Dr. Aparna Govil Bhasker, Bariatric & Laparoscopic Surgeon
Bariatric surgery was traditionally performed through the “open” technique with very large incisions on the abdomen. The open technique was practiced routinely till the early 90s. Large cuts, more pain, higher rate of complications like wound infection, formation of incisional hernias, and deep vein thrombosis, prolonged immobilization and delayed recovery, ultimately pushed bariatric surgeons towards adopting the minimally invasive or “laparoscopic” surgery.
In the early nineties, “laparoscopic surgery” started getting more acceptance in the surgical community. Bariatric surgeons were no exception to the kind cuts of laparoscopic surgery and gradually adopted laparoscopy over open surgery. The advantages were many and obvious. Unlike the big, cruel cuts of open surgery, laparoscopic surgery could be performed through kinder tiny cuts. As the trauma to the skin and abdominal wall was much lesser, patients experienced much lesser pain and could be mobilized within 4 to 6 hours of surgery. The rate of wound related complications decreased considerably and as did the incidence of incisional hernias. Recovery was much faster and patients also could get back to work much earlier. Thus, they did not lose on their income. Laparoscopic bariatric surgery is much safer and over the last 30 years, it has become the standard technique for performing bariatric surgery. Today, open surgery is only reserved for specific circumstances.
Laparoscopic technique revolutionized the field of surgery like never before and showed us the benefits of being minimally invasive. In an endeavour to become even less invasive, “single incision bariatric surgery” was proposed around the year 2007. Surgeons across the world wanted to give lesser pain and lesser scars to their patients. In a single incision surgery, the entire procedure is performed through one tiny cut which is usually in the navel. Once it heals it is practically scar less. Though technically challenging, single incision surgery is cosmetically superior in terms of conventional laparoscopy. I usually select my patients carefully for single incision bariatric surgery. In my practice, these would be patients with BMI less than 45 Kg/m2 and those with no previous abdominal surgery. I usually do single incision surgery for sleeve gastrectomy and more often than not my patients are women. Single incision sleeve gastrectomy is cosmetically superior and leaves no scar as you can see in the picture. In the Indian setting, where bariatric surgery is still a taboo, it also gives the patient, privilege of confidentiality.
“Robotic surgery” has also been proposed for bariatric surgery and many centres offer it. Robotic surgery is kinder to the surgeon. It is more time taking and in bariatric surgery, it is our endeavour to keep the surgical time as short as possible so as to avoid the risk of blood clotting or venous thrombo-embolism. It is also a lot more expensive as compared to conventional laparoscopy. The technology is still developing and in future there will be better robotic platforms that will be beneficial for patients. At the moment it does not have any added advantage for the patient.
In my practice, I usually offer either laparoscopic or single incision surgery to my patients. However, the final decision about the technique of surgery is taken only after clinical examination and discussion with the patient.
About Dr. Aparna Govil Bhasker
Dr. Aparna Govil Bhasker is an accomplished Bariatric Surgeon in Mumbai and Laparoscopic Surgeon. She is very renowned and is extremely passionate about her field of specialization.
Read more about Dr. Aparna Govil Bhasker- https://www.bestbariatricsurgeon.org/dr-aparna-govil-bhasker/
Dr. Aparna’s website is- https://www.bestbariatricsurgeon.org
You can read her lovely blogs on- http://www.aparnagovilbhasker.com
Dr. Aparna Govil Bhasker is a visiting consultant at the following hospitals: