Frequently Asked QuestionsHere Are Some Of The Questions Answered
Question About Laparoscopic Surgery Answered.
What is Laparoscopic Advanced Surgery?
Laparoscopic Advanced Surgery comprises of all those procedures which I have been successfully performing, apart form Laparoscopic Gall Bladder Surgery and Laparoscopic Appendix removal.
What are the Examples?
The list is ever-growing:
- Inguinal hernioplasty
- Umbilical hernioplasty
- Incisional hernioplasty (Post operative abdominal Hernia)
- Removal of disease of diseased intestines, rectal cancers, colonic cancers are very scientifically done Laparoscopically. It has been proven beyond any doubt that Laparoscopy is ideal of Cancer Surgery in the chest * abdomen barring a few exceptions.
- Hiatal Hernia, Diaphragmatic Hernia, rectal & uterine prolapse.
- Removal of spleen, Kidney for various reasons is best done Laparoscopically.
- Bariatric or weight loss surgery
Are there any advantages?
Yes. There are a lot of advantages as these Surgeries which are difficult even in open Surgery and are attended to by many complications. But now with the help of excellent vision I carry them out safely and in the same anesthesia time.
In addition the post operative pain, scar, wound complications are much less and patient is back on his feet within a week, even after major operation.
How does Laparoscopic Surgery score over open surgery?
- Less painful
- Very Low incidence of local wound problems, even in diabetic patients.
- Cosmetically superior.
- Early return to work.
Is Laparoscopic Hernia better than open surgery?
For Surgeons who are well trained, Laparoscopic Hernia Surgery can be done within an hour. Secondly, in Laparoscopic Hernia repair the mesh is put behind the defect and abdominal pressure tends to keep the mesh against the hernial opening, giving a superior repair.
Recurrence rate at the hands of expert surgeon is comparable to open surgery.
Further, patient is discharged comfortably on the same day or the next day and can return to his normal duties within a week
Is Laparoscopic Surgery very expensive?
Laparoscopic Surgery is a little more expensive as compared to open surgery because most of the instruments and consumables are imported. But the cost is covered by early return to work.
Question About Bariatric Surgery Answered.
What is Bariatric Surgery?
This is a group of operations done Lpaparoscopically to reduce the obese patient’s weight quickly,bringing him down to his ideal weight for his/her body frame with a goal of:
- making him /her look younger
- reducing the risk of cardiovascular disease and other comorbidities
- providing a new start from where he can maintain a healthy weight and a lifestyle that is physically, emotionally and socially more fulfilling.
What is Obesity?
When a person puts on a lot of weight it is mainly in the form of fat.Beyond a point the excess fat proves to be very dangerous and patient develops complications like high blood pressure, diabetes,heart disease, arthritis and joint pains and increased chances of developing a debilitating and dangerous paralytic stroke
How is obesity defined and categorized?
|Obesity is defined by Quetlet’s formula,giving us a quantity called Body Mass Index(BMI)
BMI=weight in Kgs/(height in metres)square.
aAll over the worldBMI<25 is normal,26-29 mild obesity,30-35 medium obesity,35-39 ishigh obesity;BMI>40 is called morbid obesity.In Asians, and especially in Indians:
BMI<22is normal,23-27 mild obesity, 28 -32moderate ,33-35 high and >35 is morbid obesity.
This difference is due to a simple fact that Asians and especially Indians are more susceptible to complications even at lower BMI.
Why should operation be done when one can lose weight by dieting and exercise?
It has been proven conclusively by various programmes and trials that the immediate success rate with these methods is only around 15-20%.Rebound weight gain is observed in about 90% of these individuals and the resultant weight is higher than the weight patient started out with !
Surgical methods reduce the weight in 95% of cases and the failure rate even in the long term is only 5%.
Even then, it is my policy to tell the patient that he/.she should try the conservative method sincerely for at least 6 months.
What are the types of operations?
There are two main types:1.Restrictive:e.g.Gastric Banding,Sleeve Gastrectomy, Plication sleeve gastrectomy.
These operations reduce the size of the stomach drastically so that patient cannot have anything more than a small snack sized meal at a time.This leads to decreased intake,reduced apetite in some operations and this leads to weight loss.
2.Restrictive and Malabsoptive:e.g.Lap RYGastric Bypass.
In this procedure a small (30ml) Gastric pouch is created.Small intestine is sutured to it so that the food bypasses the stomach ,duodenum and some part of the small intestine.This leads to restriction and favourable changes which correct diabetes , high blood pressure, lipid abnormalities and a host of other factors.
Isn’t it true that after restrictive procedure patients put on weight?
Very true. It has happened. The reason is twofold;inadequate restriction and the patient factor.
Keeping fit and trim is a lifelong commitment and the patient should never forget that.When the patient reaches a near desired body weight ,he/she should
- exercise regularly,
- take in only those many calories that are appropriate for her ideal body weight.
The commonest cause of failure is the lack of understanding by the patient that the operation has fasttracked your weight loss programme,but the programme is NOT over!Some patients think that they can take liberties with food now that the operation is done.Actually, the operation has brought your body to a level that you can diet and exercise more effectively.
What are the complications of Bariatric surgery?
1Restrictive:Early on,vomiting due to small stomach.It is important that the pt does not get dehydrated.
Leakage:very rare ,occurs after Sleeve gastrecomy.treatment is drainage rehydration.
Rarely Laparoscopic drainage may be required.
Loose motions: commonly seen after Bypass.Treatment is to avoid spices, milk and Give high fibre food.Again the food should be chewed slowly and not gulped down.Liquids should be Slowly sipped and not gulped down.Tablets like Lomotil,Ridol keep the loose motions under control within 3-4 months.
Weakness :Due to loss of vitamins,proteins,minerals.
This can be prevented by giving lifelong vitamin supplements,calcium, iron,trace elements High protein diet,fat soluble vitamins,and taking care that the patient does not get dehydrated .
Does this surgery work in diabetics who are not obese?
MOST CERTAINLY.Gastric Bypass reduces the insulin resistance,increases thebeta cell function and actually causes hyperplasia of pancreatic beta cells,increases insulin reserve and patients get rid of their insulin and even oral medications within 3-6months; HbA1C drops to normal.Even the effects of diabetes on kidney,retina, atherogenic plaques in major vessels are known to reverse.
Only thing is that we must evaluate them by estimation of C-peptide and fasting glucose levels to calculate:beta cell function,insulin sensitivity and insulin resistance.After evaluation I decide how much it is going to help the patient.But the fact is:IT WORKS VERY WELL!
Unlike what is believed patients don’t become skin and bones(because of technique)but go to the BMI of 22-21.The difference is in the technique,making the Gastric pouch bigger and the gastro-intestinal passage not too narrow.In addition less of small bowel needs to be bypassed.