What is Hysterectomy?

Hysterectomy is a surgical procedure involving removing a woman's uterus entirely or partially as needed. Hysterectomy can be done in different ways, including total hysterectomy, partial hysterectomy, and radical hysterectomy. This procedure is usually performed for women who have completed their family.

Anatomy and Physiology of Uterus

The uterus is a female reproductive organ located in the lower abdomen, between the bladder and the rectum. It is a pear-shaped, muscular organ with thick walls and is responsible for hosting a developing fetus during pregnancy.

The upper part of the uterus, called the fundus, is connected to the fallopian tubes, while the lower part, called the cervix, extends into the vagina.

The walls of the uterus consist of three layers:

1. The innermost layer is the endometrium, which is shed during menstruation and is where a fertilized egg implants and develops into a fetus.
2. The middle layer is the myometrium, made up of smooth muscle and responsible for the uterus contractions during labour.
3. The outermost layer is the perimetrium, a thin layer of connective tissue covering the uterus's surface.

Conditions Treated with Bariatric Surgery

Bariatric surgery is an effective weight management option. Moreover, it also improves several obesity-related conditions, including:

1. Type 2 Diabetes: Excess fat can lead to insulin resistance. Bariatric surgery can improve blood sugar control.
2. Hypertension (High Blood Pressure): Many patients experience better regulation of blood pressure levels after the procedure, reducing the risk of heart disease.
3. Heart Disease: By managing diabetes and hypertension, surgery can lower the risk of heart disease and stroke.
4. Fatty Liver Disease: Weight loss can reduce liver fat, inflammation, and fibrosis. This decreases the risk of non-alcoholic fatty liver disease (NAFLD) and non-alcoholic steatohepatitis (NASH).
5. Obstructive Sleep Apnea: It is a condition in which breathing stops and restarts during sleep. Weight loss after bariatric surgery can improve this disorder.

Who needs weight loss surgery?

Bariatric surgery offers a significant opportunity for weight loss. However, qualifying for this procedure involves meeting specific medical guidelines. These include:

1. Body Mass Index (BMI) of 40 or above without comorbidities.
2. BMI of 35 to 39.9 (obesity) with comorbidities like type 2 diabetes, high blood pressure, or severe sleep apnoea.
3. Long-term commitment to extensive dietary, exercise, and lifestyle changes.

Benefits of Bariatric Surgery

Surgery is the only treatment that has shown long-term efficacy for class II obesity. However, the advantages extend beyond substantial weight loss. The benefits of bariatric surgery include:

• Improved cardiovascular health.
• Remission of type 2 diabetes.
• Relief from depression (that results from physical limitations and societal stigma associated with obesity).
• Joint pain relief (as carrying excess weight can place significant stress on weight-bearing joints, leading to chronic pain and joint damage).
• Improved fertility during childbearing years (also reduces the risk of miscarriage).
• Increased metabolism.

Before and on the Day of Bariatric Surgery

Preparing for bariatric surgery requires a clear understanding of the necessary steps before and on the day of the operation to guarantee its effectiveness. Patients must adhere to their doctor's guidance.

Before Bariatric Surgery

The preparatory phase before the surgery is valuable for the patient. Before the procedure, individuals must follow instructions/guided advice to reduce side effects and be clear on the surgery risks. The other instructions and precautions include the following:

On the Day of Bariatric Surgery

On the day of surgery, patients must adhere to the instructions set by the surgical care unit and their doctor. The pre-operative guidelines before the operation can have an effect on the overall outcome. Here's what one can expect:

Bariatric Surgery Procedure

There are various types of bariatric surgery, each of which helps in weight loss by altering the structure of the digestive system. The techniques for these types differ. The most common procedures include:

1. Gastric Bypass (Roux-en-Y): A small pouch is created at the top of the stomach using surgical staples. It is then connected directly to the lower part of the small intestine. After surgery, food bypasses the rest of the stomach and the upper portion of the small intestine. The procedure takes 2 hours to complete.
2. Sleeve Gastrectomy: The surgeon makes five minor cuts in the abdomen to remove 80% of the stomach. The sleeve-shaped stomach reduces the amount of food eaten at once. Bariatric sleeve surgery takes 1-3 hours.
3. Adjustable Gastric Banding (Lap-Band): A silicone band is placed around the upper stomach. A port connected to the band allows for adjustment. The port is placed under the abdomen, which tightens the belt to create two smaller sections. This restricts food intake. The complete procedure takes 3-4 hours.
4. Biliopancreatic Diversion With Duodenal Switch (BPD/DS): It combines both gastric sleeve and gastric bypass. In this procedure, 75% of the small intestine is bypassed. This significantly reduces the absorption of nutrients and calories from the food intake.

Note: The selection of treatment approach is based on the patient's condition and the doctor's opinion.

Alternatives to Bariatric Surgery

Patients can also opt for less invasive alternatives to bariatric surgery. These techniques use an endoscope inserted through the mouth into the stomach. The following are two common procedures for weight management:

1. Intragastric Ballooning: It involves placing a silicone balloon inside the stomach to occupy space and promote early satiety. The balloon is left in place for six months before being removed. It can help patients lose up to 15% of their body weight.
2. Endoscopic Sleeve Gastroplasty: During this procedure, a series of sutures are placed in the stomach to reduce its size by 70%. It helps patients lose up to 20% of their body weight.

