| AMRI Obesity Surgery Clinic |
If you are obese and suffering from many of its associated problems there is finally a solution at hand. For the first time in Eastern India, we have established an obesity surgery clinic that provides all the well established surgeries for permanent cure of obesity. These surgeries are being performed by key-hole surgery (laparoscopy) and at fraction of cost in the west.
If you are severely overweight and have not had much success with dieting, exercise, or behavior modification, surgery may be an option. |
| WHY SURGERY? |
| We all know the best way to lose weight: Dieting and exercise! While many people are successful at using dieting and exercise to lose weight temporarily, often people have difficulty keeping this weight off. For those who are seriously overweight, weight loss is not just cosmetic |
| An Obese Person Is......... |
| 6 times more likely to develop gallbladder disease |
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| 5.6 times more likely to develop high blood pressure |
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| 3.8 times more likely to develop diabetes |
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| 2 times more likely to develop osteoarthritis |
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| Higher rates of cancer have also been linked to obesity including prostate, breast, cervix, and ovarian cancers. |
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| Losing weight will significantly reduce the many health risks that accompany obesity; |
| Co-morbidity associated with obesity (BMI 28 or over) |
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| Respiratory disease |
10-20% |
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| Menstrual irregularity & Infertility |
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| Cancers—Esophageal, Prostate, Colon, Ovarian, Cervical, Uterine, Breast, |
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| IS SURGERY FOR ME? |
If you are severely overweight (roughly 30 kg or more) and have been unsuccessful at dietary / behavioral approaches to weight loss, you may be a candidate for laparoscopic weight-loss surgery. Laparoscopic surgery is a minimally invasive procedure, performed through multiple small incisions (1/4” to ½” long) using specially designed surgical instruments and viewed through a laparoscope, or surgical telescope.
Surgery is NOT a “magic cure” for obesity. Surgery is a tool to help you lose weight. Even after a weight-loss operation, it is necessary to follow a special diet and exercise regularly. However, surgery has been shown to provide better and more permanent control of severe obesity than any other weight-loss method available today |
| HOW DO I DETERMINE IF I ‘M A CANDIDATE? |
| In order to determine if you are a candidate for weight-loss surgery, it is helpful to know your Body Mass Index or BMI. It is equal to your weight (in kilograms) divided by the square of your height (in meters). |
| Body Mass Index—WHAT DOES IT MEAN? |
| For Indian Population Classification of Obesity is as below: |
| BMI |
22.5 to 27.5 |
OVERWEIGHT |
| BMI |
27.5 to 37.5 |
OBESE |
| BMI |
37.5 and Over |
SEVERELY OBESE |
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Surgery is recommended if your BMI is over 37.5
Surgery is also recommended if your BMI is above 32.5 provided you suffer from co-morbidities like Diabetes, Sleep Apnoea, Hypertension, Insomnia, and Depression etc. |
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| Important: Remember that; while significant, your BMI is only factor in the decision to have weight loss surgery. Many other factors, such as your ability to tolerate an operation, must be carefully considered. |
| EVALUATION |
| Routine tests are done prior to surgery in all the patients to evaluate pre-operative co-morbidities and plan the surgery so as to avoid complications in the peri-operative period. The tests include: |
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| Blood sugar (Fasting, Post-Prandial) |
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| Lung Function Tests and Sleep Study |
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You will be further evaluated by a team of specialists depending upon your co-morbidities.
The team consists of associated specialists from:
Endocrinology, Psychology, Nutrition, Gastro-enterology, Pulmonology, Cardiology. |
| SURGERY FOR OBESITY |
ADJUSTABLE GASTRIC LAP-BAND: The lap band system is a device used to help you loss weight. The lap band helps you eat less by limiting the amount of the food that can be eaten at one time and it increases the time it takes for food to be digested. The lap band system consists of a hollow silicon band tubing and a across reservoir. The band is placed around the upper part of stomach, creating a small pouch that can hold only a small amount of food. The narrowed opening between the stomach pouch and the rest of the stomach controls how quickly food passes from the pouch to the lower part of the stomach. Connected to the band is tubing which is attached to a port, this part is placed under the skin in a muscle in the chest wall. Once the band is in place it can adjusted. Your consultant makes adjustments to the band by adding saline by injecting into the port. This allows for the inflation of an inner band.
By inflating the band it makes the opening to the stomach smaller causing food to pass through slowly. The band can be tightened or loosened to meet your needs; depending on your weight procedure you do not need an anesthetic for this. |
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| LAP-BAND |
GASTRIC BYPASS |
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| LAPAROSCOPIC ROUX-EN-Y GASTRIC BYPASS |
| Gastric bypass involves creating a small pouch by dividing the stomach. The small intestine is divided and brought up to join the new stomach pouch. This allows food to go straight from the stomach pouch into the small intestine, which causes it to bypass the lower stomach and the duodenum (the first segment of the small intestine). This reduces the amount of calories that the body absorbs. |
| LAPAROSCOPIC SLEEVE GASTRECTOMY |
| In this procedure stomach is divided vertically and made in a narrow tube capable of holding 80 to 90 ml. of food at a time. The effect is same as gastric bypass. Specially recommended for younger patients, or super obese. |
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SLEEVE GASTRECTOMY |
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| RESULTS OF BARIATRIC SURGERY |
The effectiveness of the Bariatric surgery depends on the success of the surgical procedure and the ability of the patient to change his/her diet and eating behavior. Patients choosing Bariatric surgery have to be committed to long term lifestyle changes, including dietary and behavioral modifications.
