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FORERUNNERS HEALTHCARE CONSULTANTS PVT. LIMITED

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Sleeve Gastrectomy Surgery in India

Obesity today ranks as a significant health challenge and studies show obesity to be a major cause of preventable mortality. Researchers in respected journals are showing the significance of Sleeve Gastrectomy surgery as a procedure with low risks. Sleeve gastrectomy (also called gastric sleeve) is usually performed on extremely obese patients, with a body mass index of 40 or more, where the risk of performing a gastric bypass or duodenal switch procedure may be too large. This procedure alone is a suitable operation with minimum risks and some surgeons even prefer it over the gastric banding operation (which is a very friendly operation), because it eliminates the need of having to insert a foreign body. What is Sleeve Gastrectomy Surgery? Sleeve gastrectomy surgery is a surgical weight-loss procedure in which the stomach is reduced to about 15% of its original size, by surgical removal of a large portion of the stomach, following the major curve. "Sleeve" refers to the appearance of the stomach after the surgeon removes 75 percent to 85 percent of it, leaving an organ with a long, tube-like shape. "Gastrectomy" refers to removal of the stomach. The open edges are then attached together (often with surgical staples) to form a sleeve or tube with a banana shape. The procedure permanently reduces the size of the stomach. The procedure is performed laparoscopically and is not reversible.

What Causes Obesity? The etiology of obesity is multifactorial. Over eating is the primary cause, but psychological problems, hormonal imbalance, eating disorders, lack of proper directions in diet could all play a part. Likewise, the treatment options for obesity are varied including diet and exercise, body contouring surgery, bariatric surgery, psychological counseling, endocrine management, etc. The most common causes for obesity include Lack of activity Overeating/ Unhealthy eating habits Hormonal problems like Cushings syndrome and PCOS Genetic reasons/ Familial obesity Poor lifestyle.

Who is the Candidate for Sleeve Gastrectomy Surgery? Patients who are morbidly or severely obese are at increased risk for health problems and tend to have a shortened life span. There is also added potential risk from continued weight increase. The risk of severe obesity is greater than that of its surgical treatments. Persons eligible for sleeve gastrectomy surgery include the following: Persons at least 100 pounds above ideal body weight Persons who are at least 80 pounds over weight and have life-threatening obesity related problems such as diabetes, hypertension, sleep apnea, etc. Above persons who have failed non-surgical attempts at weight loss, specifically a combined regimen of diet and exercise.

How does the Sleeve Gastrectomy Surgery work? The sleeve gastrectomy works through 2 mechanisms: It makes the stomach smaller, so you feel full after eating a smaller meal. The fundus of the stomach is removed. This is the area that secretes ghrelin, a hormone that makes you feel hungry. So, the sleeve gastrectomy may help you to feel less hungry through a hormonal mechanism. What is the Procedure for Sleeve Gastrectomy Surgery? This is a simple enough procedure which takes less than an hour to complete. It is performed laparoscopically (keyhole surgery) and under a general anaesthetic. Your surgeon will make a series of small incisions in the abdomen. He/she will then insert a series of instruments which also includes a small camera. This camera is attached to a thin viewing tube and is able to relay what it focuses on onto a large video screen in the theatre. This screen enables the surgeon to have a close up view of the operation site. This is also useful for the placement of the instruments and the stapling of the stomach. Your surgeon will then remove a large portion of the stomach: the remaining section is stapled together to form a banana shaped tube or sleeve. He/she does not interfere with the small intestine no cutting or bypassing so food absorption is not affected. It is unlikely that you will have to take any dietary supplements although this will be discussed with you in your aftercare sessions. There are no changes to the normal digestive functions of the stomach: food will travel down the gullet through to the stomach before carrying on through the small and large intestines. Your much smaller stomach will mean smaller portions of food so weight will start to be lost. And theres another bonus as well: the large portion of your stomach that has been removed contained the hunger hormone ghrelin. This hormone is directly responsible for stimulating your appetite. This has now been removed which means that you will not experience hunger pangs! This will reduce your appetite which means you will eat smaller meals so calorie intake will drop. And this drop means weight will be lost. It can be the case that this surgery alone will achieve your weight loss goals. Many patients have reported that the surgery has so well that they do not need any more procedures. However, there are those patients who require further surgery, in the form of a gastric bypass or duodenal switch. In these cases they are advised to wait for a year before having further surgery. This is what as known as a two stage approach. It is also considered much safer: obesity surgery can be risky and for those patients who are severely or morbidly obese the risks are even greater. So, rather than undergoing what could be a potentially life threatening procedure due to the complexity, time and physical demands on the patient, breaking this down into two individual procedures is a better option. Sleeve Gastrectomy Surgery with Duodenal Switch or Gastric Bypass This is the name given to the full, two stage procedure. The first stage, the sleeve gastrectomy is performed first and the second stage, either a bypass or a switch is performed a year later. This is seen as one way of reducing the risks for the obese patient. This is not to say that both arent performed at the same time: in some cases the full procedure will be undertaken but surgeons often prefer to do it in two stages. This is classed as a combination or restrictive/malabsorption procedure. The duodenal switch is a much more technically demanding procedure and can take around 3 hours to complete. The sleeve gastrectomy is the restrictive element and that is fairly straightforward. The more complex part is the bypass or switch. The reason for this is that involves dividing the small intestine and then rerouting the passage of food through the digestive system. This affects food absorption, with the result being that the patient has to take a daily nutritional supplement for the rest of his/her life. The duodenal switch (DS) element is very similar to the biliopancreatic diversion (BPD/DS) with one difference: the surgeon will leave a larger portion of stomach than for the BPD/DS.

