The stomach is made smaller by creating a small pouch at the top using surgical staples or a plastic band. The smaller stomach is connected directly to the middle portion of the small intestine, bypassing the rest of the stomach and the upper portion of the small intestine. As a result, the patient will feel full more quickly, thereby cutting down on food intake and thus the calories consumed. Bypassing part of the intestine also results in fewer calories being absorbed. This leads to weight loss.

Earlier doctors were using laparoscopic techniques to perform gastric bypass surgery. Today, robotic surgery is the more preferred method. Robots operate in 360 degree mode and can reach deeper getting to difficult-to-access parts such as the stomach blood vessels easily. Also, with the flexible robotic equipment suturing is far more accurate than with old straight shaped equipment. There is less blood loss and faster recovery besides leaving practically no scars.

“We call ourselves fat fighters,” says Dr Parveen Bhatia, chairman, Institute of Minimal Access Metabolic and Bariatric Surgery, Institute of Robotic Surgery (IRS), Sir Ganga Ram Hospital.

Bhatia rues at the growing obesity in India. “One quarter of what you eat keeps you alive, the other three quarters of what you eat keeps doctors alive,” he says. He distinguishes the super obese as those with BMI more than 50. And “Super super obesity” is defined as those with BMI of more than 60 kg/m2.

According to Dr Arun Prasad, “In cases where the patient is super obese, weighing over 200 kgs, the robot is useful in lifting the stomach. However much we may gym, a half hour long procedure involving lifting of stomach becomes tiring for the doctor.”

Compared to laparoscopic procedures where it takes 3-4 days of hospital stay and over a month long rest period, those undergoing robotic surgeries can go back home in 2 to 3 days and return to normal activities within three weeksor so.
 
No surgery comes without risks, though these are minimized in the case of robotic procedures. Bariatric surgery does carry some risks as most of the patients undergoing these have co-morbid conditions like diabetes, hypertension and sleep apnea adding to the complexity. Post operation, one possible risk is of nutritional deficiency. Iron and vitamin B12 deficiency can occur leading to anaemia. However, these can be handled during periodic follow-up consultations.

But increasingly benefits are outweighing the risks. Rarely is weight regained. Most people continue to lose weight for a good 12 months after the procedure before settling down to an optimum weight. Ravi Narayan has lost 35 kgs in six months after surgery.

India today has just 190 trained robotic surgeons who conducted nearly 4000 in 30 hospitals spread across during 2015. Bulk of these procedures related to Urology, Gynaecology, Thoracic, and Head and Neck and General Surgery areas.

PS: Names of patients changed to protect privacy.