
• Boys ≥ 15 years of age
– Higher BMI, > 40 may be appropriate
– Sufficient Bone Age, may be necessary for determination of physiological

20. WOMEN OF CHILD BEARING AGE
– Special counseling is important due to high-risk nature of
early post- operative pregnancies, which require special
monitoring by OB/GYN and the bariatric surgeon.
– Counseled to wait 12-18 months until weight loss is stable
prior to conception.

21. Contraindications to Bariatric Surgery
Bariatric surgery carries the potential for serious complications, morbidity and
possibly mortality.
1. Cardiac complications with poor myocardial reserve.
2 Chronic obstructive airways disease or respiratory dysfunction.
3.Significant psychological disorders, or significant eating disorders.

22. CLASSIFICATION OF BARIATRIC SURGERY:
Bariatric surgery procedures can be categorized into operations utilizing 3
methods to produce weight loss: gastric restriction, mal absorption, or a
combination of the two.
1. PREDOMINANTLY RESTRICTIVE PROCEDURES
2. PREDOMINANTLY MALABSORBTIVE PROCEDURES
3. MIXED OR COMBINATION PROCEDURES

23. RESTRICTIVE PROCEDURES:
Procedures that are solely restrictive by creating a small gastric pouch
& a degree of outlet obstruction leading to delayed gastric emptying.
The goal is to reduce oral intake by limiting gastric volume, produce
early satiety, and leave the alimentary canal in continuity, minimizing
the risks of metabolic complications
1.VERTICAL BANDED GASTROPLASTY
2.ADJUSTABLE GASTRIC BANDING (LAGB )
3. SLEEVE GASTRECTOMY
4.GASTRIC PLICATION
5. INTRA GASTRIC BALLOON (GASTRIC BALLOON)

24. MALABSORPTIVE PROCEDURES
Malabsorption is achieved by creating a short gut syndrome and/or by
accomplishing distal mixing of bile and pancreatic juice with ingested
nutrients thereby reducing absorption.. Some purely malabsorptive
operations are no longer recommended due to their potential hazard to
cause serious nutritional deficiencies.
1. BILIOPANCREATIC DIVERSION
2. THE JEJUNAL-ILEAL BYPASS
3. ENDOLUMINAL SLEEVE

25. MIXED PROCEDURES:
The following procedures combine restrictive and malabsorptive approaches.
By adding malabsorption, food is delayed in mixing with bile and pancreatic
juices that aid in the absorption of nutrients. The result is an early sense of
fullness, combined with a sense of satisfaction that reduces the desire to eat.
1. GASTRIC BYPASS ROUX-EN-Y ( RYGBP)
2. SLEEVE GASTRECTOMY WITH DUODENAL SWITCH
3. IMPLANTABLE GASTRIC STIMULATION

26. SUCCESS OF BARIATRIC SURGERY
Bariatric surgery has been available for decades. Most procedures are now
performed laparoscopicaly.
Although various procedures have been described and attempted, the 3 most
common procedures performed:
1.Laparoscopic adjustable gastric banding (LAGB),
2.Laparoscopic roux-en-Y gastric bypass (LRYGB) and
3.Laparoscopic sleeve gastrectomy (LSG).
Endoscopic Procedures like – Intra- Gastric Balloon / Endo- Barrier System

27. Armamentarium in OT

29. VALLEYLAB STERRAD

30. EXTRA LONG TROCARS
OPTI-VIEW TROCARS GASTRIC CALIBRATION TUBE

32. SERIAL COMPRESSION DEVICE

33. Vertical Banded Gastroplasty (VBG)
The stomach is partitioned along its axis with a non-
adjustable poly-urethane band and with linear&
circular staples to create a small upper stomach pouch
with a restrictive orifice to the rest of the stomach.
No malabsorption of micro or macro nutrients is
expected.
No longer done was practised in 1980.

34. IFSO 2010, CALIFORNIA WITH MAL FOBI

35. ADJUSTABLE GASTRIC BANDING
(LAP BAND SURGERY/ LAGB)
Restrictive Procedure
An inflatable silicone BAND is placed around the top
portion of the stomach, to form a small stomach pouch &
sewed .
This band is connected to a tube that leads to a port above
the abdominal muscles placed below the skin (FILL –
PORT).
During follow up visits, we inject or remove saline solution
to make the band tighter or looser.

