Rare spleen surgery at Fortis heals Nigerian girl

Zaneta Uwe Isalgedighi, an eleven-year-old girl from Nigeria came all the way to India because she wanted to be healthy again. Zaneta was diagnosed with Haemolytic Anaemia with Hypersplenism with Massive Splenomegaly. In simple terms, her spleen had grown four times the normal size.

For complete article Click here

Published: www.mid-day.com

For Stelios Tsihlas, 44, life was restricted to a specially-made battery operated wheelchair as that was the Tanzanian businessman’s only way to move around. He could not walk beyond 10 steps because of his massive 250 kg weight. A native of Dar-es-Salaam, Stelios Tsihlas underwent bariatric surgery in a hospital in New Delhi and feels he has got a new lease of life as the operation will help him reduce 125 kg in the next two years.

For complete article Click here

Published: www.aalatimes.com

Effortless as it may sound, for some the situation is a lot more complicated than likely. A Body Mass Index (BMI) of 35 and above signals a condition known as 'morbidly obese'. Dr Randeep Wadhawan, Head of Bariatric and GI Surgery at Fortis La Femme, has been operating on many clients who come demanding a quick-solution surgery. "People come to us after they have tried and tested all other weight-loss methods. It is in fact the last option for excessively overweight people. Also, the percentage of women opting for it is much higher than men since they face other weight-related health problems such as menstrual disorders," says he.

For complete article Click here

Published: THE TIMES OF INDIA

Obesity and Bariatric (Weight Loss) Surgery

Overview : Obesity is one of today’s most blatantly visible – yet most neglected – public health problems. Paradoxically coexisting with under nutrition, an escalating global epidemic of overweight and obesity – “Globesity” – is taking over many parts of the world. Obesity is a complex condition, one with serious social and psychological dimensions, that affects virtually all age and socioeconomic groups and threatens to overwhelm both developed and developing countries. The number of obese adults has increased to over 300 million and contrary to conventional wisdom, the obesity epidemic is not restricted to industrialized societies; in developing countries, it is estimated that over 115 million people suffer from obesity-related problems. In low-income countries, obesity mostly affects middle-aged adults (especially women) from wealthy, urban environments; whereas in high-income countries it affects both sexes and all ages, but is disproportionately greater in disadvantaged groups. Unlike other major causes of preventable death and disability, such as tobacco use, injuries, and infectious diseases, there are no exemplar populations in which the obesity epidemic has been reversed by public health measures.

The incidence of obesity in children is also on the rise as shown by school surveys in Indian cities, where nearly 30% of adolescents from India’s higher socioeconomic groups are overweight.

Technology and globalization has gifted a new kind of disease to mankind i.e. obesity and diabetes. This new disease is called “DIABESITY”. This is a great challenge to all agencies including the government, NGO’s & public at large. As the economy started growing, so did the incidence of diabetes. The nationwide prevalence of diabetes in India now tops 9%, and is as high as 20% in the relatively prosperous southern cities. By 2030, the IDF predicts, India will have 100 million people with diabetes

Obesity : According to the National Institute of health(NIH) an increase of 20% or more of your ideal body weight is the point at which excess weight becomes a health risk. Obesity can be calculated by a parameter called BMI (body mass index). This is calculated by weight(kg) /height(m2).

Classification of Obesity:

Obesity does not come alone. It is just not a matter of looking ugly or asymmetrical, infact it is associated with number of life threatening co-morbid conditions.
Some of the common co-morbid conditions associated with obesity are:

Diabetes type2	Hypertension and heart disease
Osteoarthritis of weight bearing joints	Gastroesophageal reflux disease and heart burns
Sleep apnea and respiratory problems	Depression
Infertility	Fatty liver and hepatic lipidosis
Skin breakdown	Swollen legs and skin ulcers
Urinary stress syndrome	Menstrual irregularities
Lower extremity venous stasis	Dyslipidemia
Pulmonary embolus;	Cancer

MEDICAL TREATMENT

Most nonsurgical weight loss programs are based on combination of diet , behaviour modification and regular exercise . Unfortunately, medical treatment has proven to be effective for only a small percentage of individuals. It is estimated that less than 5%, of individuals who participate in nonsurgical weight loss program will lose a significant amount of weight and maintain that loss for a long period of time. According to NIH most people in these programs regain their weight within one year called the “yo-yo effect”.

BARIATRIC(WEIGHT LOSS) SURGERY :

Bariatric surgery has provided the longest period of sustained weight loss in patients for whom all other therapies have failed. It should be viewed first and foremost as a method for alleviating a debilitating disease. A meta-analysis of more than 22,000 patients who underwent bariatric surgical procedure showed a complete resolution or improvement of their co-morbid conditions along with weight loss .The indications for bariatric surgery are:

BMI >32.5 with atleast two co-morbid conditions
BMI > 37.5 with or without co-morbid conditions.

