Bariatric & Metabolic Surgery
Advanced Bariatric & Metabolic Surgery for Lasting Diabetes Remission & Weight Loss
Dr. Kesava Mannur specializes in cutting-edge bariatric and metabolic surgery procedures, scientifically proven to achieve sustainable weight loss and significant diabetes remission. Using minimally invasive laparoscopic techniques, Dr. Mannur helps patients reclaim their health and enjoy a fuller, healthier life.
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Gastric Sleeve Surgery (Sleeve Gastrectomy)
A minimally invasive procedure reducing the stomach size by approximately 80%, significantly limiting food intake and controlling hunger
Benefits
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Sustainable weight loss of up to 70% of excess body weight.
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Over 85% diabetes remission rates within months.
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Improved management of hypertension, PCOS, and sleep apnea.
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Gastric Bypass Surgery (Roux-en-Y Gastric Bypass)
A laparoscopic procedure reducing stomach size and rerouting digestion, significantly limiting calorie absorption, and balancing hormones to control hunger and blood sugar.
Benefits
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Average excess weight loss: 60–80%.
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Diabetes remission rate: Over 90%.
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Rapid improvement in metabolic health, cardiovascular risks, and cholesterol levels.
One Anastomosis Gastric Bypass OAGB / Mini Gastric Bypass MGB
OAGB/ MGB involves making a long thumb sized gastric pouch and joining this to a loop of small intestine (jejunum) about 150 to 200 cm from the DJ flexure. It is one join less than RNY Gastric bypass. It is good in patients where there is not much acid reflux GORD.
Benefits
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Easier to do than RNY gastric bypass
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Similar or more weight loss than RNY gastric bypass
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Easier to reverse to normal than RNY Gastric Bypass
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Diabetic resolution more.
Omega-loop Duodenal Switch (OLDS) (Unique to Dr. Mannur)
Dr Mannur has pioneered a safe technique of performing BPD-DS as omega loop DS. DS combines sleeve gastrectomy and an intestinal bypass at Duodenum and it dramatically improves diabetes control and weight loss
Benefits
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Highest diabetes remission rates (>90%).
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Significant, lasting weight reduction.
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Ideal for severe obesity with Type-2 diabetes, hypertension, or high cholesterol.
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Hardly any dumping or Hypos as in Gastric bypass
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Single Anastomosis Duodenal switch SADI
Single Anastomosis Duodenal Swithc SADI is similar to BPD-DS, there is only one surgical bowel connection. It has two stages – Sleeve and SADI bypass at Duodenum. So there is both restriction as in sleeve and malabsorption more than gastric bypass.
Benefits
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Similar to DS, it is a good metabolic procedure. Greater resolution of Diabetes
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No Dumping (hypoglycaemia) compared to gastric bypass.
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It is easier to reverse compared to DS (sleeve can’t be reversed)
Revisional Surgery
For Failure To Achieve The Desired Weight Loss After Sleeve And Gastric Bypass Surgeries
SLEEVE – OPTIONS
Sleeve could be converted to banded sleeve, gastric bypass, OAGB/MGB or Duodenal Switch/SADI. Most Sucessful option is DS or SADI.
GASTRIC BYPASS – OPTIONS
1. Converting gastric bypass to Banded Gastric Bypass – Applying a fixed ‘ring’ to the gastric pouch with some reduction in the size of the gastric pouch and the Gastro-jejunal anastomosis. Primary banded gastric bypass (applying Ring at the index operation gastric bypass) gives very good results but secondary banded gastric bypass (applying Ring much later after gastric bypass) doesn’t give the same result; it could be that the patient find to get adjusted to the new restriction created by the ‘ring’. ‘Ring’ may have to be removed for intolerance, Erosion, Slippage, or Obstruction.
3. Revise the whole gastric bypass and apply a minimizer ring to the gastric pouch with distalisation and repair the internal hernia if present with repair of HH and repair of any internal hernias. There will be some amount of weight reduction possible; better than the 1 or 2 alone.
4. Convert gastric bypass to Duodenal Switch/ SADIS (one cannot have SADI-S if one had GORD before one had gastric bypass) with repair of hiatus hernia. This is a more complex procedure but with almost guaranteed weight loss of about 30-40kg or more. The problems are: a) Stenosis/tightness can develop where stomach pouch is joined to remnant stomach to form the sleeve; this could result in inability to eat and the Gastro-gastric anastomosis may have to be stretched or revised. b) diarrhoea – 20-30 times going to toilet if one doesn’t follow the dietary guidelines of very low fat. c) nutritional deficiencies can occur unless one takes high protein (90-120gms rather than 60-90gms) in the diet and high doses of vitamins and minerals. Post surgery one has to be followed up thoroughly and should have blood tests every 6 months – FBC, LFT, vitamin D, B12, Folate, zinc, copper, selenium, magnesium and Ferritin.
RNY Gastric Bypass to DS one stage
2. Just distalisation of the Biliary pancreatic limb (BP limb) by another 100-150cm: It does cause some amount of weight loss but difficult to predict.
Medical management
Depending on one’s requirement, one could be given weight loss management.
This involves
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Advice which includes diet, exercise, stress management, sleep advice and regular follow up to check how one is doing.
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Weight loss medication – There are many weight loss medications available. But these have to be taken under supervision. All medications have some side effects and risks. Apart from that, one puts on weight once one stops the medication. We have Mounjaro (Tirzepatide) available in India. Semaglutide like Ozempec/Wegovy would be available soon, but it has less weight loss compared to Mounjaro. One has to start at a lower dose and may not need to reach very high dose and has to be titrated according to the patient. So, it is important that these should not be bought off the counter without medical supervision
Evidence & Statistical Impact
Bariatric Surgery/ Metabolic Surgery resolves most of the Metabolic risks, including sleep Apnoea, BP, Asthma, Diabetes, & Metabolic Syndrome.
90%+
Average Diabetes Remission
60–80%
Typical Excess Weight Loss
80%+
Long-term Weight Maintenance Success
70%+
Reduced Cardiovascular Risk