36. Adjustable Gastric Band
• This Band in the stomach and induces weight-loss in 3 ways:
1. The small stomach pouch causes a sensation of fullness
2. “Squeezing of the stomach pouch like an hour glass prolongs the
sensation of fullness.
3. Suppresses appetite by central action.

37. LAP GASTRIC BANDING

38. Complications of
Gastric Lap-Band®
• Perforation of Stomach
• Mal positioning
• Abdominal Pain
• Heartburn
• Vomiting
• Inability to Adjust the Band
• Failure to Lose Weight
• Slippage
• Gastric Erosion
• Dilated Esophagus
• Infection of System
• Fatigue or malfunction

39. LAP SLEEVE GASTRECTOMY
Laparoscopic sleeve gastrectomy (LSG) is a standalone procedure
for the surgical management of morbid obesity.
It is a rapid and less traumatic operation and thus far is
demonstrating good resolution of co-morbidities and good weight
loss.
A further second surgical step is then easily feasible, if necessary.

40. WITH DR. MICHEL GAGNER
CANADA

41. SLEEVE GASTRECTOMY
Sleeve gastrectomy is a procedure in
which the stomach is reduced to about
25% of its original size, by surgical
removal of a large portion of the stomach
along the greater curvature. This is done
by using surgical staplers to form a sleeve
or a tube with a banana shape.
A bougie or GCT between 36 - 40 Fr is
used with the procedure .
Ideal approximate capacity of the stomach
after the procedure is about 30- 60 ml
pouch

42. SLEEVE GASTRECTOMY

43. BASICS OF THE PROCEDURE:
DEFINITION AND PRINCIPLES:-
The sleeve gastrectomy is also known as the
greater curvature gastrectomy,
vertical or longitudinal gastrectomy or
Pylorus preserving ‘gastric tube creation’.

44.
The sleeve gastrectomy (SG) induces weight loss by 2 mechanisms:
1.MECHANICAL RESTRICTION by reducing the volume of the stomach and
impairing stomach mobility. Also called ‘Food limiting’ operation.
2.HORMONAL MODIFICATION by removing a great part of the Ghrelin
(Hunger Hormone) production tissue.
(Ghrelin is a 28 amino-acid-peptide, secreted by the oxyntic glands of the gastric
fungus. It is a potent orexigenic (appetite-stimulating) peptide mediated by the
activation of its receptors in the hypothalamus or pituitary area.)
The gastric fundus contains 10 to 20 times more ghrelin per one gram of tissue than
the duodenum. In the SG, resection of the fundus removes the major portion of
ghrelin release, therefore, appetite decreases.

45. PREOPERATIVE EVALUATION
LABORATORY EVALUATION:
Basic chemistry panel, full blood count, thyroid function tests. Serum cortisol, urine
cortisol, lipid profile, vitamin (A, B1, B6, B12, C).Serum Insulin, C-Peptide.
UPPER ENDOSCOPY:
Rule out inflammatory ulcerous gastric pathology, search and treat H pylori infection when
present.
ULTRASOUND OF THE ABDOMEN:
To rule out cholelithiasis, which would indicate cholecystectomy along with the gastric
sleeve.
CARDIOVASCULAR/RESPIRATORY EVALUATION:
Exclude any contraindications to anesthesia by TMT, Echo, PFT, ABG , CXR etc.
PSYCHIATRIC EVALUATION:
To rule out any behavioral abnormalities that would contraindicate limited food intake.
ENDOCRINE EVALUATION: Rule out an endocrine abnormality as the etiology of
morbid obesity.
DENTAL EVALUATION

46. TEN STEPS OF LSG
1. Assembly of instruments, in order of use
2. OT set up and Trocar Position
3. Liver Retraction –using Nathansons Liver Retractor
4. Gastrolysis of greater curvature- distal to prox. Upto> of His.
5. Resection of stomach by Stapling – starts from 4 cm distal to pylorus
6. Suturing for staple line reinforcement
7. Leak test- Methylene blue, air or UGIE
8. Extraction of specimen- fish tail technique
9. Closure of Ports- by needle passer.

47. Laparoscopic Procedure
DONE UNDER G.A
5 TO 6 PORTS
The benefits are:
•Less Pain
•Quicker recovery and return to normal
activity
•Fewer complications
•Less noticeable scar
•Shorter hospital stay

51. POSTOPERATIVE PERIOD
No nasogastric tube is placed at the end of the procedure.
GASTROGRAFFIN STUDY:
A water-soluble upper gastrointestinal study is performed all cases , and for
patients with clinical symptoms and signs of leakage.
If no leak observed, then patient is allowed to drink.
From D2 to D14, the patient remains on a liquid diet. Over the next 3
weeks on pureed diet.
Normal diet after 1 month.

