Dr. Prasad Bhukebag– Consultant Laparoscopic and Bariatric Surgeon with Digestive Health Institute by Dr Muffi.
Obesity is rising and there is an overall increase in the incidence of adults as well as children who are overweight or obese in the world. It can be attributed to the consumption of high calorie foods and over-consumption of sugars. Sedentary lifestyles, longer working hours, lack of adequate sleep and exercise also contribute to excessive weight gain. Morbid Obesity is associated with multiple problems, which make it difficult for patients to lead a normal life. It inhibits one from leading a fruitful and productive life as affects almost every aspect of it. Behaviour Therapy, Diet and exercise have limited success in achieving or maintaining long-term weight loss in the morbidly obese people, it can at best be an important adjunct to bariatric surgery in achieving and maintaining weight loss.
Bariatric Surgery is surgery for weight loss and today it is the only option, which provides long-term durable weight loss. It is the only field of surgery wherein numerous coexisting medical diseases afflicting the overweight and obese individuals including Diabetes Mellitus, Hypertension, high cholesterol, sleep apnea, chronic headaches, venous stasis disease, urinary incontinence, liver disease, and osteoarthritis to name a few can simultaneously get better or potentially cured with just one single operation.
Bariatric surgery started around 50 odd years back and initially all the operations were carried out with an open technique. Open techniques involved making large incisions on the abdomen to perform the procedures and was associated with a very high incidence of morbidity and mortality. Many complications were observed which made the surgery itself more risky and difficult to accept for the general population. The complications would include severe pain, difficulty in breathing, wound infections and wound dehiscence with hernia formation because of the size of the patients, longer operating times led to delayed recovery, delayed mobilisation, clotting in the veins of the lower limbs (Deep Venous Thrombosis) and higher risk of Pulmonary Embolism and sudden death. Increase in Anaesthesia times led to risk of anaesthesia complications.
Surgeons also faced technical difficulties in performing these procedures with inadequate vision and access of intra-abdominal contents as well as difficulty in muscle closure of abdominal wall.
Minimal access surgery involves performing surgical procedures through tiny single or multiple incisions (not larger than 15mm) on the abdominal wall.
Laparoscopy or the minimal access approach to the abdomen was first attempted by Gynaecologists and eventually gall bladder and appendix removal was done through this technique.
Its application in the obese people was always a challenge and it was never attempted until 1994 when Drs. Wittgrove and Clark reported the first case series of Laparoscopic Gastric Bypass. Thereafter there was a rapid increase in the number of bariatric procedures performed and acceptability of Bariatric Surgery amongst patients started increasing.
It was not until 2008 that a single incision surgery through the navel was attempted for Bariatric Surgery. Dr M Lakdawala was the first to report a single incision Sleeve Gastrectomy in Asia.
Robotic surgery has now made inroads into the space of Bariatric Surgery through the same minimal access approach.
The main advantages that minimal access bariatric surgery offers include lesser pain, shorter hospital stay, lesser blood loss, early mobilisation, better cosmetic results and hence decrease in all complications related to big cuts on the abdomen. Shorter hospital stay in turn aids better utilisation of resources and lesser expenses.
Single incision surgery also offers confidentiality as the scar is Heiden in the belly button and is a boon to scores of young girls not wanting to reveal that they have had Bariatric Surgery.
Minimal Access Surgery has thus helped Bariatric surgery progress in leaps and bounds and gain wider acceptance amongst the general population benefitting millions of obese people have a better life.
