Obesity Management

Treatment options of obesity

Non surgical Treatment (Conservative)

• Diet
• Exercise
• Medication
• Hypnosis
• Acupuncture

These treatment options are at most, in the majority of cases, temporary fixes. For the morbidly obese results are only ever short lasting.

According to recent research non surgical methods of weight reduction help patients lose only 10% of excess weight which is regained within a few years. This repeated pattern is known as the ‘Yo Yo Syndrome”.

So if you tried some or all of the above non surgical treatment options and you failed and you are tired of feeling isolated, depressed, getting short of breath very quickly, having trouble getting in and out of your car, sitting in public transport, can not take part in playful games with family and friends and your BMI is 35+ or 30+ with associated medical problems then you are a candidate for surgery.

Interventional Treatment Options

1. Intragastric Balloon:
    

   • A balloon is inserted into the stomach with the help of an endoscope and filled with air.
   • Procedure takes only half and hour.
   • It is done under IV sedation or general anaesthesia.
   • It helps the patient lose 13-24kgs in six months.
   • It is for patients with a very high BMI to downsize them before permanent surgery.
   • This is also an option of patients not qualifying for surgery.
   • A small number of patients cannot continue with intragastric balloons more than a few days due to nausea and vomiting

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2. Laparoscopic Gastric Banding
   Click here to open an interactive presentation on Laparoscopic Gastric Banding Surgery.

   
    

   • An inflatable band is placed around the stomach with the help of keyhole surgery.
   • Its tubing is attached to an access port which is placed on the muscle of the tummy.
   • The port is used later to inflate the small balloon inside the band to narrow the stomach
     gradually to stop patients eating big meals.
   • This procedure is the least invasive with the least risk factors associated with this surgery.
     Its mortality is 1/2500 compared to 1/1000 in gall bladder surgery
   • This procedure does not change the shape of the stomach or bowel.
   • The band can be removed at any time and deflated at any time allowing the stomach to go
     to its original size and shape.
   • The band does not interfere with a baby’s development during pregnancy.
   • It has been around for more than 10 years with numerous academic publications indicating its effectiveness.
   • The band helps patients lose 50-60% of their excess weight
   • Gastric banding does not cause any nutritional/metabolic problems provided patients take vitamin
     and mineral supplements regularly.
     

     Possible side effects

   • Slippage - considered a surgical emergency usually due to constant vomiting as a result of eating wrong types of food. The lower stomach slips through the band and causes complete blockage of the stomach. The patient usually experiences severe pain and is unable to even drink water. This complication has occurred in 0.66% of our patients.
   • Gastric band erosion – The band erodes into the stomach resulting in the patient being able to eat normally with the resulting weight gain. This requires the removal and replacement of the band. Dr. Durmush has never had this complication in his series. Its incidence is normally less than 1%
   • Tubing problems – Commonest problem usually fixed with minor surgery. Its incidence is 5% in our series.
   • Leaking band – we never experienced this complication.
   • Conversion of laparoscopic surgery to an open procedure. This is usually done as a result of intraoperative complications such as bleeding, organ injury and excessive scarring from previous surgeries. We have had less than 1% occurrence in our series.
     
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3. Laparoscopic Sleeve (Tube) Gastrectomy
   
   Click here to open an interactive presentation on Laparoscopic Sleeve Gastrectomy.

   
    

   • This operation involves removing 2/3rds of the stomach with a stapling device using keyhole surgery. The stomach’s capacity is reduced from 1000mls to 150-200 mls. A patient can lose 60-70% of excess weight within a year or two.
   • This operation is a ‘set and forget’ operation. By this we mean there is not need for adjustments. Patients can eat foods like steak, sausages and bread, which is not possible with gastric banding.
   • Hospital stay is for three days.
   • A possible complication of the tube gastrectomy is leaking from the staple line in 1% of patients. Should this happen the patient might stay in hospital for a lengthy period of time.
     
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4. Biliopancreatic Bypass
   
   Click here to open an interactive presentation on BilioPancreatic Diversion

   
    

   • This operation combines removal of 2/3rds of the stomach along with a long intestinal bypass which significantly reduces the absorption of fat. It usually causes 4-5 foul smelling bowel activities a day and might cause skeletal and metabolic problems in the long term.
   • It is usually done as open surgery which increases the rate of complications and mortality significantly
   • It gives the best results in the long term. Patients can lose up to 80-90% of their excess weight in 2 years.