Centre for Bariatric & Metabolic Surgery

The centre for Bariatric & Metabolic surgery at P. D. Hinduja Hospital, Khar has a holistic approach to treat obesity and metabolic diseases like type 2 diabetes. A patient undergoes a thorough screening process with diagnostics, lifestyle modifications and medication before being considered suitable for bariatric or metabolic surgery. The key highlights of the centre include:

• Personalised Treatment Plan
• Provides Non-Surgical and Surgical Treatments
• Expert Surgical Team
• Advanced Surgeries

• Personalized treatment plan, where the specific procedure is chosen according to patient history, disease and requirements. This ensures complete safety and best outcomes.
• A team of best, highly experienced, internationally renowned surgeons. They have the best success rates in the industry for regular and complex cases.
• The Centre provides non-surgical and surgical treatments with latest, minimally invasive procedures and endoscopic procedures.
• Advanced surgeries for weight loss and for reversal or excellent improvement of uncontrolled or poorly controlled type 2 diabetes, this includes all variations in Bariatric and Metabolic surgery and Bariatric revision and correction surgery.
• Diet and Lifestyle management
• Medications to help in weight management
• Non-invasive Swallowable Balloon (Allurion)
• Endoscopic Gastric Balloon
• Endoscopic duodenal mucosal resurfacing (coming soon)
• Sleeve gastrectomy
• Mini gastric Bypass (One-anastomosis gastric bypass)
• Roux-en-Y gastric Bypass
• Sleeve + Bypass surgeries
• Duodenal Ileal Interposition + BMI adjusted Sleeve Gastrectomy (Esp for slim or normal weight patients with diabetes)
• Jejunal-Ileal Interposition with Sleeve Gastrectomy for Morbid Obesity with Diabetes
• Revisional bariatric surgeries

Conditions improved or cured by Bariatric & Metabolic Surgery:

• Uncontrolled Obesity
• Type 2 diabetes remission in case of metabolic surgery
• Fatty liver diseases
• High BP / Heart Diseases
• High Cholesterol & Triglycerides
• Sleep Apnea / Respiratory Problems
• Gastro-esophageal Reflux Disease (Hiatal Hernia and Heartburn)
• Depression and Social Withdrawal

How is weight loss achieved with Bariatric Surgery?
Bariatric surgery which is also known as weight loss surgery works on the hormones and the structure of the digestive system, mainly the stomach in most cases. As a result of this a person who has undergone bariatric surgery finds that his hunger has reduced and satiety level has increased even with small portions of meals. After some time the body’s metabolism gets accustomed to this change and the desired weight reduction is achieved.

How is type 2 diabetes controlled with Metabolic Surgery?
Metabolic surgery which is a type of bariatric surgery, works in a manner in which body’s digestive system is changed in terms of size and its physiological process. It makes the person feel satisfied even with small meals, fully satiated means you eat less. This surgery changes the working of hormones and affects the body’s insulin making capacity. It increases bile acid production making the body more sensitive to insulin and insulin function on the body, leading to lower blood sugar levels.

What information is provided to the patient before the surgery?
After the entire screening process the patient is informed about their elegibity for this surgery. The team explains the pre surgery life style modifications and other dos and don’ts before surgery. The surgeon explains the patient in-depth about the procedure that will be done on the patient.

Who all are involved in a patient's surgery and what is the process after the surgery?
A patient's surgery is a multi-disciplinary team approach which includes a bariatric / metabolic surgeon, anaesthetists, and other medical staff. The surgery in general, lasts for a few hours. The patient is transferred to the ICU and then ward, basis the assessment done by the surgeon post-surgery.

What is included in the post-surgery care for patients?
The patient stays in the hospital for a few days, depending on recovery. Post-surgery rehabilitation is done for all patients. A discharge diet, exercise, counselling etc. is designed and the schedule for the same is explained to the patient. Follow up visits are scheduled and need to be adhered by patients strictly for at least a period of one year and then later as per doctor’s advice.

Does a person need to lose weight and make changes in diet before surgery?
Patients who are a BMI more than 40 Kg/m² can be put on a pre-operative VLC liquid diet, ranging from 1-3 weeks for a good preparation. Patients with a BMI of less than 40 do not usually need it.

How much weight can a person lose after surgery?
Usually 30-50% of the total body weight or 50-70% of the excess body weight.

How long is the hospital stay after surgery?
It can usually be 24-48 hours.

Is the weight loss post bariatric / metabolic surgery permanent?
The weight loss happens for 8-12 months after surgery and then a plateau is reached. The patient can regain weight in the long term if they don't adhere to a healthy lifestyle.