What this means for the patient is that they face a complex procedure with a higher degree of risk. This equally applies to the gastric bypass. The risks are greater for those patients with a high BMI but if we keep it in perspective, they only account for 2% of cases. On the plus side, weight loss can be as much as 80%, or even 90% has been known. It can resolve or even cure Type 2 diabetes and, improve or reduce the risks from other obesity-related conditions. As a greater portion of the stomach is left this does mean that the patient is able to consume bigger portions of food than those who have had the sleeve, bypass or gastric band. They do still need to follow a sensible eating plan, take exercise and attend the follow up sessions on a regular basis.

What are the Preparations before Sleeve Gastrectomy Surgery?

The most important consideration for sleeve gastrectomy is to know about your surgeon. One should always meet with the surgeon prior to the surgery and discuss potential issues. Discuss the quality of aftercare program should be accessed prior to the surgery as a short stay and regular check up is required after the surgery.

The education of the patient is very important. One may also collect printed procedure related information including what to expect and how to deal with it. This research would answer the questions of the patients clearly and explain the exact details of the procedure, the extent of recovery period and the reality of the follow-up care that will be required.

After becoming thorough with information about all aspects of the surgery, comes the physical and psychological evaluation. Each patient is required to have a physical with their primary care physician within six months prior to surgery. This is done to determine that the patient does not have any underlying medical conditions that would prohibit them from having surgery.

A pre operative psychological evaluation is an essential part of preparing for Sleeve Gastrectomy. The comprehensive psychological evaluation consists of a detailed clinical interview and objectively scored psychological tests.

Patients who have high intake of caffeine are suggested to gradually decrease the amount of caffeine they consume. Patients who stop caffeine suddenly at the time of surgery may experience withdrawal symptoms such as intense headaches. Remember that there is a significant about of caffeine in coffee, tea and many soft drinks.

Stop smoking. This is another condition before sleeve Gastrectomy. Cigarettes interfere with the lungs ability to exchange oxygen and nicotine can impair circulation, which can impede healing after surgery and increase the chance of infection.

What are the Post Operative care following a Sleeve Gastrectomy Surgery? You will receive instructions on when and what you can eat, and how you need to restrict your activity. During the first few days after surgery, you may be restricted from eating. As your stomach stretches during your recovery, you will be able to eat more at a time. It is possible that you may experience frequent heartburn, abdominal pain, and vitamin deficiencies after your gastrectomy. Your doctor may prescribe changes in your diet, medications, and/or vitamin supplements after your procedure.

