Doss Clinic -Diabetes & Obesity Surgical Solutions

Hi,

I am Dr. Kundan Kharde so, today I will be discussing laser and laparoscopy in general surgery. So, both topics fall under minimal access surgery. Laparoscopy is basically surgery of the abdomen with the help of some optic fiber. In this, we make very small incisions. And through these buttonholes, we insert some cameras and optic fiber. We get a better and magnified view of internal organs on a big screen.

With the help of an instrument, we can operate many abdominal surgeries like appendix, gallbladder stones, and even hernia can be treated with laparoscopy. So, what are the advantages of laparoscopy surgery? As I said that the wound and the cut will be very small. So, there will be less pain, recovery will be faster. Hospital admission will be very less. Apart from this, we also do laser. Laser in general surgery is mostly used for varicose veins. We use laser for piles, fistula, and fissures. With the help of the laser, we can correct all those problems. The laser enables us to operate these cases in a minimal way. It gives fewer wounds, faster recovery, less pain, and lesser hospital stay.

Thank You.

Hi,

I am Dr. Neeraj Rayate. I am an expert in minimally invasive surgery, gastric related problem surgery and weight loss surgery which is scientifically also called bariatric surgery. What do we mean by minimal access surgery? It is a new tool in a vista of the surgeon which basically performs surgery without cutting or opening the abdomen. So, we make small holes in the patient's abdomen. And we do the same surgery which is done by the conventional open method. What are the advantages? Since it is not the big cut, the recovery is fast, the blood loss is minimal and for experienced general surgeons, the magnification helps in precise dissection. One of the latest extension of the application of minimal access surgery is in the science of weight loss. Conventionally we all know that for weight loss the diet and the exercise are the time tested methods which are used. But when diet and exercise don't work and when the expected weight loss is more than 30-40 kgs then probably bariatric surgery or endoscopic balloon are the tools which can be really effective for the patient. When these people are not able to lose weight despite several attempts on non-surgical weight loss, we have to understand that bariatric surgery is the biggest boon which has happened to them in the recent past.

We come across a lot of them who come to us and tell us that they have done the diet, they have taken some powders, exercises but the weight loss is temporary. The moment you stop the activities, it bounces back to gain probably more than what you have lost. So, in such situations, bariatric surgery comes for help. What do we do in bariatric surgery? This is a surgery which is performed by roots of minimal access or laparoscopy. We also do with the help of robotic surgery. We will reduce the size of the gastric pouch. The stomach in which our food gets stored and digested. And sometimes, we also bypass the part of the stomach. What does it effectively mean? It means that the person who has undergone this procedure, calorie intake will go down. Metabolic rate will also be increased. The magic of bariatric surgery is to such an extent that obese people who have diabetes, challenges because of excess weight or other problems like blood pressure, acidity, PCOS, heart disease. Patients come to us and tell that they have found new life. It is the surgery where you have to be hospitalized for 3-4 days.

Since it is done by laparoscopy so hardly any pain and blood loss. After the surgery, you get a new life. You get back on what you wear when you were at your young age. One of the effective application of minimal access surgery is coming up in a big way for various hernias. The hernias can be practically at belly button which is called an umbilical hernia. Or there can be a previous surgical scar which is called incisional hernia. There can also be hernia inside the abdomen. For all this type of hernia, surgical intervention is very much possible these days by means of minimal access to laparoscopic surgery. Patients of hernia stay in the hospital for 24-48 hours. So, many people are not aware that hernia can still be dealt with laparoscopy. It really gives advantages to the patients. Other common indication of minimal access surgery for gallstone disease. besides this, almost all procedure for the abdomen is done or possible by means of laparoscopy surgery. The only treatment where laparoscopy cannot be used in pregnancy or you have to have medical termination of the pregnancy. Besides, that laparoscopy is a very useful tool for the patients and it gives very effective results with quick recovery and satisfaction to the patients.