52. Complications
Peri-operative Complications of anesthesia, bleeding, positioning or pressure, and those of a
technical nature. Injury to Liver or Spleen.
Early Post-operative Complications (30 days) Bleeding: anastomosis leak, infection secondary to
leak, wound or other infection, strictures, and deep venous thrombosis/pulmonary embolism.
Pulmonary complication -Atelectatsis, pneumonia, pulmonary embolism, respiratory arrest
secondary to sleep apnea, and acute respiratory distress syndrome (ARDS).
Gastrointestinal (GI) complication - Ulcer, stricture, anastomonic obstruction, and small bowel
obstruction.
Late Complications (greater then 30 days) GI ulcer (stricture, obstruction), nutrition deficiency
(one or more nutrients, protein, vitamin or mineral), internal/ incisional hernia, redundant skin,
failure of weight loss or regain of lost weight, and psychological.

53. BIB –INTRA GASTRIC BALLOON
Intragastric balloon involves placing a deflated balloon
into the stomach, and then filling it to decrease the
amount of gastric space.
The balloon can be left in the stomach for a maximum of
6 months and results in an average weight loss of 5–
9 BMI over half a year.
Done endoscopically
The intragastric balloon may be used prior to another
bariatric surgery as a stepdowm procedure.

55. BIB –INTRA GASTRIC BALLOON

56. ENDO BARRIER LINER SYSTEM
The EndoBarrier gastrointestinal liner mimics
the effects of gastric bypass surgery.
It’s designed to work by inserting a flexible
tube-like barrier into the duodenum & prox.
Jejunum..
The barrier is placed endoscopically via the
mouth and thus helps patients to loose weight
by delaying digestion.
.Has to be removed after 6 months

57. B. MAL- ABSORPTIVE PROCEDURES
Malabsorptive surgeries rearrange and/or remove part your digestive
system which then limits the amount of calories and nutrients that
your body can absorb. Treatments with a large malabsorbtive
component result in the most weight loss but tend to have slightly
higher complication rates.
1. JEJUNAL ILEAL BYPASS – no longer performed for high complication
rates.
2. ILEAL TRANSPOSITION- New malabsoptive procedure on trial for
treatment of DM type 2 and metabolic disorders.

58. C. COMBINATION PROCEDURES
RESTRICTIVE + MALABSORBTIVE
When surgery combines both restrictive and malabsorptive techniques, it is
know as a “combination” procedure. Most types of bariatric surgery carry at
least a small element of both components, but the following surgeries achieve
a notable portion of weight loss from each…
1. LAP. GASTRIC BYPASS – ROUX-EN- Y – more malabsorption than the
restrictive
2. MINI- GASTRIC BYPASS- mainly restrictive
3. DUODENAL SWITCH – the sleeve stomach is the restrictive portion &the
intestinal bypass( duodenal switch) is the mal absorptive component

59. 1. LAP. GASTRIC BYPASS/ LGB
The Roux-en-Y gastric bypass
(known simply as the LRYGBP) is
the most commonly performed
procedure.
It primarily causes
weight loss by restricting the
food intake, however there is
more amount of mal absorption that
occurs with this operation.

60. Bariatric surgery represents the main option for substantial and long-term weight loss
in morbidly obese subjects..
Two hypotheses have been proposed to explain the early effects of bariatric surgery
on diabetes--
The Hindgut hypothesis theory- Diabetes control results from the more rapid delivery
of nutrients to the distal small intestine, thereby enhancing the release of hormones
such as glucagon-like peptide-1 (GLP-1).
The foregut hypothesis theory – Exclusion of the proximal small intestine reduces
or suppresses the secretion of anti-incretin hormones, leading to improvement of
blood glucose control as a consequence increases GLP-1 plasma levels which
stimulate beta cells to produce insulin secretion and suppress glucagon secretion,
thereby improving glucose metabolism.

61. INDICATIONS :
1. BMI 35-40: WITH SIGNIFICANT CO-MORBID
CONDITIONS SUCH AS DM, HTN
2. BMI 40-60 OR SUPER OBESE
3. PATIENTS >18 YEARS
4. PATIENTS MUST HAVE ATTEMPTED
SUPERVISED WEIGHT REDUCTION PROGRAMS.

