The day after
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