Thank You!

Hi,

I am Dr. Neeraj Rayate, General Surgeon and today we are going to discuss myths and facts about obesity surgery or weight loss surgery or bariatric surgery. The commonest myth about weight loss surgery is that it is nothing but liposuction. In liposuction, we just remove fat which is below the skin and called subcutaneous fat. In bariatric surgery, we do not remove any fat. So, liposuction is made to make someone beautiful while bariatric surgery is made to make someone healthy. Because after bariatric surgery, if you have diseases like diabetes, blood pressure, obstructive sleep apnea, PCOS, joint pain, reflux disease, heart disease, all these diseases are either cured, get reversed or they get better. Because the problem for all these diseases is weight. After bariatric surgery, your weight gets reduced and that is how you become healthy. The 2nd common myth is that bariatric surgery cures diabetes. It is partially true. Diabetes has 2 types. Type 1 diabetes. Now, this diabetes is because your body is not able to produce insulin.

And in type 2 diabetes, the body is producing insulin but because of excess fat, the insulin is not able to work effectively. This is called peripheral insulin resistance. Bariatric surgery causes fat loss and weight loss because of which the peripheral insulin resistance increases. That is why diabetes in obese people can be completely reversed. We have a good number of patients who have gone off diabetic patients like tablets, injections of insulin and living a healthy life without any anti-diabetic drug. Whereas who have type 1 diabetes and not able to produce insulin, their utility of diabetes or bariatric surgery is only for the purpose of weight loss and not for the purpose of diabetes reversal. Another common myth about bariatric surgery is that it is an irreversible surgery. No, it is not. In fact, surgery of gastric bypass is the surgery which can be completely reversed. So, in future at a given time, if you are feeling like going back to your original anatomy where you were, that is very much possible. The endoscopic gastric balloon is a procedure which is done very routinely in young woman, who wants to get married and wants to lose 15-20 kgs and is a completely reversible procedure. Endoscopy is a daycare procedure. 3-6 months down the line, when you see the result, you can take out the balloon again it is a daycare procedure.

People feel that once they get bariatric surgery, their job is done and they are free to live the way they are living. So, you have to understand, whatever weight you have gain which is excess weight is because of indiscipline lifestyle. Now if you want to get operated for bariatric surgery and do not follow the discipline, you are heading to where you were already. I have not seen a single patient who has not lost weight after bariatric surgery but yes, I have seen a few patients who have been non-compliance indiscipline and they are gaining their weight despite undergoing bariatric surgery. So, bariatric surgery does cause weight loss but diet and exercise discipline after the surgery is something which we were not able because of excess weight but now we should be doing after the surgery. A lot of people keep on asking us whether this surgery is covered in insurance.

Yes, it is. Ask your insurance person. Besides this, if somebody is obese and having diabetes or any other medical diseases, you imagine your monthly expenditure must be at least 10-15k on drugs. So, you can recover by taking bariatric surgery and also your medical cost will go down significantly. So, it is your choice whether you want to live with wellness or you want to live with sickness. There are enough institutions which give finance for getting operated for bariatric surgery. So, you can just pay 1/3 cost of the bariatric surgery and get interested free EMI to get your weight shed off and start a new healthy life. I hope, I have cleared enough myths about bariatric surgery and this video will give enough knowledge of what is right when it comes to the science of weight loss.

Thank you!

Hi,

I am Dr. Satish Pattanshetti, General Surgeon. I am practising for the last 15 years. We do all general surgery, laparoscopic surgery, advanced surgeries and also bariatric surgery. Bariatric surgery is also known as surgery for obesity through laparoscopy. Obesity is a multi-factorial disease. Even WHO has said that obesity is the mother of all diseases. Because it leads to diabetes, hypertension, knee osteoarthritis, back pain, obstructive sleep apnea and host of other diseases. Obesity is more common in our urban population because of our faulty lifestyle. In young females, obesity is more common because of PCOS. Obesity increases because of faulty food during pregnancy. Post pregnancy also obesity increases because the mother is not able to take care of herself nicely. Even post menopause, obesity goes on increasing. So, it is more common in female because they do not know how is it happening and how to take care of the same. Obesity is increasing in men because of increased parties, increased alcohol intake, increased junk food.

Even kids are becoming obese because eating out or eating on every Saturdays and Sundays. So, how to control obesity? So, every patient treatment should be tailor-made because every patient is different. The first option is to always diet control. So, we have our dietitian & nutritionist who gives the patient a proper diet plan. So they give low calorie and high protein diet to chart. And it is customized according to the patient physic and nature. Because whatever is cooked into the patient's kitchen is entirely different from the others.

Every patient's taste buds are also different. With this diet plan, the patient tends to lose 5-10% of the weight. Then we have an exercise specialist and physiotherapist who takes care of the patient and starts the exercise. So, along with the diet and exercise, the patient is able to lose weight steadily and gradually every month. Even after following diet and exercises, few of the patients are not able to lose weight. So, we have 3 options for these patients to go towards medical therapy. There are a few of the tablets which helps you in losing weight and injection which is given once in a week. It reduces the appetite of the patient and promotes weight loss in the patient. Every month we follow the patient that how is the progress. Few patients are still there who do not get satisfactory results even after all these 3 therapies. So, what are the options for these patients? So, there are 2 options for these patients. One is endoscopy through which we put a gastric balloon in the patient.

It is a silicon-made balloon. We place this into the stomach. It covers half of the patient's stomach. And that is how the portion size of the patient gets reduced. The patient loses around 25-50 kgs. This balloon can be kept for 6 months or for 1 year. It depends on the patient's choice. It is a day care procedure. It is diet and exercise control plan and the patient loses weight. If still, they are not getting the solution, so, the last solution is bariatric surgery. There are 3 types of bariatric surgery. It is popular because it is done laparoscopically. Through just 5 holes that too less than 1 cm. Surgery is done in the morning and the patient is walking in the evening and within 3 days the patient is discharged and the patient goes home walking. This is done for the patient who wants weight loss more than 25 kgs, suffering from diabetes, hypertension, a patient who have knee arthritis or any other knee problem because of obesity.

Females who are not able to conceive and suffering from infertility because of obesity. Bariatric surgery is very much helpful for them. Bariatric surgery is of 3 types. First is sleeve gastrectomy. It is a procedure where we reduce the size of the stomach. It helps in decreasing the volume size of eating. the portion size of the patients gets decreased. The patient is able to achieve ideal weight what exactly they want in 6 months to 1 year of time. But there are some patients, who do not eat much but still, they are obese. It is because of decreased metabolism rate. So, for such kind of patients, gastric bypass surgery is very much indicated. Ismein jo patient calories leta hai, uska absorption nahi hota hai.

So, it is very important and beneficial surgery for those patient suffering from type 2 diabetes and eating less. 3rd procedure is known as mini gastric bypass. This is for those who like to eat but still want to lose weight. Many patients are there who says ki paet bharta hai lekin dil nahi bharta. Because they used to over-eating. So, all these surgeries gives good weight loss. Gives a resolution to many of your problems. They get your diabetes back to normal and their sugar comes to normal next day. Why? Because hormones secreted in the body which acts on pancreas to secret more insulin. That is why bariatric surgery is also known as metabolic surgery. And then patient says, that why this surgery was not recommended before. Next day they are off from insulin, sugar medications. So, it is a miracle or big boon for those patients who have diabetes, uncontrolled diabetes and after the surgery, they get a complete reversal of diabetes. so, I would like to recommend or suggest that patients who are over-weight by more than 25 kgs of their expected weight or ideal weight should undergo this surgery asap. because the earlier you do surgery, the results are much better and you can live a longer and healthier life.

Thank You!