Bariatric surgery is a group of procedures for morbidly obese people which aim at long term effective weight loss. Though bariatric surgery is strictly not a cosmetic procedure, it has been classified as one in the ICD system and is presently not covered by private insurance companies. Most of the developed countries of the Western world and Australia fully cover bariatric surgery under medical insurance. In the Indian scenario, at present, there is big push by the healthcare system and the company manufacturing the stapling devices for including bariatric surgery under insurance. However, this process is a long and tedious one which might take many years.
Bariatric surgery in India typically costs anywhere between 2 lac to 5 lac INR depending upon the type of procedure, hospital, type of consumables used, operating surgeon and patient co-morbid conditions. The cost for bariatric surgery in the developed countries is typically 3-5 times higher than this mostly because of the overall increased healthcare costs there.
There are some agencies which can offer finance facilities for bariatric surgery to avoid the burden of down payment of a large sum of money. These facilities increase the accessibility of the procedure to the lower income groups.
Bariatric surgery is a group of metabolic procedures for morbidly obese individuals aimed at long term weight loss and comorbidity resolution. Bariatric surgery originated almost 100 years ago in the 1930s when intestinal bypass was performed for obese individuals to decrease the absorption of food and cause weight loss. These procedures carried a high morbidity and were generally condemned by patients and doctors alike. It has come a long way since that time and great advancements have been made in this field with the advent of laparoscopy and endostapling technology. The application of laparoscopy in bariatric surgery means that there is ease of access, less blood loss, lower infection rate, less pain and faster recovery of the patient. Endostapling technology has made the procedure swift and added to its safety. Newer energy devices also add to the safety of bariatric surgery although the costs are increased too.
Bariatric surgery in India has become popular in the last 15-20 years. With the growing urbanisation and adoption of the western lifestyle, there is a rapidly increasing incidence of obesity in India. This, coupled with the high incidence of diabetes and metabolic syndrome in the Indian population, has spurred the demand for bariatric surgery in India.
Safety of the procedure would be determined upon 3 basic factors- patient factor, operating surgeon and the infrastructure facilities. It would be important to consider all these factors carefully before embarking upon bariatric surgery in India.
Patient related factors are the weight, BMI, age, comorbid illnesses, behaviour, compliance and addictions. These factors determine the safety and overall outcome of the procedure. Bariatric surgery is generally safe in the 18-65 year age group. Extremes of afe increase the chances of complications. In general, old age, male gender, history of smoking, severe airway or cardiac disease and BMI> 50 increase the chances of complications during bariatric surgery. It is necessary to tackle all the modifiable risk factors and to optimise the patient in order to reduce the operative risk before embarking on the bariatric surgery.
Most of the surgeons performing basic and advanced laparoscopic surgeries have graduated to bariatric surgery in India. This is because they already have the necessary skill set to perform complex laparoscopic procedures and familiar with the technology and instrumentation. Many surgeons also have training certificates and fellowships from abroad where these surgeries are being performed routinely. It is important to consider the operative experience and the volume of surgeries being performed by the surgeon. In general, those surgeons performing at least 50 cases of bariatric surgery per year with an experience of 5 years or more would have less chances of causing complications.
The infrastructure of the hospital, medical gadgets and the support staff also play a vital role in safety of bariatric surgery in India. The hospital should have well equipped operation theatre and ICU and should have a well established care pathway for major abdominal procedures. There should be a policy for single use of all disposable instruments and equipment. Besides the surgeon, the anaesthetist and paramedical staff should be fully aware of the steps involved in the procedure and should be able to tackle any complications or troubleshooting that may arise.
Besides this, the successful weight loss result of the surgery would be determined by the regular long term follow up. In this aspect, the bariatric coordinator and the dietician play a vital role in fixing appointments, guiding the patient with diet and exercise and the use of nutritional supplement after the surgery. It is also important to have regular support group meetings for the patients to discuss their common problems and which also helps in motivations and improves the overall long term results of the procedure.
Mini gastric bypass also known as One anastomosis gastric bypass (OAGB) is a variation of the classical Roux en Y gastric bypass. It was developed in the USA by a prominent bariatric surgeon and has gained popularity particularly in India and Asian countries because of its technical ease and the excellent weight loss results with a low complication profile. The procedure involves the creation of a long and narrow gastric pouch based on the lesser curvature of the stomach and joins it to a loop of small intestine after bypassing 200 cm of its length. This results in undigested food directly entering the small intestine which creates a powerful mechanism of malabsorption leading to long term weight loss. The effect of dumping leads to bloating and passage of oily stools when there is excess of fat in the diet and this causes the patients to modify their diet to take more of healthy and fat free foods. Minigastric bypass typically takes less time to perform than a classical RYGB and is less technically demanding which reduces the chances of intra operative complications.
The cost of Minigastric bypass would be the same as other bariatric procedures and would mainly depend upon the hospital, operating surgeon and patient related factors and could be anywhere between 2.5 lac INR to 4 lac INR. The cost would increase if there are more consumables required during the procedure and also if there are complications necessitating ICU stay or increased length of hospital stay or further interventions. The costing would also be more in case a robotic operation is performed as the equipment and instruments in such a case are typically more expensive.