What are the Benefits of Sleeve Gastrectomy Surgery? The benefits of Sleeve Gastrectomy surgery are very similar to those for gastric banding, gastric bypass and biliopancreatic diversion (BPD with/without duodenal switch). Dramatic weight loss is the first and most important benefit: if you have had a two stage procedure such as a sleeve gastrectomy with a duodenal switch then you could be looking at least. The following are the benefits:

This is classed as a restrictive form of surgery which means that food absorption is not affected. Weight loss can be as much as 50 to 80%. Fewer restrictions on the types of foods that can be consumed. The basic functions of the stomach are still intact so there is no risk of dumping syndrome. Removes the area where the hunger hormone ghrelin is produced.

Other equally important benefits include a greater sense of self-worth, improved confidence levels and a more positive outlook on life in general. If you have depression and/or anxiety then this will improve as your overall sense of wellbeing improves.

What are the Risks of the Sleeve Gastrectomy Surgery? Potential for inadequate weight loss or weight regain. While this is true for all procedures, it is theoretically more possible with procedures that do not have an intestinal bypass. Soft calories such as ice cream, milk shakes, etc can be absorbed and may slow weight loss. Because the stomach is removed, it is not reversible. It can be converted to almost any other weight loss procedure.

What can you expect after Sleeve Gastrectomy Surgery? The majority of patients that undergo sleeve gastrectomy surgery achieve a profound weight loss. The average weight loss at one year after surgery is about 50 percent of the persons measured weight immediately prior to surgery. The range of weight loss from this procedure is between 33 and 83 percent of initial weight. Maximum weight loss is seen within 12 to 18 months after surgery. Also within one to two years of surgery, patients and their physicians routinely report resolution of various obesity-related illnesses including high blood pressure, type 2 diabetes mellitus, and obstructive sleep apnea. Various blood cholesterol (LDL, HDL, triglycerides) levels begin to of fully normalize after sleeve gastrectomy. While the procedure is rather new, it appears to be at least as effective and safe as other, more traditional bariatric surgeries.

Sleeve Gastrectomy Surgery in India India has become the centre for weight loss surgeries including the Sleeve Gastrectomy surgery for international patients coming all across the world. The world has realized the fact that the healthcare technologies in India are at par with the developed world as used in USA or Europe thereby delivering similar or even better results. While adherence to the highest quality standards of healthcare by competent weight loss surgery specialists seems to the priority treatment. Sleeve gastrectomy surgery in India comes with highly skilled super specialist surgeons of the nation for better outcome. Medical facility provided in India is attracting the patients crowd from the western countries as they seek treatment at low cost. Most of the obesity surgeons and doctors in India performing these weight loss procedures have vast overseas healthcare surgery experience and training from best hospitals. The foreign patients can therefore avail the finest board certified medical professionals- board certified surgeons, board certified doctors, physician and JCI JCAHO accredited, government registered and approved private medical Healthcare facilities in India for their respective surgery. Thus one can find world-class low cost hospitals with best clinical facilities in the following Indian cities:

Mumbai Delhi Bangalore Chennai

Hyderabad Pune Nagpur Gurgaon

Kerala Goa Jaipur Chandigarh

Cost of Sleeve Gastrectomy Surgery in India Recently in India there is a rampant rise of global patients coming for Sleeve Gastrectomy surgery. The reason behind this is quiet obvious, the patients can have high quality medical treatment at quiet low cost, thus making a world class treatments affordable for everyone. In India low cost of Sleeve Gastrectomy surgery is combined with success rates on par with anywhere in the world and hence is one of the fastest areas of growth in medical tourism in India. One can have a fair idea of this benefit after going through the following table:

Procedure Sleeve Gastrectomy Laparoscopic Gastric Bypass Roux-en-Y RGB Laparoscopic Adjustable Gastric Banding AGB