Are there any lifestyle restrictions including diet post-surgery?
There are no restrictions but a high protein low carbohydrate, low fat diet should be adhered to in order to prevent weight gain in the long term.

Can a woman conceive after surgery and how much time would a person need to wait for conception after surgery?
A woman can conceive but it is recommended to wait for a year until after undergoing a Bariatric surgery in order to be nutritionally active and have an uneventful pregnancy with a good outcome.

Does the person need to go for plastic surgery after weight loss surgery?
Patients with more than a BMI of 50Kg/m² may need a body contouring procedure after 1 year depending on various other factors.

What is revision bariatric surgery and how soon after the initial procedure is it performed?
A revision BARIATRIC surgery can be offered after a few years of the first procedure usually for weight regain, reflux or any other anatomical issues.

Does metabolic surgery guarantee permanent reversal of diabetes?
Studies show a remission on an average for 10 years after surgery if they have a good pancreatic Islet cell reserve.

Is Metabolic Surgery same as Bariatric Surgery?
Metabolic Surgery is a type of Bariatric Surgery that can help control and reverse type 2 diabetes, in both obese and lean individuals. It has beneficial effects on hypertension and dyslipidaemia too.

Is metabolic surgery safe and what are its complications?
The safety profile of this surgery is safer than most other elective surgeries like TKR, THR, cholecystectomy, etc.

Is metabolic surgery only for type 2 diabetics or Juvenile diabetics (Type 1 Diabetics) can also be treated with it this surgery?
It is only meant for type 2 diabetes and not for Juvenile diabetes (Type 1 Diabetes).

Who is the right candidate for bariatric / weight-loss surgery?
Anyone with an excess weight of over 25 kg or BMI more than 32.5 with any obesity associated complains is eligible for bariatric surgery as per Asian Guidelines.

What are the benefits of bariatric surgery?
Better quality of life, relief from pain, prevention and/or reversal of diseases like diabetes, hypertension, snoring, heart disease etc.

What are the risks of bariatric surgery?
Bariatric surgery is a highly standardised procedure and when performed with a standard protocol, would have minimal risks which would be lower than the risks of obesity itself.

What is surgery cost and is it being covered by insurance?
Surgery is being covered under insurance since morbid obesity is a disease. Costs vary based on different factors like room type, type of procedure, associated conditions, etc.

Can the treatment be reversed?
Yes, most of the bariatric procedures can be reversed by an expert bariatric surgeon. However, reversal is seldom needed.

What are the tests before surgery?
PRE-OP PACKAGE:

• SERUM IRON
• COVID - 19 RT-PCR TEST
• SGPT
• SGOT
• POTASSIUM
• SERUM PROTEIN
• POST PRANDIAL BLOOD SUGAR
• FASTING BLOOD SUGAR
• TRIGLYCERIDES
• HDL CHOLESTEROL
• GLCO HB/HBA1C
• MAGNESIUM
• OS - ZINC
• URINE MICROALBUMIN
• BICARBONATE
• ALKALINE PHOSPHATASE
• TRANSFERRIN SATURATION
• CREATININE
• BUN
• CHLORIDE
• CHOLESTEROL
• TOTAL IRON BINDING CAPACITY
• GAMMA GT
• ALBUMIN
• BILIRUBIN
• URINE ROUTINE
• COMPLETE BLOOD COUNT
• ERYTHROCYTE SEDIMENTATION RATE
• C-PEPTIDE
• VITAMIN B12
• 25-HYDROXY-VITAMIN D
• T3
• TRI-IODOTHYRONINE
• CORTISOL
• INSULIN (FASTING)
• THYROID STIMULATING
• HORMONE
• INSULIN PP
• HCK ECG
• HCK ECHO WITH COLOR DOPPLER
• SODIUM
• SERUM LACTATE
• ABO&RH - HHS
• PROTHOMBIN TIME
• PLATELET COUNT
• WBC & DIFF COUNT
• RED CELL INDICES
• HAEMOGLOBIN
• HAEMATOCRIT
• RED CELL COUNT
• INSULIN (FASTING)
• THYROID STIMULATING HORMONE
• INSULIN PP
• HBsAg SPOT TEST
• HCV SPOT TEST
• HIV
• SPOT TEST
• HCK ECG
• HCK ECHO WITH COLOR DOPPLER
• HCK SPIROMETRY
• HCK X RAY CHEST PA
• HCK USG ABDOMEN PELVIS
• C-PEPTIDE (PP)