The surgery for obesity, (bariatric surgery), alters the digestive process and promote weight loss by reducing the parts of the stomach to make it smaller. Operations that only reduce stomach size are known as “restrictive operations” because they restrict the amount of food the stomach can hold. Some operations combine with a partial bypass of the small intestine. These procedures create a direct connection from the stomach to the lower segment of the small intestine, literally bypassing portions of the digestive tract that absorb calories and nutrients. These are known as malabsorptive operations.

The gastric band is a restrictive operation and the gastric bypass is a combination of restfictive and malabsorptive procedure.

How does an individual loose weight in surgery?

The concept of gastrointestinal surgery to control obesity grew out of results of operations for cancer or severe ulcers that removed large portions of the stomach or small intestine. Because patients undergoing these procedures tended to lose weight after surgery, some physicians began to use such operations to treat severe obesity. The first operation that was widely used for severe obesity was the intestinal bypass. This operation, first used 40 years ago, produced weight loss by causing malabsorption. The idea was that patients could eat large amounts of food, which would be poorly digested or passed along too fast for the body to absorb many calories. The problem with this surgery was that it caused a loss of essential nutrients and its side effects were unpredictable and sometimes fatal. The original form of the intestinal bypass operation is no longer used. Now procedures like gastric bypass surgery and banding are used. The surgical treatment for obesity should not be considered as a cosmetic surgery and rather an important surgery for prevention of many complications following morbid obesity.

What about plastic surgery for obesity?
Is it true that you can loose weight immediately following these surgeries?

These plastic surgery procedures that are designed remove the excess fat from the skin level from many areas of the body. In liposuction small incisions are made in the skin through which the fat is removed in individual tubes. Abdominoplasty operation is done to tighten the loose skin of the abdomen and repair the weak muscles of the abdominal wall (rectus muscle). Excess skin and fat is then removed. A large incision is placed across the lower abdomen but sometimes is like an upside down T. The main problem is the long and sometimes heavy scar. The incision is sometimes slow to heal and crusting or scabbing along the scar may occur for several weeks. And if the incision gets infected, then it takes months together to heal, especially in these fat patients. These procedures can be done only to certain individuals who have isolated deposition of fat in the abdomen and thigh areas. In this surgery only the folded skin and the subcutaneous fat is removed. The patient continues to put on weight as there is no restriction of food intake. The patients regain the lost weight and even exceed their preceding weight within a short span of time. Otherwise these should not be considered as weight reducing surgeries as these do not tackle the root cause of obesity.

What are the advantages of laparoscopic obesity surgery?
How does it does differ from conventional surgery?

Laparoscopy is easier on the patient because it uses very small incisions. In "open surgery" on the abdomen usually requires a 20- 25 cm incision through layers of skin and muscle. In laparoscopic surgery, the surgeon usually makes two to three incisions that are about just 0.5 – 1 cm long. The smaller incisions cause less damage to body tissue, organs, and muscles so that the patient can go home sooner, recover quickly, experiences fewer post-operative complications and less pain and is associated with less scaring. Many people can return to work and their normal routine three to five days after surgery. In contrast, traditional laparotomy may require a person to limit daily activities for four to eight weeks. The incisions for most kinds of laparoscopic surgery heal without noticeable scars.

Though this treatment has been on a process of continuous refinement by the surgical community the recent laparoscopic procedures has made a significant change in the surgical treatment of obesity. What's so special about the laparoscopic procedure is that is the minimally invasive route through which the surgery is performed. This allows for more precision. There's generally less trauma to the patient and quicker healing.

What is exactly done in gastric band surgery?
What do you think of gastric band surgery?

The adjustable gastric band is a useful technique to reduce the amount of food that is taken by an individual. It simply acts like a belt around the top portion of the stomach, creating a small pouch.  The patient feels full after eating only a small quantity of food. As the intake is reduced, the calories needed are removed and burnt from the excess fat present in the body. The patient looses weight slowly. The adjustable gastric band has been in use since the mid 1980s and is more popular in Europe. Although this procedure is good for moderately obese patient, these tend to have a higher failure rate in the long run. Although it is easy to perform this procedure, the cost of the lap band is prohibitive (> 1,25,000 Indian rupees) and is much beyond the reach of common man.

We understand that you frequently perform laparoscopic gastric by pass?
Why do you think that this surgery is better than the other types of surgery?

You are right. In gastric band surgery the failure rate is higher and the cost band is too high. Moreover at times the band might have to be changed. I have performed more than 20 laparoscopic gastric bypass surgeries till now with satisfying results. Laparoscopic gastric by pass surgery is associated with a higher success rate when compared to the gastric band surgery. This proceudure is the most commonly performed Bariatric surgery in United States of America.

This operation, is the most common and successful weight reduction surgery performed through out the world. First, a small stomach pouch is created to restrict food intake. Next, a Y-shaped section of the small intestine is attached to the pouch to allow food to bypass the lower stomach, the duodenum (the first segment of the small intestine), and the first portion of the jejunum (the second segment of the small intestine). This bypass reduces the amount of calories and nutrients the body absorbs. This is aimed to achieve weight loss over a period of time and not immediately, but permanently.

At the end of the 3 rd day the patient recovers fully well and they can eat normal food. But due to the reduction of the size of the stomach they can eat only a portion of the quantity of food that they were having before. Their appetite gets satisfied with small quantity of food as the fullness of the small portion of the stomach stimulates the satiety center in the brain, which controls the appetite. Once this center is stimulated the patient gets satisfied and does not crave for food any further. The second part of the surgery the bypass surgery, allows the food and the digestive enzyme to mix at a farther level than the normal patients. Due to this the nutrients are not absorbed in the body effectively.

In much simpler terms, lets take an example of a person eating 12 idlis for breakfast. After surgery, he will be able to eat only 2-3 idlis due to reduced size of the stomach and out of these 2-3 idlis only part of this is effectively absorbed in the body due to the intestinal bypass. But he continues to spend the same amount of energy everyday. Once the body is not able to derive energy from the daily food intake, it starts using the energy stored in the form of fat through out the body. These fat are slowly melted and burnt to produce energy for the day-to-day working. As a result of this continued removal of fat from the body the patient looses weight and at the end of 4- 6 months, the patient can loose upto 40% of the excess body weight. Since the weight is gradually reduced the patient never feels tired and there is no need to take rest at any point of time