World's top Mini Gastric Bypass Bariatric Surgeons - Kular & Rutledge collaboration in India

 

Common Questions about Bariatric / Weight Loss Surgery;

 

Why we need Bariatric or Weight Loss/Obesity surgery? Why not only exercise and dieting?

 

Appetite is the biggest gift of God to the mankind. If we lose our appetite, we get depressed. We all want to eat. Eating is not only to fill our tummies but, it also gives a sense of pleasure and satisfaction once we have our dinner out with friends or loved ones. God gave us a design, which would conserve…. we have a large stomach approx. 2 litres pouch and 27 feet of intestine to absorb & conserve the food…. but now …. probably we don’t need to conserve so much…10 grams extra a day would make 3.5kilos in a year. We need to eat in moderation and absorb in moderation. Weight loss surgery is like designing & that too a customized one. Designing a smaller stomach and bypassing the first part of the intestine can make us lose a significant amount of weight. How small the stomach and how long the bypass?? This is the most important question in bariatric surgery.

 

We should understand the mathematics of exercise: Try to burn calories in the gym. Do some cycling or treadmill etc. and try to burn 200 cals. It will make you breathless and you will sweat a lot. Especially those who are heavy…carrying the extra 50 or more pounds on their backs! Do you know …taking 2 cups of coffee or tea with sugar and two biscuits will get you these 200 calories back. So…how much we need to work out to lose weight? We need to work out for hours together…the way we were supposed to run after the animals …never forget. we all have been hunter-gatherers…and that’s all that we have been doing and that’s all that we are supposed to do…then this design of 27 feet long intestine and a large stomach is very much required.

 

Probably, now, we don’t need to conserve so much…we don’t need this long intestine and this big stomach…either we change or design …or we start running after the animals for hours together…as we were supposed to do… or we change our designs and lose weight…. or don’t do anything….and live with this punishment of the extra weight on our backs!

 

 

 

Why choose weight loss/Bariatric surgery in India with Kular Bariatrics?

 

 

Kular bariatrics are the leaders of Mini Gastric Bypass surgery in India and have the maximum experience in this weight loss surgery in Asia. We have the best-documented world class results in bariatric surgery. Our results are at par with the best bariatric | weight loss surgery hospitals of the world. Dr Kular is a certified surgeon having U.S accreditation in Bariatric and Metabolic Surgery. He is a certified surgeon of Excellence in Bariatric & Metabolic Surgery by the SRC, USA. Dr Kular is trained by Dr Rutledge, the inventor of the Mini Gastric Bypass procedure. He has a decade-long association with Dr Rutledge.

 

Dr Kular has the honour to operate upon one of the family members of Dr Rutledge, as he wanted Dr Kular to do the surgery on his family member. Such is the confidence which Dr Rutledge has posted in Dr Kular.

 

Dr Kular has the honour to start the Mini Gastric Bypass surgery for the first time in India. He has done maximum Mini Gastric weight loss surgeries in the world after Dr Rutledge.

 

Kular Bariatrics is also accredited by the International Excellence Federation (IEF).

 

Dr Kular has the honour to be the founder President of the World Mini Gastric Bypass Surgeons Association (The MGB-OAGB Club). This club, with Dr Rutledge as the Honorary President and Prof. Mervyn Deitel as the Director, comprises of all the top MGB weight loss surgeons of the world.

 

Dr Kular has been appointed the director for the MGB Training Courses by the IFSO (International Federation of Surgeons for Obesity). Dr Kular has trained more than 200 surgeons from different corners of the world in this field.

 

 

 

How do we work at Kular Bariatrics?

 

 

First consultation:

 

The first time, you can have a telephonic/Skype consultation with our doctors. Your problem will be discussed in detail and then the treatment plans will be discussed. Whether you need weight loss surgery/ bariatric surgery will be determined.

 

 

Arranging a visa: Our team will assist you in arranging a visa to India, once you have finalized to undergo the surgery with Dr Kular.

 

Airport We would be more than happy to arrange the airport pick up and drop, if you express the need.pick up and drop:

 

Professional approach: Kular Bariatrics is amongst the top bariatric/metabolic surgery institutes of the world. Our team approach is totally professional and world class. We would be happy to assist you with whatever your needs may be. Our moto is “care comes first”

 

Budget: We understand that finances are an important part of the medical treatment. At the same time, we want to deliver a world class treatment. So, at Kular Bariatrics, you will get a combination of both. Our packages are low cost but our care is world class.

