• More and more awareness is spreading about obesity and people worldwide are realizing that obesity is not just a problem, it is a disease.
• Other approaches to obtain weight loss do not yield long term results.
• The latest breakthrough in medical field-'Bariatric Surgery' has relatively low complications and has excellent results.

• Understand the surgical process and what to expect afterward.
  
• Understand what are realistic goals and what changes will be needed to achieve them.
  
• Get connected to other patients who have had Bariatric surgery
  
• Mentally prepare for the surgery. They will also talk to your family and explain them how they could offer their support in this process.

Before the surgery, you will be required to undergo the pre-surgery medical, nutritional, and psychological evaluations. Once the surgeon announces that the patient is fit for surgery, he will explain the treatment process in details and together you will choose the most appropriate surgery suited for you. Most surgeons will perform Bariatric surgery using the laparoscopic method. However, this is a decision that the doctor and patient must make together. Read the topic-'The Surgery' to learn more about both procedures.

On the day of the surgery, you will be required to sign a consent form. Before you sign a consent form, you should have a solid understanding of what is about to take place. At Aastha, we have a panel of experts like psychologist, dieticians too who will take care of all the concerns of the patient. Your surgeon will have specific instructions for you to follow. A few of the more frequently given instructions include:

• Do not drink or eat anything prior to surgery, beginning the evening before the day of surgery.
  
• Most medicines can be taken the day of surgery, just with small sips of water (however, your doctor will have instructions regarding specific medications).
  
• Bring all of your medications with you.

So as discussed above, this surgery can be done either as an open surgery or laparoscopically. The surgeon is the best person to decide what is ideal for the patient. Ofcourse in the open method, the surgeon operates through an abdominal incision, so the recovery takes time. Laparoscopic surgery is a minimally invasive approach that involves a surgeon to operate through four tiny incisions, most of which are less than a half-centimetre in size! The surgeon inserts the laparoscope through very tiny incisions and gets a magnified view of the patient's organs on a television monitor. The surgeons are especially trained to develop skills in operating by this new method, without being able to feel tissue directly. The use of laparoscopy for more complex operations, in which the stomach or bowel is cut and re-connected, is called "Advanced Laparoscopy". Though the operating time is slightly longer than the open operation but the recovery time is much shorter. Complication rate has been similar to that with the open operation, except that no Incisional hernias (hernias occurring through the scar of the incision) have been a rare occurrence, with the laparoscopic technique.

But not everyone qualifies for less-invasive surgery. In some patients, the laparoscopic or minimally invasive approach to surgery cannot be used. It depends on medical history, surgical difficulty, and body shape. Here are reasons why you may have an open procedure, or that may lead your surgeon to switch during the procedure from laparoscopic to open:

• Presence of any dense scar or fibrosis from any previous abdominal surgery
  
• When the surgeon is unable to view the organs clearly due to any reasons.
  
• Bleeding problems during the operation

• Malabsorptive procedures: This surgery does focus at reducing the stomach size but they mainly aim on creating malabsorption. i.e. Biliopancreatic Diversion (Scopinaro procedure - rare)
• Restrictive procedures: This kind of surgery primarily reduces the stomach size.
  • Vertical Banded Gastroplasty (Mason procedure, stomach stapling)
    
  • Adjustable gastric band (or "Lap Band")
    
  • Sleeve gastrectomy
    
• Hybrid procedures: In this type, both the techniques of restriction and malabsorption are applied simultaneously. i.e. Gastric bypass surgery, like Roux-en-Y gastric bypass

After surgery, the healthcare team will make sure that your vital signs are correct and arrange for you to be taken to a recovery room. The patient will be closely monitored for the first 24 hours after surgery. To help manage pain, analgesia medication will be given.

In the laparoscopic surgery, since the incisions are small, the healing rate is faster. After surgery, the patient is put on a liquid diet and then is slowly encouraged to have a pureed, soft and regular diet. Depending upon the condition of the patient, leg exercises may be recommended and/or a compression device may be attached to the legs to help prevent the formation of blood clots and to improve circulation. The doctor generally encourages the patients to be up and walking as soon as possible to help the circulation. This surgery usually involves a 4- to 6-day hospital stay (2 to 3 days for a laparoscopic approach).

Gastric bypass surgeries may cause dumping syndrome. This occurs when food moves too quickly through the stomach and intestines. It causes nausea, weakness, sweating, faintness, and possibly diarrhoea soon after eating. These symptoms are made worse by eating highly refined, high-calorie foods (like sweets). But these problems can be easily overcome with the help of a nutritionist. In a gastric bypass, the part of the intestine where many minerals and vitamins are most easily absorbed is bypassed. Because of this, there may be deficiency of iron, calcium, magnesium, or vitamins. This can lead to long-term problems, such as osteoporosis. To prevent vitamin and mineral deficiencies, one need to work with a dietician to plan meals, and it may be required to take nutrient supplements and injections of vitamin B12. So immediately after Bariatric surgery, the surgeon will review the dietary instructions. Many Bariatric surgeons begin patients with liquid diets, and after a period of time, move them on to semisolid foods. Later, when the surgeon deems it appropriate, patients can begin eating solid foods.

Before discharge, the surgeons will discuss post-operative plan with patients, which is essential to the long-term maintenance of weight. This may include referrals to nutritionists, exercise programs, psychotherapists and/or support groups.

• Studies show that weight loss ranges from 28% to 87%. Initially, dramatic weight loss is experienced. Weight loss tapers off 18 months post-operative.
  
• No alteration of natural anatomy, food consumed passes through the digestive tract naturally allowing for normal absorption
  
• In case of Restrictive Procedure, the band can be adjusted to increase or decrease restriction
  
• Disappearance of co-morbid conditions (patients are able to stop taking many of the medications for co-morbid conditions, sleep is improved, patient can be more active, and can re-enter the workforce)
  
• Feeling of confidence and the patient can lead an active life.

• Tiny Incisions, tiny scars, so faster healing
  
• Less Discomfort
  
• Reduced Risk of Incisional Hernias
  
• Less Stress on Body's Defences
  
• Shorter Hospital Time
  
• Quick Recovery

• Respiratory problems including pneumonia.
  
• Infection, bleeding, inflammation of the intestines.
  
• Abdominal blockage.
  
• Leakage around surgical connection sites/stretched stomach outlets.
  
• Blood clots, which can result in heart attack or stroke.
  
• Stomach ulcer.
  
• Breakdown of staple line in stomach.
  
• Nutritional deficiencies including anaemia, osteoporosis or metabolic bone disease.
  
• Gall bladder disease.
  
• Nausea, vomiting, bloating and gas
  
• Diarrhoea or constipation.

After surgery, it is like a re-birth. You body has to re-adjust to the new changes. It will take some time to heal. And so recovery will also take efforts. Some patients begin to lose pounds within few weeks of their surgery. For others, a couple of months go by before they see noticeable weight loss. With courage and a circle of support, you will make it through recovery and start to do things like never before.

Always remember, the weight loss surgery is not a one-time visit to the operating room. As discussed above, it calls for a long commitment, change in lifestyle habits which include diet, exercise etc. The consequences of neglecting nutritional health postoperatively can be devastating. Vitamin and mineral deficiencies can occur. Moreover if the instructions of the surgeons are not followed well, patients may not deliver good results. So one must remember that this surgery requires a careful follow up and an extensive lifelong program of nutritional health. Let us see some of the changes that need to be made: