Wockhardt Hospital

Hi.

I am Dr. Ramen Goel and today we are going to talk about safe outcomes of bariatric surgery. So it has been seen that the surgery can be safely done if the surgeon is doing large volumes of surgery every year. So, general cut off is about 100 surgeries a year. So those who do more than hundred surgeries, the outcomes are better. Outcomes also depend on what is the kind of follow up the program is providing; do they have a counselor; do they have a dietician and outcome also depends on patient's condition before surgery.

So, if they have controlled diabetes, controlled blood pressure, thyroids are well-taken care; the outcomes are better. Outcomes are also better if the patient is compliant that means you follow the instructions that are given by the bariatric program. So bariatric surgery overall can be achieved with very very fewer complications. Complications almost at par with hernia surgery provided you choose the right surgeon and you are willing to follow the instructions. If you need any more details you can connect me through Lybrate.

Thanks!

Hi,

I am Dr. Ramen Goel. Today we will talk about whether surgery should be offered to all uncontrolled diabetic patients? Now in last 10 years it has been accepted worldwide that metabolic surgery is a good option for diabetes control and gradually the cut off point has been reduced to 27.5 BMI. That is if someone is about 10 to 12 K.G. overweight he can get the surgery done to control his diabetes.

It is also been seen that this surgery work better if you do it early. If somebody has diabetes for last 6 months he will do a very well after surgery compared to those who have diabetes for last 20 years. So gradual realisation has come that surgery should be offered early and many physicians are actually sending patients who are actually prediabetic because their pancreatic function is quite good and after surgery if the pancreatic function is good the outcomes are better.

So for all uncontrollable diabetic, metabolic surgery is a good option. Don't considered as a last option. Don't wait till the pancreas are damaged irreversibly. It should be done at a stage and then it can give you disease free, drug free life for very long time and that's very important.

If you need any further information about this, please connect with me on Lybrate.

Updates From Lybrate: A Good and healthy Diabetic diet of nutritious products can help in managing the diabetes problem. You can explore a wide range of diabetic products available at Lybrate.

Hi,

I am Dr. Ramen Goel.Today I am going to share with you the current information that it is the physiological changes that happens after bariatric surgery which are responsible for weight loss. Typically we believed that after surgery because the stomach is small, there is restriction on food intake and weight loss happens. But research in last 5-10 years have established that it is not the restriction of the food intake but it is the physiological changes which includes changes in Ghrelin hormone, changes in GLP-1 hormone, changes in the bacterial which are present in the gut, changes in the bile acid levels in the blood. All these together are responsible for physiological changes and that helps in weight loss.

Now look at the scenarios, if someone gets pregnant in 2 months after surgery, then the person will gain weight, they will not lose weight. So if only the stomach size was responsible for weight loss this lady cannot gain weight. So the physiology of pregnancy is much stronger than the surgery and that's why the current concept says that just by restricting the food intake you cannot lose weight. It is a physiology, biology which changes the body. Its a great information because at no stage with diet manipulation you can lose as much weight as with surgery because the physiological changes do not happen after dietary regulation.

If you need any further information about it, please connect with me through Lybrate.

Hi,

I am Dr. Ramen Goel.  Today we are going to talk about that Bariatric surgery is not the last option for morbidly obese patients. It's probably the only option for these patients. Why I say this, because when a morbidly obese person goes to do lifestyle changes they can always lose weight, but there is a 98% probability that within 3 years they will regain all the weight and everytime they lose weight and their gain weight, they lose more muscle and they gain more fat.

So they become physically weak. I think surgery is a very good option for them at early stage. Logically people do think that you should try everything and then you should consider surgery but scientifically looking at it, anybody who is more than 32.5 BMI and has diseases or 37.5 BMI and even if they don't have a disease they are a good candidate for surgery.

If you need any more detail you can connect with me on Lybrate.

Hi,

My name is much that you tell and I am a neurosurgeon at Wockhardt hospitals in Mumbai central as well as an assistant professor at the grant Medical College and sir JJ group of hospitals. I am going to talk to you about how can one prepare for brain surgery once one is diagnosed with a problem that requires a brain operation.

You could be even having a brain tumor or a vascular problem in the brain or refractory epilepsy requires something called as a craniotomy. It can be Priya Nursing for the patient is well as for the family we usually do all investigations on an outpatient basis and ensure that the patient is fit for surgery to undergo a pre-anesthetic evaluation and make sure that all the blood tests are in order typically used something called as neuronavigation.

At surgery which enables us to approach the exact location of the problem in a three-dimensional space in gases towards that location of patients ask me if there will head is going to be saved before surgery news me that's not the case which is save strip of hair along which where we meet me in station. So what typically happens is patience cremated one day prior to surgery the anaesthesia doctor takes 1 final look at them to make sure that heart rate blood pressure everything is under control and the next morning there being into the operating room xxvi anaesthesia doctors will wake you up a certain monitors the ECG leads extra before putting a tube done your throat to give you something college general anaesthesia when which your unconscious throw the operation there are some operations where in which humans are located in elopement areas of the brain and we need patients to be awake so that we can check their motor function and actually we can do the operation when patients are awake and talking to US and moving the hands and legs and that's something college in awake craniotomy which requires a slightly different preparation the operation takes place and the extremely sterile conditions and everything is cleaned and raped in a systematic fashion the protocol of which is completely standardized you make a skin incision usually using a drill remove the part of the bone that is wire to be removed.

When there is a covering of the brain called the dura which is what we cut and then enter the appropriate space and deal with the pathology it will be the beer tumor it will be a vascular malformation it could be anything that requires to be removed or transacted or disconnected usually Brain Tumor operation last for about 3 or 4 hours on an average it could be longer depending on the case what happens is 13 belt with the pathology we close that layer of dura back and we replace the bone flap and we fix it with plates and screws are often than not activated immediately after the operation in the operating room itself very rarely if the operation is really long or there is a lot of blood loss be kept overnight on a ventilator in extubated the next morning in the ICU typically there will into the ICU for about 24 hours after surgery.