 

Other important services: We also take care of your needs after the surgery. It is a kind of long-term relationship. After care at Kular, is even better amongst the best bariatric institutes in the world. Ongoing dietary advise and telephonic consultations for the post-surgery patients even years after the surgery are our responsibility.

 

Obesity & the need for Weight Loss Surgery

 

These days obesity surgery/ bariatric surgery is becoming very common. Every day more & more obese patients with excess weight problems are opting for weight loss surgery or Bariatric Surgery. When other weight loss methods like exercise, dieting and medical management fail, Obesity surgery comes to the rescue. In many cases when the patients lose weight with these methods, they tend to regain the weight or even bounce back to a higher weight than where they started from. This excess weight is like a big punishment to a person who carries this weight on his/her back. Excess weight/Obesity gives rise to other medical problems like Diabetes type 2, hypertension, breathlessness, sleep apnea, joint problems, heart disease, stroke etc. In very near future, Morbid obesity is going to become the biggest challenge to the mankind. Childhood obesity is also coming up in a big way. Thus, excess weight / obesity is going to add to a lot of financial burden on the families and the countries as well. Morbid obesity comes with the cocktail of other diseases like sleep apnea, type 2 diabetes, heart attacks and strokes etc. Obesity is not just a single disease but it refers to a spectrum of diseases owing to the excess weight. Once your body becomes morbidly obese…these measures rarely produce results in terms of sustained weight loss.

 

 

What is Obesity?

 

Nature has given us a conservative design inside the tummy to deposit fat & gain weight. This fat deposit was required in olden days…we never knew if/when we would get the next food? Probably now, we don’t need to deposit so much fat, we don’t need to gain so much weight. Imagine if you add even 10 grams of extra weight/ fat every day! How obese you would be at the end of a month and imagine how much weight we would gain in a year and then in 5-7 years!

This fat accumulation, when increases to an extent, that our body feels diseased…is called as Obesity. This disease may be in the form of breathlessness, Type 2 diabetes, heart disease, stroke, joint problems, sleep apnoea or only a psychological disorder without any of these problems. We have seen patients depressed to the extent that they start hating their bodies, even if they are not diseased with any of these enlisted diseases directly related to obesity or weight gain.  In simple words, if we gain weight about 20% more than the required body weight, we are obese. Scientifically, when our body mass index (BMI) exceeds 30kg/sq.m, we are labelled as obese.

 

Why do we become obese, what are the causes of obesity or weight gain?

 

Gaining weight is simple. Eat more and burn less. But, sometimes this “eat more” is not true. We have a lot of experience with obese patients who are low volume eaters, they never ‘eat more’, they only “absorb too much”! Even water gives them weight gain.

 

• Consuming calories more than required causes obesity or weight gain – Appetite is the biggest gift by God. It gives us health, but the excess causes obesity! Now, what to eat and where to stop? This knowledge should be given to little kids in the schools so that they start fearing obesity or weight gain when they are growing. Once you gain weight, it becomes difficult to lose! On an average, women need 2000 calories per day to have a healthy life. If she takes 1500 per day, generally she should lose one pound in a week. Males would need 2500 calories to keep the weight sustained and 2000 calories per day to lose one pound in a week. This is just a rough idea, true for an average person with a typical office type sedentary lifestyle. There are other factors like age, height, present weight, physical activity, metabolism etc. which control your daily requirement to maintain weight and avoid obesity.

• Sedentary lifestyle & lack of sufficient physical activity.

• Hormonal disturbances like PCOS/PCOD or Cushing disease.

• Genetic factors or family inheritance causing weight gain.

• Increased absorption in the intestine. Maybe high absorption surface area or too much length of the intestine. Dr Kular has done a lot of research on this subject of intestine length and weight gain.

 

What is Bariatric Surgery / Obesity Surgery / Surgery to lose weight?

 

Bariatric / Obesity surgery encompasses various procedures performed on obese patients. Weight loss can be achieved by inserting a gastric band on the stomach or by taking out a part of the stomach by stapling (Laparoscopic sleeve gastrectomy or duodenal switch or biliopancreatic diversion) or by making a small pouch of the stomach and then joining this to a distal point on the intestine to make a gastric bypass. Bariatric/weight loss surgery is now a well-established science, being done from last 80 years. Studies show that the weight loss surgery improves the associated diseases like sleep apnea, type 2 diabetes, breathlessness, cardiac and vascular risk factors and reduces the mortality anywhere from 20- 40%.

