The day af­ter

Down to Earth - - HEALTH -

pass pro­ce­dure, are at an el­e­vated risk for al­co­hol use af­ter surgery.A study pub­lished in the Jour­nal of the Amer­i­can Med­i­cal As­so­ci­a­tion in 2012 sug­gests an in­crease in al­co­hol abuse (ten­dency to in­crease al­co­hol in­take) af­ter surgery, as it af­fects the release of hor­mone dopamine,a key player in drug abuse cir­cuitry. The Na­tional In­sti­tutes of Health, usa, also sup­ports this find­ing. Re­search also in­di­cates that bari­atric surgery pa­tients might be “over­rep­re­sented” in sub­stance abuse treat­ment fa­cil­i­ties though they said that their find­ings were not con­clu­sive.

Pro­ce­dures and risks

At an in­ter­na­tional con­fer­ence held in New Delhi in July this year, bari­atric sur­geons pointed out the ab­sence of stan­dard­i­s­a­tion in the pro­ce­dural tech­niques of surgery, which in­creases the risks of in­de­ci­sion and slip-ups by sur­geons.In In­dia,there are no pub­lished post-op­er­a­tive records of pa­tients. Lack of such data con­ceals the true pic­ture of the sta­tus of surgery pa­tients. More­over, sur­geons of­ten negate the guide­lines for this surgery, says Deep Goel, weight loss sur­geon, BLK Su­per Spe­cial­ity Hos­pi­tal, Delhi.The ques­tion as to who should de­cide on a qual­i­fy­ing pa­tient a doc­tor, a gov­ern­ment of­fi­cial, or a pa­tient re­mains unan­swered,says US-based Robert Rut­ledge,pioneer of mini gas­tric by­pass surgery.

Two years ago, a weight-loss surgery could not save Keith Martin, a res­i­dent of Lon­don, who died from pneu­mo­nia fol­low­ing a lengthy bat­tle with his 400 kg weight. The sur­geon had op­er­ated upon him fol­low­ing the guide­lines of the Na­tional Health Ser­vice (nhs), which al­lows pa­tients with body mass in­dex (bmi) be­tween 35-40 kg/m2 or above and Type-2 diabetes,but the surgery proved to be in­ef­fec­tive. Rut­ledge says that peo­ple with a greater bmi of about 60-70 kg/m2 face more com­pli­ca­tions.

Weight loss re­ver­sal post-surgery is also com­mon.Satish Ku­mar,con­sul­tant en­docri­nol­o­gist at Narayana Health City,Ben­galuru, What's in store af­ter a weight­loss surgery Ex­ces­sive bleed­ing In­fec­tion Ad­verse re­ac­tions to anes­the­sia Blood clots Lung or breath­ing prob­lems Leaks in your gas­troin­testi­nal sys­tem Death (rare)

Bowel ob­struc­tion Dump­ing syn­drome, caus­ing di­ar­rhea, nau­sea or vom­it­ing Gall­stones Her­nias

Low blood sugar (hy­po­glycemia) Mal­nu­tri­tion Stom­ach per­fo­ra­tion Ul­cers Vom­it­ing Death (rare) says pa­tients, who un­der­went bari­atric surgery three to five years ago, are putting on weight again as they were un­able to fol­low nu­tri­tional guide­lines as­so­ci­ated with bari­atric surgery.Doc­tors call it a con­se­quence of un­healthy diet af­ter surgery.Lead­ing bari­atric sur­geons say while hunger is hor­monal, de­sire to eat is emo­tional. Bari­atric surgery has no con­trol over the lat­ter.

The prob­lem is that there are few stud­ies that doc­u­ment the long-term ef­fects of weight loss surgery. The surgery does not guar­an­tee that a pa­tient will lose all of his or her ex­cess weight or keep it off in the long run. Worse, sex­ual life of teens may also be dis­turbed post-surgery.K S Ku­lar,sur­geon at Ku­lar Hos­pi­tal, Ludhiana, says that fer­til­ity among fe­male pop­u­la­tion in­creases af­ter the surgery.Un­con­trolled in­stances of sex­ual in­ter­course could in­ten­sify the pos­si­bil­ity of un­wanted preg­nancy in teens. While many sur­geons might dis­agree for an in­va­sive pro­ce­dure at a ten­der age,oth­ers agree.“This dis­crep­ancy has no jus­ti­fi­ca­tion, it’s a sur­geon’s choice,”says Goel.

Cost and cos­met­ics

It is time to as­sess the safety of the surgery as th­ese pro­ce­dures are ex­pen­sive. The cost of this surgery in In­dia ranges be­tween to lakh.Lit­tle pro­tec­tion from in­sur­ance for this surgery makes most peo­ple pay from their own pock­ets. In In­dia, there is also a con­flict on whether to view bari­atric surgery as cos­metic or non-cos­metic. The Med­i­cal Coun­cil of In­dia states that bari­atric surgery is a gas­troin­testi­nal non-cos­metic surgery. How­ever, in­sur­ance ex­perts con­sider it as cos­metic surgery. “If you take a look at the bari­atric surgery cases in In­dia,al­most 95 per cent are cos­metic in na­ture.So in­sur­ers refuse to ac­cept a claim for such a surgery,” says Kapil Me­hta,man­ag­ing di­rec­tor,Se­cureNow In­sur­ance Bro­ker Pvt Ltd.

More­over, bari­atric surgery is not a ‘one and done deal’as pre- and post-op­er­a­tive ex­penses are very high.Prior to the surgery,pa­tients need to bear the ex­penses of con­sult­ing psy­chol­o­gists and nu­tri­tion­ists to help them pre­pare for the surgery. Post-op­er­a­tive ex­penses in­clude life-long ex­pen­di­ture on nu­tri­ent sup­ple­ments and reg­u­lar fol­low-ups with the doc­tor.Ma­jor out­lays emerge in cases of body con­tour­ing and oper­a­tions of her­nia ul­cers and gall stones that de­velop af­ter the surgery. Weight loss re­ver­sal in­vites the ex­penses for a re­vi­sion surgery with no ben­e­fits of com­pen­sa­tion for the fail­ure of the pre­vi­ous surgery.

About 50 per cent pa­tients in In­dia do not un­dergo this surgery due to high cost, says Prasad. How­ever, doc­tors be­lieve that com­pli­ca­tions due to obe­sity are more dan­ger­ous than that of post-surgery and thus it is an ef­fec­tive cure.Obe­sity of­fers both choices surgery or no surgery and none is ideal.The choice of preven­tion or cure is ours.

Lead­ing bari­atric sur­geons say while hunger is hor­monal, de­sire to eat is emo­tional. Bari­atric surgery has no con­trol over the lat­ter

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