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Q. What are the procedures established in bariatric surgery?

A. The field of bariatric surgery is ever-evolving. The number of cases has increased dramatically with the adoption of laparoscopy in this field. According to a survey by International Federation for the Surgery of Obesity and Metabolic disorders (IFSO), the total number of bariatric procedures has increased by more than ten-fold over last decade. Although many old procedures like intestinal bypass, Vertical Banded Gastroplasty (VBG) have been abandoned, a lot of newer procedures have been adopted by bariatric surgeons.

The main aim is to achieve a successful weight loss solution with remission of obesity related problems along with adequate safety measures. According to fourth IFSO Global Registry Report (2018), Sleeve Gastrectomy is the most commonly performed procedure (46%) followed by Roux-en-Y Gastric Bypass (RYGB) (38.2%). These are the two well established and accepted procedures with subtle variations done by different bariatric surgeons. Among the other procedures, One Anastomosis Gastric Bypass (OAGB) has been fast evolving in recent years (7.6%). However, the total number of gastric banding operations has gone down since 2014.

Q. What are the recently adopted surgical techniques in bariatric surgery?

A. Technological advancement and increasing expertise has made a lot of changes in the practice of bariatric surgery in recent years. Endoluminal or endoscopic bariatric procedures and robotic bariatric procedures are two of them. The initial results of endoscopic bariatric procedures are at par with conventional laparoscopic bariatric procedures but we are yet to obtain long term data.  Evolution of robotics has given the advantage of performing the procedures at ease with equivalent outcome.

Q. What are the challenges here?

A. Obesity management needs multidisciplinary involvement. A successful bariatric team needs the specialisations of an experienced and dedicated nutritionist, endocrinologist, pulmonologist, physiotherapist and psychologist. They are as important as the bariatric surgeon and bariatric anaesthetist. So the initial challenge is to form a dedicated bariatric team. The most successful centres of bariatric surgery are regularly conducting obesity awareness activities among the general population along with the bariatric support group meetings with all pre- and post-bariatric surgery patients. The whole team should continuously update themselves on present trends and practices in this fast-evolving field.

Q. What are the present opportunities in this field?

A. Bariatric surgery is a team work which needs dedicated and efficient team members from various specialities. Thus, there are huge opportunities for young, dynamic, and qualified health professionals to get involved in various bariatric centres.