 

 

What are the different types of Bariatric /Weight Loss/ Obesity surgeries?

 

There are several procedures available to control obesity. Following three are the common forms of obesity surgery;

 

• Restrictive techniques.          

• Malabsorptive techniques.

• Combined procedures (Restrictive & Malabsorptive)

 

Restrictive Procedures:  These are the surgeries which result in a decrease in the size of the stomach or stomach volume. This decreases the food intake thus decreasing the number of calories ingested. Five restrictive procedures are well known;

 

• Sleeve Gastrectomy.

• Gastric Band.

• Gastric Balloon.

• Vertical Banded Gastroplasty.

• Non-Banded gastroplasty (Non-resectional sleeve gastrectomy or old Magenstrasse and Mill procedure)

 

The first three procedures in the list are common.

 

Malabsorptive Procedures: A malabsorptive obesity/bariatric surgery mainly decreases the absorption of the food. Once our food passes down the food pipe into the stomach, it meets the stomach acids and is broken down. Further, it is released into the small intestine (duodenum, jejunum and ileum). The liver pours in Bile, which causes emulsification of the fats and thus helps digestion of the fats. Pancreatic juices also drain into the first part of the intestine and help digestion. In pure malabsorptive procedures, like jejunoileal bypass long lengths of intestine were bypassed. These procedures are not common now as they have high incidence of deficiencies and complications.

 

 

Combination Procedures (Restrictive cum malabsorptive): These are double edged surgeries i.e they have both the powers, restriction and decreased absorption. The restriction causes decrease in the stomach volume, thus allowing smaller volumes to be ingested. Malabsorptive component means bypassing the first part of the intestine and thus decreasing the absorption of food, primarily fats and sugars. Combination surgeries are preferred these days as they have shown promising results in the long run in terms of good sustained weight loss and lower incidence of deficiencies.

 

Four procedures are common in this category:

 

Roux-en-Y gastric bypass.

 

Mini Gastric Bypass (MGB) or One anastomosis reversible gastric bypass (OAGB).

 

Sleeve gastrectomy with duodenal switch.

 

BPD - Biliopancreatic diversion (+/- duodenal switch).

 

These procedures need more expertise, but if performed by and experienced bariatric surgeon, give dramatic and sustained results in terms of weight loss and improvement in the obesity-associated diseases like diabetes, cardiovascular problems, metabolic syndrome, PCOS & Sleep apnea etc.

 

How to find the best bariatric /obesity surgeon and the best bariatric hospital in India/Asia?

 

You will need a lot of research on the internet to make out the most experienced and best obesity surgeons in India/Asia. India has become a hub of Bariatric / weight loss surgery because of the everyday increasing medical tourism in India. India has provided one of the finest and top bariatric surgeons to the world. India also provides world class bariatric hospitals at a significantly low cost and world class surgery facilities at the same time. India is famous for low cost bariatric/obesity surgery with best hospital standards in the world.

 

 

Is there any preparation required for the obesity /weight loss/ bariatric surgery?

 

Before finalizing for the obesity surgery, you must first understand the mechanism of these procedures, know the risk and benefit ratio. Our bariatric surgeons at Kular Bariatrics will help you chose the best procedure for your body after understanding your food habits and needs.

 

First, prepare yourself psychologically and in your head.

 

Discuss the need with your family.

 

Talk to some of our old patients and discuss in detail.

 

 

Don’t think that bariatric surgery is a lock! It is a great effective tool which makes you lose weight easily and then you can maintain easily.

 

Talk to your family and get their support. Many a times only the patient understands the need for obesity surgery whereas all the family members don’t want this surgery. Either they fear the complications or because they don’t have the first hand feel of this punishment of carrying excess weight, living with diseases and not feeling good about yourself.

 

You must try other methods as dieting and exercise to your best.

 

Stop smoking at least one month before the surgery.

 

Better to be on liquid diet 12-24 hours before surgery.

 

Try to bring your latest available reports.

 

Bring your sleep apnea machine if you are already using it.

 

During a long journey in the plane, keep walking every hour to avoid clots in the legs.

 

 

What are the common Obesity / Bariatric Surgery procedures?

