Snip…Tuck…Staple…..And bend it like Maradona

By Sudha Hariharan

Football legend Diego Maradona will soon turn 50 --- an entire generation of football lovers adored and worshipped the player in the striped No.10 jersey. When Diego was on the field it was pure magic. But off the field he was only human. Ballooning weight, divorce, separation from his children, his flashy lifestyle and burgeoning debts , and numerous scuffles kept him continuously in the spotlight.

And then, what started as a minor post-match habit from his mafia-ridden days in Napoli---his addiction to cocaine--- ate into his greatness. The downfall was swift—personally, professionally and physically.

On his last birthday, he was fighting death, put on a respirator in a Havana Hospital while his fans still held candles outside, stood vigil and prayed for his life.

Who would have believed that Diego who was given up for dead would rise like the Phoenix, give death the famous dribble and slip past it as only he could.

He now hosts a weekly TV show La Noche del 10 (The Night of 10) and looks slim and trim……he’s even returned to his first love—football! All thanks to surgery in which his stomach was stapled, cutting him down to size. Maradona weighed 266 pounds( 125 kgs) when he went into surgery. Now at 75 kgs, Diego has become a powerful advertisement for Bariatric or Obesity Surgery.

Most physicians consider obesity to be an important factor in personal health for three reasons:

1 . It is common

2 . It is associated with increased sickness and death tales, notably in respect to heart, circulatory, kidney and metabolic disorders as well as surgical and obstetrical complications.

3. It can be treated with success as one practical way to help control associated medical conditions.

Obesity is not always readily subject to treatment and correction of obesity does always ensure elimination of the added risks associated with this condition. Yet efforts towards its control seem justified by the relative health advantages identified with normal weight status.

Eminent Bariatric Surgeon Dr. Mufazal Lakdawala (Dr. L.H. Hiranandani Hospital) and Obesity expert Dr. Sanjay Borude( associated with Wockhardt Hospital among others) demystify obesity surgery.

Explains Dr. Borude, “Gastric Banding is a restrictive procedure which is safe, quick and most popular form of surgery to control obesity. It restricts the amount of food ingested, with early satiety ( quite like forced dieting) but it cannot restrict liquid calories and hence post-op care has to be meticulously planned with proper diet and exercise”.

Elaborating on the procedure, Dr. Lakdawala says,” Gastric Banding entails a laparoscopic implantation of a Silastic band around the stomach to section off a small portion called as stomach pouch creating an hour-glass effect. A small outlet, about the size of a pencil eraser, is left at the bottom of the stomach pouch. The hour glass configuration only constricts the upper stomach thus acting as a pure restrictive operation. Since the outlet is small, food stays in the pouch longer and one also feels satiated for a longer time.”

The procedure involves placing an Adjustable Gastric Band, which consists of a silicone ring with its inner balloon, a connecting tube and a reservoir port around the stomach.

The silicone ring passes around the stomach and the reservoir is placed under the skin in the midline just below chest such that it can easily be felt while lying down. A needle can be injected through the skin into the reservoir to add or remove fluid to adjust the size of the stomach outlet.

Who needs Lap Gastric Bypass?

Dr. Lakdawala explained that Lap Gastric Bypass is usually recommended to those with morbid obesity, who are 30kgs over or a Body Mass Index (BMI)> 33 kg/m² for more than 5 years . Also those who fail to sustain weight loss on supervised dietary and conservative approaches, show absence of an endocrine cause, compulsive eaters and educated and compliant are the common candidates.

The procedure is minimally invasive and patients recover fast. The band is inflatible so it can be adjusted over time and, completely reversible

Pre-Surgery

Prior to the operataion the patient is subjected to a complete check-up, and a medical and diet history helps the doctor to rule out:

ð Alcohol or drug abuse

ð Endocrine cause for obesity

ð Severe psychological problems or mental illness.

A week before the surgery, says Dr. Lakdawala, “ we keep the patient on an optifast diet. This helps to reduce liver swelling and helps the doctor verify whether you are ready for the surgery”

Replying to a query on the safety of the procedure, he explained that hurdles could arise because of anaesthesia complications, bleeding, injury to the liver, stomach or spleen during surgery, pulmonary embolism and wound infection.Sometimes Band infection, slippage and erosion also occur later.

“Gulping down liquids,”says Dr Lakdawala, “ could trigger vomiting., but if this occurs regularly, more so in the first month, there is a danger of band displacement. Thus one has to be very careful of drinking/eating fast especially in the first few weeks post the procedure.”

“Also”, he warns, “ medication for co-morbidities like diabetes, hypertension or asthma will have to be reduced after the surgery”.

Dr. Borude and Dr. Lakdawalsa caution that the period between surgery and weight stabilization is a period of relative starvation hence it would not be a good idea to conceive during this phase of weight loss and, one should avoid any pregnancy for at least 12 to 18 months after surgery. To accomplish this, the band is loosened to facilitate increased intake to take care of the nutritional demands of mother and unborn child.

With the LAGB, weight loss can be attuned at any time after the operation according to your needs and optimal health. This is because the diameter of the gastric band can be modified be injecting or removing fluid via a port placed under the skin.

In general, you could expect – loss of 50-60% excess weight by the end of 1.5 years,greater capacity for physical activity and improvement in quality of life.

Rouz-en-y Gastric Bypass

Explaining the intricacies of this procedure, Dr. Lakdawala said the surgery involved a creation of a small stomach pouch with the help of staples which restricts the food intake. In addition, the initial segment of the small intestine, duodenum and a small portion of jejunum, are bypassed and a direct Y-shaped connection is made from the remaining part of the jejunum to the new stomach pouch for mal-absorption.

This surgery is a combination of restriction and mal-absorption. The small stomach pouch created sends early signals of satiety and the bypassed segment of the intestine results in incomplete absorption of food. Due to this dual effect, there is a greater degree of weight loss than gastric banding.

The actual weight loss is dependent on several factors. These include:

ð Age

ð Weight before surgery

ð Overall condition of your health

ð Surgical procedure

ð Ability to exercise

ð Commitment to maintaining dietary guidelines and other follow-up-care

ð Motivation of patient and cooperation of their family, friends and

ð associates