Benefits of Bariatric Surgical Procedure

Bariatric Surgery / Procedure is a general term used for a variety of surgical procedures used to induce weight loss in obese or overweight persons by restricting the amount of food that the stomach can hold and/or reduce the volume of nutrients that the body can absorb.

There are multiple methods like: Gastric Bypass; Sleeve Gastrectomy, Gastric Banding. Which method is to be used depends on each particular case, and this is not something to be taken lightly. In fact, this should be considered only if dieting and exercise options have completely failed.

Benefits of Surgical Procedure:

1. Drastically improved quality of life. Obese persons suffer severe fatigue, body pain and physical limitations like restricted movement. And, this surgery, by reducing their weight improves their quality of life. 
2. Slows down/reduces fatty liver disease. This is a liver condition affecting non-drinkers. While no real cause of this disease is known, it is linked to obesity, and severe weight reduction drastically slows/ reduces it.
3. Controls diabetes. 92 % of all obese people are often diabetic and gastric procedure can significantly improve blood sugar control in such people.
4. Reduces Hypertension. It is said that obese people account for around 25-28 % of hypertension cases and 15-23 percent of coronary diseases. This surgery has been reported to cause normalization in about 30-50% of the cases.
5. Relief from Osteoarthritis/Joint pain. Reduced body weight means reduced strain on the body’s joints and this surgery has been known to provide dramatic pain reduction.
6. Highly reduced mortality rates. Given the serious medical issues obese people face any weight reduction can have drastic reduction in mortality risks.
7. Obstructive Sleep Apnea (OSA): This is the stoppage of breathing during sleeping and is more common in the obese, and weight loss can have substantiatve effect in reducing this improving sleep patterns and thus stress.
8. Reduced risk of various forms of cancer like that of colon, gallbladder, breast and pancreas.
9. Greatly reduces infertility risks in both men and women.

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How elective surgery is safe with due precautions during Covid-19?

Elective Surgery or Procedure is any surgery not involving medical emergency and has been scheduled in advance.

The current Covid-19 health crisis has drastically changed the way that medical and surgical services are provided around the world. To prevent hospitals from being overwhelmed, the healthcare authorities had restricted medical care to emergency cases and postponed elective surgeries. 

While the situation has not normalised to any degree, authorities have started discussing plans to reduce restrictions and restart daily operations, elective surgery being one. This is not something to be taken lightly and the plans can vary from place to place and time to time.

Following are some of the “recommendations”.

1. Isolating specific facilities for treating Covid-19 reducing the risk of viral transmission. This includes medical personnel and patients. 
2. Testing, testing, testing. BOTH THE PATIENTS AND MEDICAL PROFESSIONALS MUST BE TESTED. Currently there are 2 tests being done. Polymerase Chain Reaction (PCR) test; a positive indicating current infection. However, as the incubation period is variable, a negative result may be a false negative, so it would be advisable to take an antigen test as close to the procedure as possible. The other is a Serology Test for SARS-CoV-2 antibodies; a positive result showing past infection. It is still unknown if presence of antibodies provides immunity and/or prevents retransmission. 
3. Bariatric surgery, i.e. surgery performed on obese or overweight people, can also be started, provided all the precautionary measures are taken. This is recommended because of the possible criticality of the cases, and the possibly compromised immune systems.
4. Non-bariatric surgery, like that for appendicitis, gallstones, hernias and hemorrhoids can also be considered, as hospitals are seeing an increase in complications arising due to their postponement. 
5. Ensure more than adequate supply of Personal Protective Equipment, like N95 masks, protective face shields and goggles, disposable gloves and gowns, etc.,  for all medical personnel.
6. All surgeries should be classified as per degree of urgency and indication. Priority being given to essential surgeries.
7. Keeping the hospital environment clean and safe. This may seem obvious, but is something to be done consciously. It has to be assumed everybody is infected and act accordingly.

It must be noted that even if all the above “recommendations”, and others if any, are satisfied, it is still upto to the medical professional to decide whether to go ahead with the surgery.

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How to face the weight battle after menopause

Commonly, women will gain weight during menopause, even if their calorie intake is very less. Menopause is a natural phenomenon that occurs when a woman stops ovulating and her monthly period (menstruation) ends. During the menopause period, women will change their shape, especially around the waist and abdomen. Here we are discussing how to deal with the weight gain due to menopause. 

Body changes at menopause

A shift in hormone levels, particularly a drop in the estrogen level, results in body fat distribution. Apart from this, factors that may contribute to weight gain after menopause include:

• age
• reduced physical activity and loss of muscle mass
• number of children
• family history of obesity
• use of antidepressant or antipsychotic medications
• chemotherapy
• lowered metabolic rate
• altered lifestyle – for example, eating out more.

