Laparoscopic Mini Gastric Bypass Bangladesh

The guidelines of the Obesity and Metabolic Surgery Society of India (OSSI) for patient selection are as under:

• Bariatric/metabolic surgery should be considered as a treatment option for acceptable Indian patients with a BMI ≥ 35 Kg/m2, with/without presence of any obesity related co-morbidity.
• Bariatric/metabolic surgery should be considered as a treatment option for acceptable Indian patients with a BMI ≥ 30 Kg/m2, in presence of two or more obesity related co-morbidities.
• Bariatric/metabolic surgery should be considered as a non-primary treatment option for acceptable Indian patients with a BMI ≥ 27.5 Kg/m2, with uncontrolled type 2 diabetes despite optimum medical management.
• Any bariatric/metabolic surgery for an Indian patient with BMI < 27.5 Kg/m2 should be strictly performed under experimental study protocol with prior ethics committee approval and informed consent from the patient.
• Bariatric/metabolic surgery should be considered as a treatment option for acceptable Indian patients with central obesity with a waist circumference ≥ 80 cm in females and ≥ 90 cm in males along with type two diabetes and other obesity related co-morbidities.
• Bariatric/metabolic surgery may be advised as a treatment option for acceptable Indian patients who qualify for the above BMI criteria if they are ≥ 18 years of age. It may be advised as a treatment option to patients younger than 18 years of age under special circumstances with approval of a multi-disciplinary team constituting a paediatrician, endocrinologist, dietician, psychologist and the bariatric team including a bariatric surgeon. Attainment of puberty and completion of skeletal maturity must be taken into account for this patient population when considering the option of surgery.
• Bariatric/metabolic surgery should be advised as a treatment option for acceptable Indian patients who qualify for the above BMI criteria for patients up to 65 years of age. Bariatric/metabolic surgery may also be recommended for patients ≥ 65 years of age if they are medically fit and the benefits of surgery outweigh the risks.
• All patients who are advised bariatric/metabolic surgery as a treatment option should be motivated to enter a long-term weight management program and should be committed to life-long follow up.
• Long term weight management program and follow up must be provided by all bariatric teams

Who should not undergo Laparoscopic mini gastric bypass/ one anastomosis gastric bypass?

As per the guidelines of the Obesity and Metabolic Surgery Society of India (OSSI) for patient selection the contra-indications for Laparoscopic mini gastric bypass/ one anastomosis gastric bypass are as under:

• Bariatric/metabolic surgery may not be advised as a treatment option to a patient who is unable to adhere to prolonged follow up program or express inability to take nutritional supplements.
• Bariatric/metabolic surgery may not be advised as a treatment option to patients who are medically unfit to undergo a surgery.
• Bariatric/metabolic surgery may not be advised as a treatment option to patients with non-stabilized psychiatric disorders.
• Bariatric/metabolic surgery may not be advised as a treatment option to chronic smokers, chronic alcoholics or patients with drug dependencies unless they have been through a deaddiction program successfully.
• Bariatric/metabolic surgery may not be advised as a treatment option to patients who have a short life expectancy or are suffering from a terminal illness.
• Bariatric/metabolic surgery may not be advised as a treatment option to pregnant women or those who wish to conceive within one year after surgery.
• Patients with severe gastro-esophageal reflux disease or hiatus hernia must avoid a laparoscopic mini gastric bypass/ one anastomosis gastric bypass.

What is the pre-surgery preparation before Laparoscopic mini gastric bypass/ one anastomosis gastric bypass?

After consultation with our bariatric surgeon and the team, you will be advised to get investigations done. Once the reports come in, you will be seen by other specialists like the endocrinologist, hepatologist, chest physician, psychologist, nephrologist etc depending on your clinical profile. You will also be seen by the anaesthesia team for requisite fitness.

Along with this, you will be advised to start on a 7 days pre-surgery high protein liquid diet. Our team of dieticians will guide you through this phase. In case your tests reveal any abnormalities or nutritional deficiencies, correction is advised prior to the surgery.

How is the recovery after Laparoscopic mini gastric bypass/ one anastomosis gastric bypass?

Laparoscopic mini gastric bypass/ one anastomosis gastric bypass is performed under general anaesthesia. Patient is awake soon after the surgery gets over. We encourage our patients to mobilize out of the bed and walk for a short distance within 4 to 6 hours after surgery. Generally, no urinary catheters are inserted. This motivates the patients to get up and walk to the washroom. Oral liquids are started from the next day and continued for 15 days. After this soft diet is advised for another 15 days. Patients can start normal diet after one month from surgery, however, this is highly restricted in quantity.

Most of the aches and pains at the incision sites settle down within a week of surgery and patients generally are able to get back to work after seven to ten days. Mild activity is encouraged even in the first week of surgery.

What is the diet protocol after Laparoscopic mini gastric bypass/ one anastomosis gastric bypass?

Day of surgery- Nil by mouth (fasting)

Day 1 & Day 2- Clear liquid diet

Day 3 to day 15- Full liquid diet

Day 15 to day 30- Soft/pureed diet

Day 31 onwards- Normal diet (Restricted in quantity)