**Surgery for Morbid Obesity**, commonly known as **Bariatric Surgery**, encompasses various surgical procedures performed to induce significant and sustained weight loss in individuals suffering from morbid (severe) obesity. This medical intervention is considered when conventional weight loss methods (diet, exercise, medication) have failed, and obesity poses severe health risks. While **Dr. Neeraj Dhar, a leading Gastroenterologist in Faridabad, does not perform the surgical procedures himself**, he is an **integral part of the multidisciplinary team** providing comprehensive care to bariatric patients, focusing on crucial **pre-operative gastrointestinal evaluation and long-term post-operative GI and nutritional management.**

Understanding Morbid Obesity and Indications for Surgery:

Morbid obesity is a severe medical condition characterized by excessive body fat that significantly increases the risk of numerous health problems, including Type 2 Diabetes, hypertension, sleep apnea, heart disease, joint pain, and certain cancers. Bariatric surgery is typically recommended based on specific criteria:

• **Body Mass Index (BMI) of 40 or higher:** This indicates extreme obesity.
• **BMI of 35 or higher with at least one serious obesity-related comorbidity:** Such as uncontrolled Type 2 Diabetes, severe sleep apnea, high blood pressure, non-alcoholic steatohepatitis (NASH), or severe joint pain.
• **Failed attempts at sustained weight loss** through supervised diet and exercise programs.
• **Commitment to lifelong lifestyle changes** and medical follow-up.

Common Types of Bariatric Surgery:

These procedures work by restricting food intake, reducing nutrient absorption, or both:

1. Laparoscopic Sleeve Gastrectomy:

• About 80% of the stomach is removed, creating a smaller, banana-shaped "sleeve."
• Reduces stomach capacity and levels of the hunger hormone (ghrelin).
• **Pros:** Simpler than bypass, no re-routing of intestines, less risk of nutrient deficiencies compared to bypass.

2. Roux-en-Y Gastric Bypass:

• Considered the "gold standard." A small stomach pouch (about the size of an egg) is created and connected directly to the jejunum (middle part of the small intestine), bypassing a large portion of the stomach and duodenum.
• **Pros:** Excellent weight loss, significant improvement in diabetes, well-studied.
• **Cons:** More complex, higher risk of nutritional deficiencies, potential for dumping syndrome.

3. Mini-Gastric Bypass / One-Anastomosis Gastric Bypass (OAGB):

• Similar to Roux-en-Y but involves only one intestinal connection, making it technically simpler.
• **Pros:** Good weight loss, effective for diabetes, potentially shorter operative time.
• **Cons:** Higher risk of bile reflux in some cases, potential for greater nutritional deficiencies than sleeve.

Other procedures like Adjustable Gastric Banding (less common now) and Biliopancreatic Diversion with Duodenal Switch are also performed in specific cases.

Benefits of Bariatric Surgery:

• **Significant and Sustained Weight Loss:** Typically 50-70% of excess weight in the first 1-2 years.
• **Remission or Improvement of Co-morbidities:**
  • Type 2 Diabetes remission in a high percentage of patients.
  • Improvement in hypertension, high cholesterol, sleep apnea.
  • Reduced joint pain, improved mobility.
  • Resolution of non-alcoholic fatty liver disease (NAFLD/NASH).
• **Improved Quality of Life and Mental Health:** Enhanced physical activity, self-esteem, and social engagement.
• **Increased Life Expectancy.**

Preparation for Bariatric Surgery:

The preparation is extensive and multidisciplinary, with Dr. Neeraj Dhar's gastroenterological expertise being crucial:

• **Comprehensive Medical Evaluation:** To assess overall health, identify pre-existing conditions, and ensure the patient is fit for surgery.
• **Gastrointestinal Evaluation (by Dr. Neeraj Dhar):**
  • **Upper Endoscopy (EGD):** Essential to examine the esophagus, stomach, and duodenum for any abnormalities (e.g., ulcers, polyps, hiatal hernia, severe esophagitis) that might need to be addressed before surgery or influence the choice of procedure.
  • **H. pylori Testing and Eradication:** To test for and treat *Helicobacter pylori* infection, which can increase the risk of post-operative ulcers.
  • Assessment of any existing GERD, as some procedures (like sleeve gastrectomy) can worsen it, while others (like bypass) can improve it.
• **Nutritional Counseling:** To educate on pre- and post-operative dietary changes and lifelong vitamin/mineral supplementation.
• **Psychological Evaluation:** To assess readiness for surgery and commitment to lifestyle changes.
• **Lifestyle Modifications:** Includes a supervised pre-operative diet and smoking cessation.

