Alarming rise in bariatric surgeries

MUSCAT, July 21 – The Sultanate has been witnessing an alarming rise in the number of obese youth opting for bariatric surgery in order to lose weight or control diabetes. Obesity is reported to be 20 per cent among men and 36 per cent among women in Oman. The figures, though, are lower than that in other countries of the region. “The number of people going in for bariatric surgeries is certainly on the rise,” says Dr Mahmood al Abri, Head of Emergency Medicine, Al Nahda Hospital.
According to him, bariatric surgery causes weight loss by reducing the stomach size, thereby restricting the amount of food entering the stomach. “The surgery is usually performed using minimally invasive techniques known as laparoscopic (keyhole) surgery,” says Dr Al Abri.
Dr Nigel Kuriakose, Sultan Qaboos University Hospital, says people with metabolic syndromes are on the rise, the prime reason being obesity, lack of exercise and unhealthy lifestyle practices, leading to multiple co-morbidities.
“Finally, the treatment for weight reduction would be bariatric surgery, as it turns out to be an easier alternative for many,” he says.
One would need a regular follow-up and some lifestyle modifications after the surgery.
Although there is no official statistics to support the finding, hospitals that the Observer approached have admitted there has been at least a five-per cent increase in the number of bariatric surgeries in the last few years.
“In the past decade or so, bariatric surgery has made rapid strides in providing relief to millions of obese people; there has been an increase in the number of bariatric surgeries that we have conducted in the past few years,” says Dr Harikrishnan of a private hospital.
According to him, obese people are likely to suffer from an increased incidence of complications after a surgery.

“The most important complication after bariatric surgery is the leak from operated area of the stomach or intestines.”
“This situation needs urgent attention, often in the form of surgical intervention. While every care is taken by operating teams to reduce such a complication, it is seen in a small percentage of patients undergoing such procedures,” says Dr Hari.
He says it is important to follow post-operative instructions and report early to the hospital in case of any problems. “Operative site infection, bleeding and occasional hernia at the sites of operation are reported, but they aren’t life threatening.”
Bariatric surgery is conducted by either restricting the capacity of the stomach by reducing the size of stomach with an implanted medical device (gastric banding) or by removing a portion of the stomach (sleeve gastrectomy) or by causing malabsorption of consumed food by diverting ingested food to a portion of small bowel (short limb gastric bypass surgery) or a combination of restrictive and bypass procedures (long limb gastric bypass surgery). Hospitals in Oman and elsewhere offer this procedure to help those for whom obesity has become a “life-altering challenge”.
Also on offer are non-operative weight reduction methods like the placement of an intra-gastric balloon.
Bariatric surgery is not just a weight-loss procedure.
It also involves observing standardised surgical methods and follow-up protocols to ensure patients recover well and maintain their weight loss.
Some of the complications of bariatric surgery are dehydration in Type-2 diabetic patients.
They may have difficulty in drinking appropriate quantity of fluids as they adapt to their new gastric volume.
Limitations on oral fluid intake, reduced calorie intake and higher incidence of vomiting and diarrhoea will lead to dehydration.
Type-2 diabetes is a long-term metabolic disorder in which there is resistance to insulin, the naturally produced hormone that controls blood sugar. While Type-2 diabetes may occur regardless of someone’s age, gender or body mass, the disease tends to be more severe among the obese.
Because of excess weight, obese individuals develop resistance to insulin.
Professor Dr Guido Mannaerts, who has over 25 years of experience in the field of bariatric surgeries and performed more than 5,000 bariatric procedures, told the Observer that one should “not go for inexperienced hands, but an experienced surgeon who can safely perform the task”.
“With experienced hands, the rate of complications is extremely low for bariatric procedures. In the first few months, patients can get a bit tired and experience some temporary hair loss. However, after a few months, patients in almost all cases feel much more energetic and can sleep much better than before the surgery. In almost all cases, the quality of life improves,” Dr Mannaerts said.
“Long-term drawback can be some redundant skin due to the weight loss which can be corrected through plastic surgery.”
Dr J S Rajkumar, consultant in advanced laparoscopic and metabolic surgery services, Al Hayat International Hospital, says 20 per cent of population in the country will benefit from some kind of weight loss programme, including lifestyle modification, but in many cases bariatric surgery as well.
“The maximum waiting list for the weight loss surgery exists all over the world because the available expertise does not match the demand,” he added.

KABEER YOUSUF