62. ADVANTAGES:
1. Most commonly performed.
2. Most reliable operation for long term weight loss.
3. Long term weight loss averages 60 to 75 percent of EBW.
6. Malnutrition is unusual.
7. Substantial improvement & resolution in many co-morbid obesity conditions:
Type 2 DM – 90% Sleep apnea -90% Hypertension-70%
Hyperlipidaemia-70% Heartburn from GERD- all patients.
Urinary stress incontinence-75%
89%reduction in mortality over 5 yrs. Following surgery, compared to non-
surgically treated group.

63. GASTRIC BYPASS/ LRYGBP
•
The stomach is stapled into
2 pieces, one small and one
large.
The small piece
becomes the “new” stomach
pouch.
• The larger portion of the
stomach stays in place,
however will lie dormant for
the remainder of the
patient’s life.

64. GASTRIC BYPASS/ LGB
• The small intestine (the jejunum) is
divided using a surgical stapler
Approx. 50-70 cm from the DJ Junction.

65. GASTRIC BYPASS/ LGB
• The end of the Roux limb is
then attached to the newly
formed stomach pouch .
Roux limb or alimentary limb
• The Roux limb carries food
to the distal intestine.
Y- LIMB/ BP
• The Y limb or BPD limb carries digestive LIMB 100-150 cm
juices from the pancreas,
gall bladder, liver and
duodenum to the intestines
• The food and the digestive
juices mix where the Roux
limb and Y limb meet much below
say 100-170 cm from DJ

66. LAPAROSCOPIC GASTRIC BYPASS
COMPLICATIONS
1. Not reversible.
2. Mortality 0.5- 1%
3. Peri operative complications 5-10%
4. Stricture of gastrojejunostomy.-10% (long term)
5. Long term risk of protein &vitamin deficiency, and marginal
ulceration of GJA.
6.Long term risk of intestinal obstruction – 2%.

67. LAP GASTRICT BYPASS

68. Bariatric surgery can be effective in achieving significant weight loss, restoration of the
hypothalamic pituitary axis, reduction of cardiovascular risk and even in improving
pregnancy outcomes.
Ultimately, bariatric surgery should be considered part of the treatment in PCOS
women, especially in those with MS.

69. Weight and type 2 diabetes after bariatric surgery: systematic
review and meta-analysis.
Buchwald H, Estok R, Fahrbach K, Banel D, Jensen MD, Pories WJ, Bantle JP, Sledge I.
Source
Department of Surgery, University of Minnesota, Minneapolis, MN 55455, USA. buchw001@umn.edu
1. METABOLIC IMPROVEMENTS AFTER BARIATRIC SURGERY
Bariatric surgery ameliorates metabolic abnormalities.
BMI and excess body weight decreases substantially after surgery .
Marked improvement is noted in glucose abnormalities, dyslipidemia and hypertension
Improvement of DM II @ 2YR follow up after surgery is proportional to weight loss.

70. Fasting glucose and insulin resistance measured by (HOMA-IR ie; HOMEOSTASIS
MODEL ASSESMENT INSULIN RESISTANCE) can
decrease > 50% within 1 month of surgery.
Whereas INSULIN SENSITIVITY measured by the eug lycemic –hyper insulinemic
clamp does not change as quickly.
Hypertension – 75% saw improvement, in 50% there was complete resolution.
WC, Lipid Profile, Insulin resistance along with in prevalence of MS from 55% - 0%
in 1 yr.

71. Clin Endocrinol Metab. 2005 Dec;90(12):6364-9. Epub 2005 Sep 27.
The polycystic ovary syndrome associated with morbid obesity may resolve after
weight loss induced by bariatric surgery.
Escobar-Morreale HF, Botella-Carretero JI, Alvarez-Blasco F, Sancho J, San Millán JL.
Source
Department of Endocrinology, Hospital Ramón y Cajal, Madrid E-28034, Spain.
hescobarm.hrc@salud.madrid.org
2. ROLE OF BARIATRIC SURGERY IN PCOS PATIENTS
A limited number (n = 17) of PCOS patients with an average age of 30 years were followed
prospectively for up to 26 mo after bariatric surgery.
Most women (12/17) regained normal menstrual function and most (10/12) had documented
spontaneous ovulation. .
Significant improvement in hirsutism, androgen profiles and about a 50% reduction in
HOMA-IR
Follow up for more than 2 years showed that all women resumed normal menstrual cycles,
HbA1C decreased from 8.2% to 5.1% in < 3 months.
78% saw improvement in metabolic syndrome & 48% showed improvement in PCOS .

