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Indian surgeon gives Karachi the skinny on fat surgery

Staff Report

KARACHI: For the first time in human history the number of overweight people in India, 2.1 billion, is equal to the number of underweight people, said Dr Pradeep Chowbey, an Indian surgeon who has been championing the cause of obesity or bariatric surgery in the Indian subcontinent.

Chowbey gave a lecture on this relatively new technique at a local hospital Tuesday as part of the opening of the 23rd annual congress of the Pakistan Society of Gastroenterology and GI Endoscopy from Feb 27 to March 3.

Chowbey cautioned that the people of the Indian subcontinent needed to watch out for obesity which he predicted could spiral out of control. The west has not been able to control its epidemic, he said. Morbid obesity is the “mother” of many other ailments, he said while referring to Type-II diabetes, gall stones, coronary heart disease, hypertension, cancer and arthritis.

The number of obese people in developing countries is about 1.15 billion, according to the WHO. According to a press release, an alarming revelation comes from a recent WHO report that states that the number of overweight children has doubled and overweight adolescents have trebled over the last two decades. Childhood obesity has reached to alarming stage in the teenagers, which are going to be a great menace in the future. Recent surveys conducted in schools of Delhi found as much as 30 percent of children to be overweight. Over 70 percent of these children if not treated will grow into obese adults.

However, with recent advances in surgical field there is hope for those suffering from morbid obesity. People with morbid obesity don’t respond to medicines, can’t exercise due to excessive weight and find it difficult to cut their quantity of food. Obesity surgery has been touted as the only viable option for these patients.

Through bariatric surgery, the patient reduces about 8-10 kg every month and can reach a normal weight within 1-2 years with most of the diseases either disappearing or significantly improving.

Bariatric surgical procedures for the morbidly obese patient are performed laparoscopically. “Laparoscopic surgery” involves making a few punctures in the body of few milimetres in size, which don’t take a long time to heal and the patient can resume work in a few days.

There are three types of surgical procedures routinely performed for treating Morbid Obesity: Restrictive - LAGB (Laparoscopic Adjustable Gastric Band), VBG (Vertical Banded Gastroplasty); Combined - Roux-en-Y Gastric Bypass; Malabsorptive - BPD ( Bilio-Pancreatic Diversion ), BPD and DS (Duodenal Switch) and Restrictive with an Adjustable Gastric Band.

The last one is the least invasive procedure possible amongst all bariatric surgeries. It is accomplished by placing a silastic band around the upper part of the stomach to create a tiny stomach pouch. Hence early satiety is attained. The band is adjustable, that is, it can be inflated or deflated with saline via the access port placed subcutaneously and fixed to the rectus sheath. It is preferred in less obese patient.

In the combined (Roux -en- Y GBP) surgery, a gastric pouch of volume 20ml is created after transecting the stomach. A Roux-en-Y jejunal limb is constructed and attached to the pouch.

In the Malabsorptive surgery the stomach is divided at D1 so as to preserve the function of pylorus hence allowing normal filling of stomach and the maintenance of satiety sensation. A modification of this procedure involves a vertical sleeve gastrectomy. The advantage of this procedure is that it can be performed laparoscopically. It is an excellent option for super obese people. It affords good relief from co-morbidities, such as diabetes and hypertension.

Chowbey, who is the chairman of the Minimal Access and Bariatric Surgery Centre at the Sir Ganga Ram Hospital, New Delhi, is in the Guinness Book of Records 1997 for performing the maximum number of minimal access surgeries. He was awarded the Padma Shri in 2002 in the field of Minimal Access Surgery by the president of India who has been his patient.

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