How risky is weight gain after menopause?

Menopause weight gain can increase the risk of having many issues, such as breathing problems, heart and blood vessel disease, and type 2 diabetes. Overweight can also increase your risk of various types of cancer, including breast, colon, and endometrial cancers. Along with these, your body will undergo the following changes during menopause:

• skin changes, such as dryness and loss of elasticity
• vaginal dryness
• hair growth (or loss).
• These changes can create a serious toll on a woman’s body image and self-esteem and increase her risk of depression and sexual difficulties. 

How to fight weight gain?

The only way to fight menopause weight gain is to make healthy lifestyle changes and do regular exercise. The following are some tips to control your weight gain during menopause.

• Eat less and move more
• Keep a check on your sweet tooth
• Limit alcohol
• Reduce the stress level
• Check your medications
• Get proper sleep
• Seek expert medical advice

It would help if you kept in mind that permanent changes in lifestyle, diet, and exercise habits are essential to lose weight.

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Post operative care after Laparoscopic Hernia Repair

What is a Hernia?

Hernia is a disease that develops when an organ, fatty tissue or intestine protrudes through a weak spot or a hole in the surrounding muscle. Hernias mostly occur at the abdominal wall.  Sometimes it can be visible as a bulge externally especially when bearing down or straining.

Patients are recommended to take any prescribed pills for pain only when they really need it. Avoid prescription pills that consist of codeine (e.g. Co-codamol). Paracetamol is often as effective. Other non-steroidals are fine which does not provide contraindications.

Treatment Options for Hernias

Hernia repairs are very common—more than one million hernia repairs are performed each year. Around 800,000 of these are inguinal hernia repair and the rest are for other types of hernias.1

Non-Surgical

Watchful Waiting – In this method your surgeon will test and identify the size of the hernia and make sure that it is not causing problems or getting larger. Watchful waiting can be an option for people who are suffering from hernia only if they do not have complications, and if prescribed by their surgeon.

Surgical

1. Laparoscopic - The surgeon makes several small cuts in the abdomen that access surgical tools inside the openings to repair the hernia. Laparoscopic Hernia Repair usually requires use of surgical mesh except in paediatric age group.
2. Open Repair - The surgeon makes a cut around the hernia and the weak muscle area is repaired. Open repair can be performed both without surgical mesh and with surgical mesh. Open repair uses the sutures without mesh which is referred to as primary closure. Primary closure helps to repair inguinal hernias in infants, strangulated, small hernias or infected hernias.

Wound care

The body temperature will rise right after the operation; it may persist for a day or so which is normal. Patients are recommended to  bathe daily after the successful operation. A plastic see-through dressing covers the wound and it is peeled off around 7 days after the operation. Clean bathing water will not harm the wound at all.

Dr. Nikhil Agnihotri is well known surgeon for Hernia treatment at Max Super specialty Hospital, New Delhi. It has all the required tools and best healthcare facilities needed for such cases.

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Common Bile Duct Stones

Bile duct stones are usually developed in the gall bladder which migrates to the bile duct or sometimes even forms in the bile duct primarily. Choledocholithiasis is the condition characterized by the presence of stones in the common bile duct. The bile duct is responsible for carrying bile from the liver and gallbladder to the intestine, which is responsible for digestion and fat absorption. The development of bile stones will cause hindrance in the proper flow of bile to the intestine, which in turn affects the digestion process.

Gall stones or bile stones are made up of cholesterol, bile salts and pigments which have solidified into stones. The size of the stones differs along with their numbers. Sometimes the stones may pass out of the bile duct spontaneously without any medical intervention. However, for the stones that are large and get stuck to the bile duct, proper treatment is necessary to prevent the inflammation, bacterial infection, and surrounding organ damage.

SYMPTOMS

Usually, bile stones may not cause any symptoms until they obstruct the duct. People may experience the below-mentioned symptoms  in severe cases such as :

• Fever
• Jaundice
• Abdominal pain mostly right or middle abdomen
• Loss of appetite
• Vomiting and nausea
• Greasy or light-coloured stools

Sometimes they also cause a severe bacterial infection in the liver known as ascending cholangitis. Biliary stones are also the cause of Acute Pancreatitis which may even be life-threatening.

DIAGNOSIS

Mostly bile duct stones can be diagnosed on the basis of symptoms and blood tests which indicate a high level of bilirubin and other liver enzymes. The other diagnostic tools that can be used to confirm the bile stones include the ultrasound, abdominal CT scan, endoscopic retrograde cholangiopancreatography (ERCP), and magnetic resonance cholangiopancreatography (MRCP).