72. COMPLEX
DISORDER
Key features of polycystic ovarian syndrome and improvements seen after
bariatric surgery. BMI: Body mass index.

73. 3. BARIATRIC SURGERY IN ADOLESCENTS
35% reduction in BMI and resolution of hypertension.
BMI decreases by more than 10 units
Reduction in glucose abnormalities > 80%
Excess weight loss > 80%
Reduction in Metabolic Syndrome
Improved Insulin Sensivity.

74. 4. BARIATRIC SURGERY IN REPRODUCTIVE
WOMEN:
Decrease menstrual irregularities.
PCOS women have less hyper androgenism
Sex hormone binding globulin increases
LH and FSH levels have been reported to increase
Ovulatory function measured by luteal LH and Progesterone secretion improved .
Leptin levels decrease , reflecting improved reproductive metabolic status.
Subclinical hypothyroidism significantly reduced.

75. The incidence of gestational diabetes were drastically decreased.
No effect on post-partum hemorrhage, infection, shoulder dystocia or fetal demise.

76. Improvements in pregnancy induced hypertension and diabetes mellitus and a decrease in
cesarean delivery rate.
The length of labor decreased as well as neonatal birth weight.

77. Transmission of obesity to offspring was reduced by 50%
OR
The risk of fetal macrosomia was reduced

78. THE SAFE TIMING OF PREGNANCY
optimal or minimal time
>12 mo after bariatric surgery before becoming pregnant in order to allow the
rapid weight loss and metabolic changes to subside.

79. 104 pregnancies were followed in women who became pregnant < 1 year (mean 7.0
mo) of bariatric surgery compared to
385 pregnancies (age, BMI matched) conceived > 1 year (mean 56.7 mo) post-
operatively.
There were no differences in
Maternal complications
Fetal outcomes
Delivery complications

80. 5. CONCLUSION
Overall, PCOS is highly prevalent and strongly associated with obesity and MS.
PCOS with obesity and/or MS develop coronary artery disease and glucose abnormalities
at a very young age and are therefore at risk for life threatening cardiac events.
Bariatric surgery is a powerful tool that should not be overlooked simply because a woman
is young or presents with PCOS and MS.
Every woman with PCOS and MS should be offered education and counseling regarding
the role of bariatric surgery in reducing their illness.
Bariatric surgery should be considered along with other medical and lifestyle alterations as
first line therapy in PCOS women with obesity and MS.

81. Research Ranking scores using a combination of factors
Types of Bariatric Category Average Long Term Complication Rate Research Ranking*
Surgery Excess Weight Loss (and reason if below ‘A’
(approx. %)
LGB Combination (primary 50 to 70% Up to 15% A
restrictive
Lap Gastric Banding Restrictive 25% to 80% Up to 33% A
BPD/DS Mal absorptive 65% to 75% Up to 24% A
Vertical Banded Restrictive 50% TO 60% Up to 21% B
Gastroplasty
Vertical Sleeve Restrictive 65% to 75% Up to 10% B
Gastrectomy
Mini Gastric Bypass Combination (primary 60% to 70% Up to 8% C
Surgery restrictive
TGVR Restrictive Needs more research n/a C
TOGA System Restrictive n/a n/a
Endobarrier Mal absorptive n/a n/a D
Endoluminal Lining
Implantable Maestro Neither restrictive nor n/a n/a
System mal absorptive;
electrical impulses said
to affect hunger

82. SUMMARY OF ALL TYPES OF SURGERY
LRYGBP – worlds best procedure, 60-70% WL, dumping syndrome,
malnutrition.
LAGB- low complications, varying range of wt. loss, frequent post-op visits ( 10)
DS/BPD- more wt. loss , high complications, good for high BMI > 50,
malabsorption +
VBG – longest available results, good wt. loss, improved co-morbidities, right for
some pts.risks too high to justify rewards
SG- needs long term research, 1st step procedure, low risks, higher wt. loss,
pouch could Stretch over time, long staple line could cause problems in future .

