|Year : 2015 | Volume
| Issue : 1 | Page : 37-39
Evolution of bariatric and metabolic surgery in India (1999-2014)
Managing Director, Shree Hospital, Pune, Maharashtra, India
|Date of Web Publication||6-Jan-2015|
Shree Hospital, Pune Nagar Road, Pune - 411 006
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Dhorepatil S. Evolution of bariatric and metabolic surgery in India (1999-2014). J Obes Metab Res 2015;2:37-9
Massive obesity was well-known in ancient India, particularly abdominal obesity, seen in depiction of images of gods and mighty bodies of demons. It was not until recently, it was seen as a problem, in fact as the myth of "Obesity as sign of Prosperity" was well rehearsed in the Indian psyche. Only at the end of 20 th centuries, in last decade or so, some medical practitioner's (I know of Dr. Vinod Durandar in Mumbai) took initiatives from his own examples, started practicing weight loss medicines and therapies.
The concept for a surgical treatment of obesity was developed from observing the significant postoperative weight loss developed in patients that had large portions of their stomachs or small intestines removed Victor Henrikson (1952), Varco (1953), Kremen and Linner (1954), Payne (1963) Sherman (1965). This led to the development of different bariatric surgery procedures that can be categorized into three approaches including restrictive, Mason (1971), Long (1978), Paul (1979), Wilkinson (1980), Kuzmac (1986), Marceau (1993) and combined mal-absorptive and restrictive, Mason (1966), Griffen (1977), Torres (1983), Fobi (1988) and solely malabsorptive procedures (Scopinaro (1976), Hess and Hess (1986).
It was in December 1997 during ASICON Bengaluru, which I heard a talk on Bariatric Surgery by Andrew Jemieson from Melbourne, Australia. I remembered reading a footnote in Bailey's Textbook of Surgery on Weight loss surgery. I was impressed with the results of bariatric surgery for weight loss for morbidly obese patients. Though it was not considered necessary in India, in my practice I had come across few morbidly obese patients who had tried all means, but were not able to lose weight. Unfortunately, at that time no one was doing bariatric surgery in the country. I co-ordinated and visited Andrew Jemieson at Melbourne, Australia in August 1998 for training in Bariatric Surgery. Andrew was performing only open VBG and RYGB at the time. During the same visit, I also attended the Laparoscopic Adjustable Gastric Banding (SAGB) workshop at Adelaide.
After much persuasion and many counseling sessions with obese patients, I did India's first Open VBG in January 1999 in Pune. After 3-4 surgeries the word spread quickly and by end of May 1999, I had performed more than 20 surgeries. The outcomes were presented at the ICS Conference in Maldives/Mysore during the same year. Subsequently, I conducted the first Live Bariatric Surgery Workshop in Pune, in September 1999, where 3 open VBG Surgeries were demonstrated by Andrew Jemiesson (Australia) and Dr. Harold Engler (USA).
Since the end of the 1980s, laparoscopic techniques have revolutionized general surgery. Though in the beginning bariatric surgeons were reluctant to perform laparoscopic bariatric surgery, introduction of gastric band made it easier to adapt this approach. International pioneers in this field were Belachew (Belgium) and Forsell (Sweden) (1991). Subsequently, Wittgrove (1993) performed RYGB laparoscopically. By the end of year 2000, laparoscopic bariatric surgery was a well-established entity and proved to be better for early postoperative recovery. The adaptation of conventional vertical banded gastroplasty to laparoscopy was difficult and studies showed higher rate of complications.
I travelled for Laparoscopic Gastric Banding Training and proctorship with Prof. Klaiber and Stephen in Bern in December 2000 and attended Laparoscopic gastric Banding workshop at Lyon, France with Gerome Dargent. Ramen Goel and I attempted the first Laparoscopic Gastric Banding procedure in August 2001, but converted to open due to technical difficulties. Subsequently, Laparoscopic Gastric banding was successfully done by me in September 2001 in Pune. The International Federation for the Surgery of Obesity (IFSO) was formed at Stockholm in 1995. The first International Congress of IFSO was held in Prague in 1996, followed by Cancun in 1997, Bruges in 1998, Salzburg in 1999 and Genoa in 2000 and Chania, Greece in 2001. I attended the IFSO 2001 at Chania, Greece with Dr. Raman Goel for the first time, though he had become individual member of IFSO since 1998. I started open RYGB in December 2001 after returning from IFSO. I attended laparoscopic RYGB workshop with Schaeur in March 2002, but did not do until Dr. Muffazzal Lakdawala in Mumbai performed the first laparoscopic RYGB in 2004.
In September 2002 with Obesity Surgery Society of India (OSSI) was founded by us including Ramen Goel (Mumbai), Sanjay Borude (Mumbai), Mahendra Narwaria (Ahmedabad), P.K.Chowbe, (New Delhi), Shanugsundram (Coimbatore), Sanjay Deshmukh (Pune), Krishna (Bilaspur) and Ashok (Chennai). OSSI was registered with IFSO in January 2003 and confirmed during IFSO Congress in Salamanca, Spain in September 2003. I must mention, for formation of OSSI, the great help came from Andrew Jemison, Aniceto Baltasar and Nicola Scopinaro.