 

Gastric bypass is a classical type of weight loss procedure which was also known as gold standard. It usually takes 1.5 to 2.5 hours to do the Gastric bypass (Roux – en –Y Gastric bypass). Stomach is stapled to make it very small about 30-50 cc in size. Then this stomach is connected to the small intestine(jejunum), which in turn is further connected to the first part of the intestine about 50-70 cms away from the starting point of the intestine. Thus, patient eats less and the food then passes through a long segment of the jejunum and is then delivered to the small intestine at 70 cms from the starting point. This makes the patient eat less and absorb less. Because of the complexity and irreversibility of the procedure, now it is being less commonly performed.

 

Gastric band – It is a ring made up of silicone. The ring can be inflated through a bulb and a tubing attached to tithe bulb stays underneath the skin. Doctor can inject/extract saline in/from the bulb to inflate/deflate the band. Gastric banding was commonly used in the last decade, being a reversible procedure. Its numbers are also decreasing because of the need for adjustments and guarded success rate in the high calorie eaters.

 

Duodenal switch- The duodenal switch can be either Biliopancreatic diversion and duodenal switch, or a sleeve gastrectomy and duodenal switch. Duodenal switch means rerouting the intestines in such a way that the duodenum and a long length of the small intestine is bypassed, thus causing malabsorption. It is again a complex procedure, non-reversible. This obesity procedure is not amongst the very commonly performed procedures.

 

Sleeve Gastrectomy- It is a restrictive procedure, where a major part of the stomach is removed and the rest of the stomach is reduced to a banana shape. About 75-85% of the stomach is excised. This gives weight loss because of the calorie volume restriction. Soft calories must be avoided. Sleeve gastrectomy was initially performed as a stage 1 procedure for extremely obese patients, but, now it is performed even as a primary restrictive procedure in the morbidly obese patients.

 

Gastric Balloon – Gastric balloon is being promoted as an alternative to the surgical procedures, as it can be performed with the help of an endoscope. The balloon is placed in the stomach through the mouth and the food pipe and is then inflated. This gives a feeling of fullness and thus helps us eat less and lose weight. You can go home within 30 minutes. Gastric balloon is generally reserved either for those who are not fit for bariatric / obesity surgery or for those patients who need a small amount of weight loss only. Gastric balloon cannot be kept inside forever, it must be taken out after certain period.

 

Mini Gastric Bypass(MGB) - Mini Gastric Bypass was originally performed by Dr. Robert Rutledge in North Carolina, USA in 1997.It involves making the stomach smaller like a sleeve and connecting it to the small intestine at about 6 to 8 feet from the starting point of the intestine. This gives restriction and decreased absorption at the same time. Mini Gastric bypass can be easily reversed or revised in case of too much weight loss or inadequate weight loss. This makes Mini Gastric Bypass a promising procedure for long term weight loss. All the studies published on Mini Gastric Bypass show that it is either equivalent to or better than the traditional gastric bypass or RNY gastric bypass. There was an initial but long scepticism of the bile reflux in Mini Gastric bypass in the USA. One of Dr. Rutledge’s prominent students, Dr Kular, started the procedure in India and did it in big numbers, his studies clearly show that the results are better than the classical RNY procedure and MGB is a relatively safer procedure amongst all the available bariatric surgeries at present. Dr. Kular from India, Dr Chevalier from France, Dr W J lee from Taiwan are amongst the prominent world leaders of the MGB who brought it to the rest of the world after Rutledge from USA.Dr M. Carbajo from Spain did a variant of the Mini Gastric Bypass, OAGB (One anastomosis gastric bypass), his studies also showed similar good results.

 

Mini Gastric Bypass is now becoming more and more popular in different corners of the world. but the rest of the stomach is not excised.

 

What is ROSE procedure, is it the advanced Obesity surgery procedure?

 

Restorative Obesity Surgery (ROSE): This procedure is performed with the help of an endoscope. No surgery or incisions are required. It is not a step 1 procedure for obesity/weight loss surgery. It was used to tighten the gastric outlet of the RNY gastric bypass patients, once they come back significant weight regain because of the outlet dilation. Outlet dilatation has not been a problem in the Mini Gastric Bypass, as this procedure has a 5-cm outlet right from day 1 of the procedure, MGB does not rely upon the tightness of the gastric outlet, but here the food is delivered directly to the small intestine, thus causing dilation of the small gut, and this gives a feeling of fullness to the patient.