83. RESOLUTION OF DISEASES FOLLOWING BARIATRIC SURGERY

91. TABLE SHOWING % OF WEIGHT LOSS AT SHANTI MEMORIAL HOPSPITAL
S.L PATIENT INTIAL B.M.I I.B.W P.B.W WEIGHT D.OO PROCEDURE % OF
NO NAME BODY LOSS (K.G) WEIGH
WEIGHT T LOSS
1 RAGHAV 135 KG 44.5 76 KG 72 KG 63 KG 27.02.2010 SLEEVE 96 %
GOENKA GASTRECTOMY
2. SANJAY 158 KG 56 72 KG 80 KG 68 KG 23.04.2010 SLEEVE 79 %
SWAIN GASTRECTOMY
3. DIGBIJAY 127 KG 45 70 100 KG 27 KG 23.04.2010 SLEEVE 47%
SAHOO GASTRECTOMY
4. MANOJ DAS 139 KG 56 60 KG 90 KG 49 KG 09.12.2010 SLEEVE 58%
GASTRECTOMY
5. SANTOSH 108 KG 46 57 KG 67 KG 41 KG 16.01.2011 SLEEVE 80%
PRASAD GASTRECTOMY
6. M.ARUNA 112 KG 44 63 KG 75 KG 32 KG 07.04.2011 SLEEVE 65%
GASTRECTOMY
7. MANASMITA 110 KG 43 60 KG 78 KG 29 KG 25.07.2011 SLEEVE 58%
PRIYADARSINI GASTRECTOMY
8. UMESH 100KG 35.5 72 KG 80 KG 20 KG 04.11.11 SLEEVE 53%
GOENKA GASTRECTOMY
9. HEENA 132 KG 53 63 KG 92 KG 40 KG 17.04.2011 SLEEVE 58%
AGARWAL GASTRECTOMY
10. KISHANLAL 109 KG 38 72 KG 83 KG 26 KG 12.05.2012 SLEEVE 70 %
PANCH GASTRECTOMY

92. TABLE SHOWING % OF WEIGHT LOSS AT SHANTI MEMORIAL HOPSPITAL
S.L PATIENT INTIAL B.M.I I.B.W P.B.W WEIGHT D.OO PROCEDURE % OF
NO NAME BODY LOSS (K.G) WEIGH
WEIGHT T LOSS
11. CHANDAN 149 KG 47 79 KG 95 KG 54 KG 12.05.2012 SLEEVE 77%
MOHANTY GASTRECTOMY
2. PUSPITA DAS 100 KG 41 60 KG 75 KG 25 KG 10.06.2012 SLEEVE 62.5%
GASTRECTOMY
3. GOPAL 107 KG 37.5 73 KG 86 KG 21 KG 10.06.2012 SLEEVE 61%
SIKARIA GASTRECTOMY
4. SUDATTA DAS 90 KG 43 52 KG 56 KG 34 KG 07.07.2012 SLE EVE 84.5%
GASTRECTOMY
5. RABINDRANA 107 KG 42 66 KG 81 KG 26 KG 15.07.2012 SLEEVE 63%
TH SENAPATI GASTRECTOMY
6. SMITARANI 100 KG 40.5 57 KG 71 KG 29 KG 19.08.2012 SLEEVE 60%
SWAIN GASTRECTOMY
7. VIJAY 174 KG 56 76 KG 153 KG 21 KG 03.09.2012 SLEEVE 21.5%
SHARMA GASTRECTOMY
8. VINOD 154 KG 55 71 KG 126 KG 28 KG 03.09.2012 SLEEVE 35%
SHARMA GASTRECTOMY
9. DINESH 122 KG 43 65 KG 98 KG 24 KG 01.10.2012 SLEEVE 42%
AGARWAL GASTRECTOMY
10. APARAJITA 100 KG 38 65 KG 83 KG 17 KG 04.11.2012 SLEEVE 33%
PATNAIK GASTRECTOMY

93. Conclusions
• Bariatric surgery is an effective
means to achieve clinically
significant, permanent weight loss
with low rates of complications

94. Bariatric surgery saves lives and
money

95. MY SINCEREST THANKS TO ALL THE MEMBERS OF
ASSOCIATION OF OBSTETRICIANS &
GYNECOLOGISTS OF ODISHA
MY SPECIAL THANKS TO ORGANISING
CHAIRPERSON
DR. S. KANUNGO
& ORGANISING SECRETARY DR. SUJATA MISHRA