There are two basic approaches to bariatric surgery according to the mechanism of action.

Restrictive Procedures: It works on the principle of restricting the diet intake of the patient. The procedures are:
Gastric Banding
Sleeve Gastrectomy.

Malabsorptive Procedures: Malabsorptive procedures alter digestion, thus causing the food to be poorly digested and incompletely absorbed so that it is eliminated in stool. In addition to restriction , these techniques involve a bypass of the small intestine, limiting the absorption of calories. The commonly done malabsorptive procedure is Roux en Y Gastric Bypass.

All the above mentioned procedures are being done routinely by LAPAROSCOPY (key hole surgery). The advantage of laparoscopy is:
• Faster recovery with reduced post-op pain
• Minimal blood loss ,
• Short hospital stay( 3-4 days)
• Better cosmetic results
• Early return to work.( within 7-10 days)

PROCEDURES:

(Laparoscopic Adjustable Gastric Banding(LAGB):Purely restrictive procedure. In this a silicone band is placed around the uppermost part of the stomach. This band is adjustable by an access port kept under the skin. The band divides the stomach into two portions: one small and one large. The small pouch gives early satiety hence patient eats very small amount of food, gets satisfied with it, and ultimately gains its goal of dieting voluntarily. This is a reversible procedure but it requires follow up in OPD for band adjustment.


Laparoscopic Sleeve Gastrectomy (LSG): Essentially a restrictive procedure. It involves cutting and stapling 75% of the stomach and leaving in place 25%(70ml) of gastric tube along the lesser curvature of the stomach. It also decreases appetite as with the removal of fundus of stomach ,the appetite stimulating Ghrelin hormone is also removed. This is an irreversible procedure but it does not require frequent follow up in the OPD. LSG  is being increasingly favoured as a stand alone procedure internationally. The evidence has indicated that LSG provides satisfactory weight loss with minimal morbidity and mortality. LSG also improves co-morbidities such as diabetes and hypertension.


Laparoscopic Gastric By-Pass(LRYGB) : This is a combination of restrictive and malabsorptive procedure. In this procedure a small stomach pouch(30cc) is created by stapling and then a large length of small intestine(150cms) is bypassed to join with the stomach pouch. It therefore restricts the intake of food and also produces higher levels of malabsorption . Compared to the other two procedures long term weight loss(10 years and beyond) is more and resolution of Type2 Diabetes is better in this procedure. It is a major surgery and therefore has more complication rate along with certain nutritional deficiencies eg. Iron deficiency, Vitamin B12 deficiency and Calcium deficiency.

Metabolic Surgery(MGB) : Mini gastric bypass involves making of a long narrow tube of the stomach along its right border, the lesser curvature. A loop of the small gut is brought up and hooked to this tube at about 180 cms from the start of the small intestine. The MGB has been suggested as an alternative to the LRYGB due to the simplicity of its construction, which reduces the challenges of Bariatric surgery. There are few proponents of MGB and minimum data available to compare the long term weight loss & resolution of co-morbidities vis a vis an LRYGB .

Health Benefits of Bariatric Surgery:
• Hyperlipidemia is corrected in over 70% of patients.
• Essential hypertension is relieved in over 70% of patients, and medication requirements are usually reduced in the remainder.
• Obstructive sleep apnea is markedly improved with weight loss and bariatric surgery may be curative for sleep apnea. Snoring also improves in most patients.
• Type 2 diabetes is reversed in up to 90% of patients usually leading to a normal blood sugar without medication, sometimes within days of surgery.
• Gastroesophageal reflux disease is relieved in almost all patients.
• Venous thromboembolic disease signs such as leg swelling are typically alleviated.
• Lower back pain and joint pain are typically relieved or improved in nearly all patients.

A study in a large comparative series of patients showed an 89% reduction in mortality over the five years following surgery, compared to a non-surgically treated group of patients.

Concurrently, most patients are able to enjoy greater participation in family and social activities

LIFE AFTER SURGERY:

Diet: Some of the generally accepted post surgical guidelines are:
• Chew thoroughly
• Not to drink fluids while eating.
• Omit desserts.
• Omit carbonated drinks.
• Avoid alcohol.
• Limit snacking between meals.

To gain the maximum benefit from this physiology, it is important that the patient eat only at mealtimes, 5 to 6 small meals daily, and not graze between meals, which can effectively "bypass the bypass". Concentration on obtaining 80–100 g of daily protein is necessary. This requires a change in eating behavior and alteration of long-acquired habits for finding food.

Going back to work: Most patients return to full pre surgery levels of activity within two weeks. In conclusion surgery combined with behavioural modification, is currently the only proven method of achieving long-term weight loss along with resolution of co-morbidities for the morbidly obese.