USA ($) 23,000 28,000 18,500

Singapore($) 12,000 15,000 10,000

UK($) 17,000 22,000 15,000

India ($) 6,580 7,970 5,490

ABOUT INDIA Located in South Asia, bordered by Pakistan, Nepal, China and Bangladesh, India is South Asia's largest, sovereign, democratic republic. India has an edge over other countries when it comes to offering comprehensive, cost-effective and timely medical care: it also offers an exotic, adventure-filled or cultural -if you wish array of destinations to discover and revel in for the travelers. Indian cities like Mumbai, Hyderabad, Goa, Bangalore, Nagpur, Kerala, Delhi, Pune, Jaipur, Chennai, Gurgaon, and Chandigarh offers best medical tourism service. Mumbai - Formerly known as Bombay, is the commercial & financial capital city of India. Mumbai is famous for many things, including its thriving Bollywood film industry, teeming bazaars, colonial-style buildings, Art Deco structures and a superb choice of restaurants, often being rated as the dining capital of India. The tourist district of Colaba in Mumbai is a great place to start exploring this great city. Hyderabad Hyderabad city is a great place to visit in the state of Andhra Pradesh. The place has witnessed a continuous growth for last many years. Hyderabad has become a tourist hotspot following ever increasing number of tourists during past few years. Hyderabad has a well-founded reputation as one of the safest cities in the world. Goa - The country's smallest state and famed for its colonial Portuguese and Catholic past, most tourists visit Goa for its endless selection of sandy beaches and coastal attractions. Standing proudly next to the Arabian Sea, Goa is a particularly compact state and often feels like a large town, being easy to travel. Around Goa, tourists will soon realize that the state has much more to offer than simply stunning beaches, fishing, water scooters, windsurfing and scuba diving. Bangalore - Beauty lies in the eyes of beholder and if you want to see one of the most beautiful places in India then Bangalore is the word for it. Bangalore has earned sobriquets like 'Silicon Valley of India', 'Pub Capital of India', and 'City of Gardens'. Pleasant climate with colorful gardens with lakes and glittering nightlife, Bangalore has made its own attraction for travelers as one of the most charming cities in India, Nagpur - Nagpur is the largest city in central India, but with its friendly atmosphere and dependable transportation, youll instantly feel at home. The city of Nagpur has a well-built infrastructure, is a clean and affluent city which makes a good jumping-off point for a series of trips into the far eastern corner of Maharashtra. Kerala - Natural beauty, clean air and primordial greenery amidst the vast expanse of water and sky, typifies the state of Kerala better known as God's own country. Kerala is famous for its alternative medical therapies such as Ayurveda, which help to rejuvenate and revitalize the body. The region is also home to Indias only virgin tropical rain forest the Silent Valley National Park, supporting an overwhelming range of life forms, many of which are highly endangered, and endemic to this part of the planet. Delhi - "Welcome to The Capital City of India - New Delhi" Delhi is famous as Capital city of India is located in North India. Delhi is truly a symbol of the old and the new; a blend of ancient well preserved monuments and temples along with jampacked burger joints and up market shopping malls. Delhi has state of the art Hospitals and the best qualified doctors. Pune - Once referred to as the Oxford of the east, Pune continues to be a stronghold for academics and culture. An array of factors like availability of efficient and experienced doctors, comparatively low treatment costs, hospital facilities of international standards and many more have made Pune one of the top destinations for medical tourism. Jaipur - Jaipur is one of the most popular destinations on a tourist's itinerary. The magnificent forts, beautiful havelis and colourful bazaars make Jaipur a popular tourist destination among tourists. Jaipur has pioneered health and medical tourism in India. Chennai - Chennai is one of the most developed urban centers in the Indian subcontinent. The city forms the capital of Tamil Nadu state and is the fourth largest metropolitan city in India. They have some of the very best hospitals and treatment centers in the world. Each hospital is equipped with state of the art facilities. The technology brought into practice is the very latest, including robotic surgery.

Patients Testimonial:

Ms. Monique Carson, Canada Sleeve Gastrectomy Surgery

Hi! I am Monique Carson, from Canada. I came to India for my Sleeve Gastrectomy Surgery. Back in Canada and US I tried having my surgery done, but the cost of the surgery was not fitting in my budget. I decided to have my surgery done in overseas. I started searching for low cost Sleeve Gastrectomy Surgery, and I came to Forerunners Healthcare website. I first read about Sleeve Gastrectomy Surgery over the site, and found it to be beneficial and then I exchanged e-mails and calls. Forerunners Healthcare is one of the best options to choose for Sleeve Gastrectomy Surgery in India for overseas patients as the provision is of the high standards at low cost. I would love to recommend Forerunners Healthcare in India as one of the best medical faculty for treatment and surgery. I thank Forerunners Healthcare for their support and assistance in my Surgery.