Patients can expect gradual weight loss up to 2 years. Patients may lose 70-80% of their excess weight within 18 months after surgery. Studies with a follow-up of over 5-years confirm that weight loss is long term. Majority of weight loss occurs in the first year. Much depends on the degree of post-operative complications and patient compliance with dietary guidelines. Weight loss is more, rapid and is sustained in the gastric bypass procedure compared to lap band which in itself is very powerful modality for sustained and significant weight loss in comparison to supervised dietary regimens. Sleeve Gastrectomy is equally effective in reducing weight. |
| CAN THERE BE ANY COMPLICATIONS OR RISKS? |
As with all surgery obesity surgery also has risks.
These include: |
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| Band slippage or band erosion. |
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| Conversion to open surgery (larger incision) may required if it proves impossible to perform your surgery with key hole technique. |
| LIFE AFTER SURGERY |
| The following factors can prevent you from losing weight effectively. |
| Eating beyond the point of filling full |
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| Drinking high calorie drinks, this includes alcohol |
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| Not exercising regularly or sufficiently. |
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You should realize that surgery is not the end of your weight problem rather it’s a means to achieve your desired weight loss goal in a more effective and reliable manner. You can make your surgery doubly effective by following simple nutritional and fitness recommendations. Moreover, here the surgery is a powerful tool to enforce lifestyle modification. Hence, successful outcome depends upon your ability to make necessary changes and not on surgery alone.
The stomach pouch that is created by the operation is only 25-30 ml in size, and thus it creates a substantial restrictive effect. The pouch fills rapidly after eating a very small amount of food. Therefore, the operation significantly decreases the amount you are able to eat in one sitting. At the same time you loose the desire of eating (satiety effect).
The operation also has a slight malabsorptive effect. Because of this, it will be necessary to take vitamin and mineral supplements after the operation.
Finally, the operation may cause you to experience a “Dumping Syndrome” if you eat concentrated sweets or carbohydrates. With dumping, you may feel weak and sweaty and may suffer from diarrhoea afterward. This is an intentional side effect of the procedure that has been referred to as the “post-op police officer,” as it strongly discourages the eating of sweets. |
| POST OPERATIVE DIET ADVICE |
| First one week after surgery: |
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| Three meals a day consisting of soups and milk based puddings |
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| The following Three weeks |
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| Fluids such as water, tea, coffee must be taken between meals, not with meals. Remember fluids must be zero/low calorie. |
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| The consistency of the meal should be smooth, no lumps. |
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| You may need to sieve the pureed food. |
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| From eight weeks onwards |
| Introduction of a well balanced diet based on solid foods 3 meals a day. |
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| Daily food allowances: (90gm protein) (Raw weights) (1100 calories) |
1. Cereals
a) Rice & rice based products
b) Wheat & wheat based products
c) Corn & corn based products
(Whole wheat Pasta/Rice/Oats/Barley/Millets)- 50gms/day
2. Pulses & its products / soyabean-25gms/day.
3. Fresh vegetables (as desired) - which are allowed (Boiled, Steamed, Blanched/ Salad/Soup)
4. Fresh fruits - 200gms (which are allowed)
No juices- fruits, vegetables, soups,
No sauces no canned & tinned.
5. Skimmed milk-500ml/day
6. Lean chicken-200gms/day
7. Venison meat/fish-50gms/day
8. Egg white-3
9. Oil- 1 tsf (Soya oil/ Olive oil/ Butter) |
| Sample Chart |
| 7.00 am |
Buttermilk from 250ml yogurt (no sugar) |
| 9.00 am |
Porridge (of 20gm raw weight) + egg white (3-boiled/poached) |
| 11.00 am |
Fruits (which are allowed) |
| 1.00 pm |
Steamed rice (of 15gm wt) + chicken stew or pasta/pish pash, plain salad |
| 4.00 pm |
Plain salad |
| 6.00 pm |
Cold milk-250ml (no sugar) |
| 9.00 pm |
Steamed rice (15gm raw wt) + fish/venison (stewed/backed) + Soya bean |
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| Foods allowed |
Vegetables
Cucumber, tomatoes, radish, papaya, lettuce, spinach, cabbage, broccoli, Cauliflower, onions, ginger, garlic, Brussels sprouts, mint, parsley,Celery, mushroom, eggplant, French beans, bottle gourd, squash, Capsicum. |
Fruits
Watermelon, muskmelon, strawberry, pineapple, raspberry, guava, sweet lime, orange, blackberry, rose apple, pummelo, papaya, and kiwi |
| Try to eat home cooked foods |
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| Keep kitchen weighing scale for your convenience |
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| Take small frequent meals |
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| Foods not allowed |
| Whole milk & its products. |
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| Ghee, oil, fried foods, rich gravies, cheese , cream, ice-cream |
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| Canned & tinned products, readymade soups, cutlets |
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| Bakery products , cakes ,pasty patties, ham, sausages , sauces, chips, cookies |
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| Mutton, egg yolk ,mayonnaise |
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| Potato, banana, fruit juice, mango, water chestnut, sweetmeat |
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| Sweets of all kinds like sugar, honey |
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| Dry fruits & nuts, coconuts & its products, muffin |
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| It is very important that the food is chewed well. |
Fluids such as water, tea, coffee must be taken between meals, not with meals.
Remember alcohol has high calorie content.
Multi vitamin must be taken.
It is important that you maintain regular contact with the dietician before and after your surgery. |
| Patient Before Surgery and Patient after surgery |
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| BEFORE SURGERY |
AFTER SURGERY |
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| CONTACT |
DR. V. K. BHARTIA FICS, FRCS,
Chief Bariatric Surgeon
Director, Institute of Minimally Invasive Surgery
Head of Department, Laparoscopic Surgery
Room 112, Annexe Building, AMRI Hospitals, Dhakuria, Kolkata
Tel : 91 33 2461 2626 Ext. 2212
Cel : 91 98310 73999
Email : vkbhartia@gmail.com |
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