Obesity is today, the most talked about problem in this modern world.  A morbidly obese patient will also suffer from anxiety; low self esteem, low vigour and stamina etc. But these problems can be taken care of thanks to the emerging techniques in “Bariatric surgery”. This surgery has come as a beacon of hope for morbidly obese patients who weigh as much as 100 kg and above!

Bariatric surgery has been in practice for over three decades. It was an all 'open' operation in the beginning. With the advent of laparoscopic or key hole surgery, many wound and lung-related complications of open surgery were eliminated. Further the post-operative pain was minimal and the recovery was faster. Morbid obesity has become a menace for millions of overweight people across the world. Hence, there has been a resurgence of bariatric surgery in the last decade. All morbidly obese patients are not suited for Bariatric Surgery. A patient has to be fully evaluated before surgery. Evaluation includes work up for hormonal problems, presence of association abnormalities like diabetes, hypertension, and heart and lung disease. The patient is evaluated psychologically to rule out depression and other related issues. He must also be keen to be motivated to adhere to the regime that precedes and follows surgery.

Restrictive Surgery: This aims to reduce the capacity of the stomach to about 60 ml - thus ensuring early satiety in the patient and reduced food intake. The capacity can be reduced by using a silastic band that goes around the upper part of the stomach and constricts it. It may also be done by applying staplers that compartmentalise the stomach with a small capacity upper part and a larger de-functioned lower part. Gastric Bypass: Bypasses cause reduced absorption by diverting food away from parts of the small intestine that is responsible for absorption of food. The typical gastric bypass done today combines the reduction of capacity of the stomach and the bypass of the upper small intestine thus ensuring effective weight reduction. What is important is for the patients to understand that a whole regime of disciplined life style is needed even after surgery. Most people think that obesity surgery is like surgery for gall stone disease or hernia. It is not!
Dr K Lakshman

The author is a Laparoscopic surgeon at Sagar Apollo   Hospital, Bangalore.