Mrs. Linda Williams, England Sleeve Gastrectomy Surgery

Initially I was very worried about the treatment I needed , but the surgeons there, did everything so easily with a great care. The whole medical staff really made me feel ease at every step of the surgery. The end results were fantastic. I would recommend Forerunners healthcare consultants to everyone who are interested in making their Sleeve Gastrectomy surgery done by best Sleeve Gastrectomy surgeon at a hospital of Bangalore in India. Many of the international patients are coming to India for getting world class quality private health care at low cost by the safe hands of best Sleeve Gastrectomy surgeons at a hospital of Bangalore in India.

Mr. Tony Singer, USA Sleeve Gastrectomy

I am Tony Singer from USA and I came for my sleeve gastrectomy in India through Forerunners Healthcare Consultants. I have been fat all my adult life. I do have health problems but mainly I over eat. I had a very uneasy relationship with food always viewing it as an enemy that I had not bested in thirty years. I had thought about surgery to help with my obesity at odd times over the past few years but never gone any further than that.India is having a vast resource of excellent surgeons and medical professionals with the best and the world class medical facilities for lap band surgery in India. India has excellent hygiene norms with the best patient and doctor ratio. The support from Forerunners Healthcare Consultants me through every stage with ease. Still, when I left for India to have the operation I was very nervous and questioned myself as to whether I was doing the right thing. When I arrived at Mumbai India on the arranged flight. I and another lady having the same operation were met at the airport and taken to our hotel for the first night. The hotel was efficient and clean and the following morning our taxi arrived to take us bright and early to the clinic for tests and to meet the surgeon associated to Forerunners Healthcare Consultants.

Knee Replacement Surgery in India

Knee replacement surgery also known as knee arthroplasty is procedure to replace the weight-bearing surfaces of the knee joint to relieve the pain and disability of osteoarthritis. It may be performed for other knee diseases such as rheumatoid arthritis and psoriatic arthritis. The procedure has been proven to help individuals return back to moderately challenging activities such as golf, bicycling, and swimming. Total knees are not designed for jogging, or sports like tennis and skiing (although there certainly are people with total knee replacements that participate in such sports). Knee replacement is a routine surgery performed on over 600,000 people worldwide each year. Over 90% of people who have had Total Knee Replacement experience an improvement in knee pain and function.

Knee Replacement Surgery Candidates A person would be considered a candidate for knee replacement if there is: Daily pain The pain is severe enough to restrict work, recreation and ordinary activities of daily living Significant stiffness in the knee Significant instability (constant giving way) of the knee Significant deformity (knock-knees or bow-legs) that hinders normal function of the knee Damage from arthritic conditions, such as osteoarthritis, rheumatoid arthritis or post-traumatic arthritis

Success Rate of Knee Replacement Surgery: Knee replacement surgery is recognized as a miracle of modern surgery. Most orthopedic experts consider replacement to be the best method of handling arthritis in the knee. Knee replacements have literally put hundreds of thousands of Americans back on their feet and allowed them to enjoy their golden years.

Knee Replacement Surgery Preparations: If you smoke, cut down or quit. Smoking changes blood flow patterns, delays healing and slows recovery. If you drink, don't have any alcohol for at least 48 hours before surgery. Ask your doctor for pre-surgical exercises. If you are having hip or knee replacement surgery, doing exercises to strengthen your upper body will help you cope with crutches or a walker after surgery. Your primary care physician or an internist will conduct a general medical evaluation several weeks before surgery. This examination will assess your health and your risk for anesthesia. The results of this examination should be forwarded to your orthopaedic surgeon, along with a surgical clearance. Shortly before your scheduled surgery, you will probably have an orthopedic examination to review the procedure and answer any last-minute questions. You may need to take several types of tests, including blood tests, a cardiogram, a urine sample and a chest X-ray. Advice your surgeon of any medical conditions you have and of all the medications you are taking. You may need to stop taking certain medications or your surgeon may recommend substitute medications until your surgery. Medications such as corticosteroids, insulin or anti-coagulants will need to be managed before and after surgery.