TREATMENT

The treatments mainly focus on relieving the blockage and might include various methods such as :

Endoscopic Technique –  miniaturized instruments can be passed through the ERCP that enlarge the duct opening in the duodenum and remove the stones. It is then followed by Laparoscopic Cholecystectomy.

Laparoscopic Cholecystectomy with CBD Exploration - In this technique along with the removal of the gall bladder, CBD is opened, stones retrieved and then the duct is sutured back usually over a stent.

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Hernia - Surgery Or Ignorance

When a fatty tissue or organ squeezes or protrudes through a weak spot in a surrounding muscle or fascia (connecting tissue), it can be considered as a hernia. Usually, hernias occur in the abdomen, but it could also come in the upper thigh, tummy, and groin areas. There are mainly 5 types of hernias, such as: 

• Incisional hernia - occurs after abdominal surgery. The intestine might push through the incision or scar surrounding the weekend tissue
• Inguinal hernia - occurs in the inner parts of the groin area  
• Femoral hernia - usually occurs outside the groin area
• Ventral hernia - occurs in the abdomen 
• Hiatus hernia - occurs in the diaphragm

Inguinal hernia

An inguinal hernia occurs when a tissue such as part of the intestine or organ protrudes from the abdominal region. Such hernias could be painful, especially while coughing, bending over to lift a heavy object.  

Surgery  is recommended to prevent complications. These are one of the most common hernias which occur in men. 

Causes 

  Certain reasons why inguinal hernias are developed are as follows:

• Chronic cough or sneezing
• Pregnancy 
• Severe pressure within the abdomen 
• The pre-existing weak spot near or in the abdominal wall
• Performing heavy or difficult activities 
• Abdominal surgery or injuries 
• Age 
• Constipation 
• Prostatic enlargement

Complications if left untreated 

There are a few complications for inguinal hernia such as:

• Surrounding tissue will experience pressure - if the hernias are not treated or removed surgically, then it could get enlarged over time. This might cause swelling and pain for men as it would get extended to the scrotum.
• Incarcerated hernia - the contents of hernia might get trapped in the weak point in the abdominal wall and can cause severe pain, vomiting, constipation, and nausea.
• Strangulation - these incarcerated hernias can become an obstruction for the blood flow to the intestinal parts. Strangulation can become a serious threat to the bowel tissues hence, it needs to be treated immediately. 

Medical care 

Sometimes reducing the excess weight or obesity can reduce the pain, avoid further complications, helps to prevent discomfort, and in certain situations, it would reduce the size of the hernia. Hernias that gives severe pain or that gets enlarged need to undergo surgery. Most of the hernias are dealt with laparoscopically. 

Hernias are no different than any other problems people face in life. Hence, they should be treated immediately.

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Can Treating Sleep Apnea Cause Weight Loss?

        The perils of leading a dissolute life tend to manifest at a later stage especially in the form of obesity. Very often people grapple with this health condition and find themselves at a loss as to how to trim those extra pounds. To further exacerbate the issue of weight gain there are a host of other ailments that thrive in this condition and often converge to make life miserable for the unsuspecting individual. Hypertension, Type 2 diabetes and Sleep apnea are the potentially dangerous maladies that have the potential to significantly disrupt one's quality of life.

        

Sleep Apnea requires special mention since it's one of those conditions that usually gets overlooked leading to fatal consequences. It's often considered to be a corollary of obesity and weight gain is checked Sleep Apnea is naturally taken care of. Obesity leads to the accumulation of fat in almost all areas including the neck. This tends to constrict the airway and restrict air flow when the person is asleep. One of the most prevalent medical procedures to cure Sleep Apnea is that of CPAP (Continuous Positive Airway Pressure).

        

While studies have been conducted to ascertain whether the treatment of Sleep Apnea via CPAP could potentially lead to a reduction in Body Mass Index and thus facilitate weight loss, the findings have been inconclusive. The objective was to find out whether consistent CPAP administration could regulate leptin levels by way of increased physical activity. However the results of multiple tests conducted on men and women have yielded inconsistent results.

       

 However it's almost conclusively proven that CPAP in itself isn't a major contributor to weight loss. It's the resultant spurt in physical activity that addresses a host of issues that are an outcome of obesity and eventually shaves off the extra flab thus rejuvenating the body. Sleep disruption unsettles the body, rendering the individual lethargic and shorn of energy. Once the sleeping pattern is reinstated the person finds the vigor and vitality to go about his daily routine, pursue weight reduction programs and as a consequence acquire a well-toned and balanced physique.

        

To conclude, medication is never the means to address the root cause of Sleep Apnea. It could at best revitalize your system and the metabolism levels and perhaps indirectly induce weight loss. However it's in the best interest of everyone to not let things spiral out of control by leading a balanced life which has moderation as its ethos.

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