Recovery and Post-Operative Care:

• **Hospital Stay:** Typically 2-4 days, depending on the procedure and patient recovery.
• **Diet Progression:** A strict, gradual dietary progression from clear liquids to full liquids, pureed foods, soft foods, and eventually regular solid foods over several weeks.
• **Pain Management:** Managed with prescribed medications.
• **Activity:** Early ambulation is encouraged. Strenuous activities are restricted for several weeks.
• **Lifelong Follow-up:** Essential for monitoring weight loss, managing nutritional deficiencies, and addressing any potential complications. This involves regular visits with the bariatric surgeon, dietitian, and Dr. Neeraj Dhar.
• **Vitamin and Mineral Supplementation:** Crucial for life, especially after malabsorptive procedures like gastric bypass, to prevent deficiencies (e.g., B12, iron, calcium, vitamin D).

Potential Risks and Complications:

While generally safe, bariatric surgery carries risks, including:

• **Early Complications:** Leakage from staple lines/anastomoses, bleeding, infection, deep vein thrombosis (DVT), pulmonary embolism, anesthesia risks.
• **Late Complications:**
  • **Nutritional Deficiencies:** Most common long-term complication, requiring lifelong supplementation and monitoring (where Dr. Dhar plays a critical role).
  • **Dumping Syndrome:** Rapid emptying of stomach contents into the small intestine, causing symptoms like nausea, vomiting, dizziness, and diarrhea (more common after gastric bypass).
  • **Gallstones:** Due to rapid weight loss.
  • **Strictures:** Narrowing at the connections (anastomoses).
  • **Marginal Ulcers:** Ulcers at the connection point between the stomach pouch and small intestine.
  • **Hernias.**
  • **Weight Regain:** If dietary and lifestyle guidelines are not followed.

Dr. Neeraj Dhar's Indispensable Role in Bariatric Care:

As a Gastroenterologist, Dr. Neeraj Dhar provides crucial support throughout the bariatric journey:

• **Pre-operative GI Clearance:** He performs essential diagnostic endoscopies to identify and treat any pre-existing GI issues like ulcers, H. pylori infection, or significant hiatal hernias that could complicate surgery or post-operative recovery.
• **Management of GI Comorbidities:** He manages conditions like GERD, fatty liver disease, and other digestive disorders that often coexist with morbid obesity, ensuring the patient is in the best possible GI health before surgery.
• **Post-operative Complication Management:** Dr. Dhar is vital in diagnosing and managing common post-bariatric GI complications, including:
  • **Strictures:** Using endoscopic dilation.
  • **Ulcers:** Medical management and endoscopic interventions.
  • **Dumping Syndrome and Malabsorption:** Providing dietary guidance and medical management.
  • **Nutritional Deficiencies:** Monitoring levels and guiding supplementation.
  • **Bile reflux.**
  • **Diarrhea or constipation issues.**
• **Long-Term Follow-up and Surveillance:** He ensures ongoing gastrointestinal health and nutritional status, recommending further endoscopic surveillance if needed (e.g., for gastric pouch issues) and managing any new GI symptoms that arise years after surgery.
• **Holistic Patient Care:** Dr. Dhar collaborates closely with the bariatric surgeons, dietitians, and other specialists, providing integrated care that is essential for the long-term success and well-being of bariatric patients.

If you are considering surgery for morbid obesity, consult with Dr. Neeraj Dhar in Faridabad for a thorough gastrointestinal evaluation and comprehensive support before and after your procedure. His expertise is crucial for optimizing your outcomes and ensuring your long-term digestive health.