Recovery After Bariatric Surgery

After weight loss surgery, recovery and post-operative care are critical to achieving long-term success. The following is what patients can expect during the recovery phase:

In Hospital Recovery

Depending on the type of surgery, patients may be hospitalised for 1 to 3 days. During this time, they are monitored for any complications.

• After surgery, the patient is shifted to the recovery room. The nurse monitors their breathing, heart rate, and blood pressure.
• Once their condition stabilises, they are moved to a general ward.
• The doctor prescribes antibiotics to prevent infections and pain relief medications for discomfort.

At-home Recovery

Patients can return to their normal activities 4 to 6 weeks after discharge. During this time, it is important to follow these instructions:

1. Diet: Adhering to portion control is vital to avoid regaining weight and to support nutritional health.
   • For the first two weeks, patients will follow a liquid diet (to thin soup).
   • During weeks 3 and 4, they will transition to pureed foods like yoghurt.
   • They can eat soft foods like mashed potatoes during weeks 5 to 8.
   • After that, return to a balanced diet can be achieved under medical advice.
2. Hydration: Staying hydrated is crucial to avoid nausea and vomiting. However, it is important to sip small amounts of fluids throughout the day to avoid filling the stomach too quickly. It is recommended that patients drink 1.5 to 2 litres of water every day.
3. Wound Care: It includes keeping the area dry, checking the surgical site for signs of infection, such as redness, swelling or discharge.
4. Physical Activity: Walking is highly recommended to improve circulation and promote healing. However, patients should avoid strenuous activities and heavy lifting for six weeks after surgery.

Follow-Up Appointment

The initial follow-up appointment will be scheduled with the healthcare team two to three weeks after surgery. After the initial visit, regular check-ups will be scheduled at three, six, nine, and twelve months post-operation. The patient will continue to see the doctor for extended check-ups after the first year post-operation. The surgeon and nutritionist will assess the need for removal of sutures, order the next phase of the diet, and monitor any other issues. The doctor may recommend laboratory tests, blood work, and other assessments.

Risks and Complications of Bariatric Surgery

The procedure and other various benefits for individuals with obesity. However, like any major operation, certain risks and complications can occur. The bariatric surgery side effects can range from short-term issues to long-term challenges.

Short-term Risks

• Infection
• Blood clots
• Bleeding
• Adverse reactions to anaesthesia
• Breathing problems

Long-term Risks

• Malnutrition
• Gallstones
• Hernias
• Bowel obstruction
• Dumping syndrome (food passes too quickly from the stomach to the small intestine)

When to consult a doctor?

After bariatric surgery, it is important to know when certain symptoms or changes in the patient's condition warrant a call to the doctor. Here are situations when reaching out to the healthcare provider is advised:

• Fever above 101°F
• Increased swelling, redness, or discharge from the surgical incision sites
• Shortness of breath or chest pain
• Nausea or vomiting for more than 12 hours
• Unable to urinate for eight hours
• Persistent pain that does not improve with medication

Risks of Delaying Bariatric Surgery

Delaying bariatric surgery can have several risks and implications for individuals struggling with severe obesity. This is especially true when a doctor recommends the procedure for medical reasons. These risks include:

1. The pain and social stigma associated with obesity can impact mental health. It leads to depression, anxiety, and a reduced quality of life.
2. Postponing the procedure can increase the severity of conditions such as arthritis and joint pain. It can impact a patient's ability to exercise and maintain mobility.
3. The risk associated with other obesity-related diseases is likely to increase with a delay in weight loss surgery. These may include cardiovascular disease, dyslipidemia (abnormal cholesterol levels), and diabetes.

Cost of Bariatric Surgery

The bariatric surgery cost in India ranges between ₹ 2,20,000 to ₹ 6,00,000. The average price of the procedure is ₹ 3,50,000.

Note: These figures are approximate. Patients are advised to consult HexaHealth experts for the most current expenses. Factors that influence the cost of weight loss surgery include:

1. Type of Surgery: Different bariatric procedures have varying costs. For example, gastric bypass is costlier than adjustable gastric banding due to the technical aspects involved.
2. Surgeon's Fee: Medical specialists with extensive experience or a high success rate in performing bariatric surgery may charge more for their services.
3. Hospital Charges: Hospital infrastructure, quality of care, and the services provided can impact the overall cost.
4. Location: Costs are higher in metropolitan cities and urban areas due to regional economic factors.
5. Health Coverage: Insurance that covers bariatric surgery can reduce the financial burden on the patient.

Takeaway

Bariatric surgery offers a life-changing solution for individuals with severe obesity. It provides significant and sustained weight loss, improvement in related health conditions, and the prevention of future complications. Success is contingent on lifelong changes in diet and lifestyle to maintain the benefits.

If you or a loved one is considering bariatric surgery, consult a qualified healthcare provider to discuss the options, risks, and expected outcomes. Early intervention can help maximise the benefits and improve quality of life.