 

Will my life change after Obesity / Bariatric Surgery?

 

We should not take Obesity / Bariatric surgery as a quick fix. Once you undergo the procedure, you will see your weight going down. You will be eating small amounts of food and become full. You will also be absorbing less if you have undergone a combination procedure. As a matter of common sense, you will be eating less but you must eat nutritious food rich in proteins. The patient needs to be aware that our body also needs nutrition, it is not only the weight loss that matters. We need to become thin and energetic and not thin and weak. There are patients who would eat 2 pieces of bread or rice and take tiny amounts of any vegetables or chicken etc.  It should be the reverse after bariatric surgery. Bread being carbs, we should be eating at the last and first fill your tummy with the diet rich in proteins, if still there is some room you can take a small piece of bread. This will keep your nutrition maintained even with huge weight loss.

 

You should chew the food well and eat slowly.

 

Don’t drink with food. Drink 30 minutes before or after the main meal.

 

Take very small meals, but you can eat 4-5 times a day.

 

Avoid carbonated drinks and hard drinks. Other junk food like chocolates and candies etc and any other soft calories should be limited.

 

What are the advantages or benefits of the Bariatric/ Obesity Surgery?

 

Bariatric or weight loss surgery, on one hand, will make you feel good once you consider the mirror every day. One the other hand it will also make you diabetes control much better. Many patients won’t even need medicine for diabetes once they lose a good amount of weight. Still, Obesity surgery should not be considered as a treatment of diabetes, it makes diabetes significantly better but does not cure it.

 

Other diseases like sleep apnoea, breathlessness etc. would become remarkably better. Most patients won’t need their sleep machines after 6 weeks of the surgery. Blood pressure control, cholesterol and triglycerides levels are controlled in a much better way in the majority of the patients.

 

Are there any risks associated with Obesity/ Bariatric Surgery?

 

All surgeries have some chances of complications, but these days with the improvement in the techniques and availability of the laparoscopic procedures, the risks have come down significantly. The common risks involved are slippage of the band, bleeding during surgery, leak at the staple point, infection, clot formation in the legs and moving to the heart and lungs and even death. After surgery complications may be vomiting, nausea, some deficiency in the form of iron, Vitamin or proteins giving rise to weakness or other symptoms. Dilatation of the pouch and weight regain, inadequate weight loss, bile reflux, acid reflux, hair fall & internal hernia are amongst other possible complications. You must check the experience of your surgeon before deciding on Obesity or Bariatric Surgery. Experience will matter in a big way in making the obesity surgery safe for you.

 

Most of the bariatric surgery patients are complex. Many are on insulin, many have severe Sleep apnoea, cardiac disease, respiratory disorders. These patients are already at risk even without surgery. We need to access the risk-benefit ratio before taking the decision for surgery. Like any other surgery, the risks involved would be higher than normal in these kinds of patients.

 

What is the cost of weight loss / Bariatric Surgery?

 

The cost of various bariatric procedures can vary depending on the type of the procedure involved & the type of package ranging from a basic economy, premium, business or a First Class package.

 

Our cost of bariatric or weight loss surgery is highly competitive to the best bariatric hospitals in different corners of the world.We provide highly economical, yet a world-class bariatric surgery. Packages are available for the following common procedures;

 

Laparoscopic Gastric Band - USD 4000 / 5000 / 6000 ( Economy / Premium / Business )

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Laparoscopic Sleeve Gastrectomy - USD 5000 / 6000 / 8000 ( Economy / Premium / Business )

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Laparoscopic RNY Gastric Bypass - USD 5000 / 6000 / 8000 ( Economy / Premium / Business )

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Laparoscopic Mini Gastric Bypass - USD 6000 / 7000 / 9000 ( Economy / Premium / Business )

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Surgery for type-2 diabetes control - (Laparoscopic Ileal Transposition- IT  or others) -USD 8000 / 10000 / 12000

( Economy / Premium / Business )

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Revision Surgeries - Needs to be discussed individually.

High-risk patients - Charges as per the case and need.

 

Exclusive First Class packages (Business +3000 USD) are also available.

 

We also have customised NRI packages inclusive of airfare, airport pickup/drop and Punjab sightseeing.

 

Special sponsored programs are organised for poor patients time to time, where we provide a free hospital and surgical service for needy patients; no hospital and surgeons fee is charged & the patient purchases his/her own consumables.

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