First Obesity Surgery Congress of Obesity Surgery Society of India (OSSICON 2003) was organized in Taj Mahal Hotel, Mumbai in March 2003. The international faculty included Andrew Jemiesson, (Australia) Martin Fried, (Cheq Republic) Luigi Angrisani, (Italy) Anna Maria Wolf (Germany) among others. T.E Udwadia was the organizing chairman and I was the organizing secretary.
The second OSSICON was held by Dr. Chowbey in Delhi 2004 at Gangaram Hospital.
By this time Laparoscopic surgeons, Ramen Goel, Lakdawala, Borude, Narwaria, Chowbe, Dr. Ajay Kriplani, Rajesh Khullar, Aashish Vashistha, Reddy, Rajkumar, Palanivellu, Balashanmugam, Sunil Sharma, Shashank Shah… not only started perfoming but organizing the meetings and workshops on Bariatric surgery. In January 2005 Dr. Michel Gagner demonstrated the first laparoscopic sleeve gastrectomy (Coimbtore). Nicola Scopinaro demonstrated the laparoscopic biliopancreatic diversion (BPD) in Pune (2005). Balashanmugam performed first laparoscopic sleeve gastrectomy in February 2005.
Third OSSICON was held by. Narwaria in Ahmedabad 2005, 4 th OSSICON was held in Pune 2006 by me, while 5 th OSSICON was held by. Rajkumar in Chennai in 2007.
K.S. Kular (Ludhiana) started MGB in 2007, which was followed by Om Tantia, Arun Prasad, Atul Peters, Mohit Bhandari, Muhammad Ismail and many others.
Sixth OSSICON was held in Kolkata 2008 by. V K Bharatia.
During this period, worldwide bariatric surgery was getting recognized for effects beyond weight loss for metabolic effects since 2004. The procedures like Duodeno-Jejunal Bypass by Rubino, Ileal Interposition by Aureo de Paula were introduced. In India Muffazzal Lakdawala did first DJ Bypass with Sleeve gastrectomy in 2008, while Ileal Interposition was started by Surendra Ugale in 2008, followed by Ramen Goel, Padmakumar and Mohammad Ismail. Ileal Interposition was not widely accepted by Indian surgeons, may be because of the complexity of procedure and long-term results are yet to come. According to some experts lowering of body mass index by International Diabetes Federation to 27.5 and reported efficacy of sleeve in glycemic control are the main reasons for reduction in numbers of DJB and SGIT in practice.
Seventh OSSICON was held in Hyderabad 2009 by Laxmikumari Kona. Dr. Mahendra Narwaria started double blind randomized trial comparing Sleeve with Gastric Plication in early 2009. Since results were not so encouraging the trial was abandoned by 2010.
Eighth OSSICON was held at Jaipur in 2010 by Rajesh Bhojwani, while nineth OSSICON was held at Indore in 2011 by Shivhare.
It was a tribute to the development and widespread acceptance of bariatric surgery in India when the IFSO 2012 was held in India at New Delhi with Dr. Chowbey being given the honor of becoming the Congress President, where later he went on becoming the IFSO President in 2013.
Robotic Bariatric Surgery started in India for the first time when laparoscopic gastric sleeve was performed by Rajkumar Pallaniappan (Chennai) in 2011, followed by Arun Prasad. Slowly Robotic Bariatric surgery found its way to other procedures too, Palaniappan, RYGB (2012), MGB (2012) and gastric band (2013) followed by Dr. Mohit Bhandari, Dr. Bhatia et al. Endoluminal Revision Gastroplasty, Endoluinal Sleeve Gastropexy were performed by Palaniappan (2012).
When single incision laparoscopy era came in MIS, Muffazzal Lakdawala performed the first Single Incision Sleeve Gastrectomy in India in 2009 while Rajkumar Palaniappan performed the first SILS Gastric By-pass in 2011. Single anastomosis duodenal-Ileal Switch was performed by Mohit Bhandari (2013) and Arun Prasad (2014).
Notably BPD and BPD-DS is not practiced in India. Mahendra Narwaria, Shashank Shah and I performed BPD/BPD-DS in few cases, but no one continued the practice. In my experience both the patient developed severe mal-absorptive symptoms. Though many say, it is due to Indian Vegetarian diet, but it is difficult to prove.
The development of bariatric surgery has changed the way people look at obesity problem. It has boosted the all other modalities to treat obesity in India and helped the level of understanding of obesity as a serious health problem.
Tenth OSSICON was held in 2012 in Bengaluru by Ramesh and 11 th OSSICON was in Ahmedabad in 2013 by Narwaria. The 12 th OSSICON will be held in 2015 in Mumbai by Ramen Goel.
As envisaged where ever the OSSICON happened bariatric surgery picked up in that region starting from Mumbai.
(Thank you note: This article is compiled from the inputs provided by bariatric surgeon colleagues).