Mr. O had one of the best results from Metabolic surgery. He was on more than 60 units of insulin and two oral meds. His Diabetes was uncontrolled and he was hypertensive. After surgery he made a spectacular recovery. His Diabetes induced tremors disappeared. His blood pressure is normal without medication. He is off insulin, Latest blood sugar is 4.9 mmole/l, BP is 102/75. He is already eating porridge. His operation was just 3 weeks ago.

Ms. T was a diabetic on 16 units of insulin a day and multiple oral meds. She also has blurring of vision from Diabetic Eye complications. The first picture shows her a few hours after surgery and the second a few days later. She was off insulin at discharge and is now on no medication for her Type II Diabetes. Her eye problems also cleared up immediately after the surgery and she now has clear vision. She had a Laparoscopic Roux en Y Gastric Bypass and recovered uneventfully.

This Indonesia patient was 108 Kg and had uncontrolled hypertension. This series of pictures documented his rapid recovery after metabolic surgery. He was waling around a mere 5 hours after surgery. He went back to his hotel in 2 days and was on the golf course about 2 weeks. His blood pressure is normal He had uncontrolled hypertension 170/110 before surgery on medication. He is no longer on medicine.

For the Chinese speaking audience. Here is a newspaper write up on our activities.

We provide new solutions for those suffering from Diabetes Type 2.

 The Day after Surgery

3 Days after Surgery.

Mr. Sharma is a top executive from the US IT Company Oracle. He was a Diabetic on 30+units of insulin a day. He opted to have a sleeve resection. In his case the results were really good and he got off insulin on discharge. Here is his account:

"A Belated Happy Birthday to you doctor. (I missed it by 3 days, I think)

I want to take this opportunity to thank you for the "Textbook Perfect" Sleeve surgery that you performed on me last month. Its been 3.5 weeks. I am losing weight gradually and my diabetes is so far under control without any drugs or Insulin!!! If you remember I was on 30 units of insulin daily. I have a new life and hope for the future.

I am especially impressed and grateful for the high quality of surgery that you performed. Healing was so quick... I was quite well by the 2nd day and the 3rd day I actually went shopping!! My energy levels have increased and I am looking forward to getting back to normal eating in a couple of weeks. I hope that my sugar levels remain low with normal eating as well and I don't have to get back on drugs or insulin.

Thanks again Doctor,

Vinod Sharma.
Oracle Singapore. "

My two Kazak patients one day after discharge from hospital. The one on the left had a sleeve resection and the one on the right a gastric bypass for Diabetes Melitus. His fasting blood sugar is now 5.7mmole/dl. It is well within the normal range and he is off insulin and all diabetic medication.

The picture shows him having drinks at a French Cafe alon Scott's Road. He left for Kazakstan two days later and is doing well.

I got this picture of Nagment now from Facebook. Nov 2013. He looks really good!

 

Intragastric Balloon

There are a large number of people who want to lose just 10 to 15Kg. They are not candidates for surgery and they have run through the gauntlet of diets, exercise programs and a variety pills. For this group the intragastric balloon is an attractive option.

We inserted the first balloons in 2001 in Singapore and subsequently did the first insertions of the balloon in Japan and Indonesia soon after. The device has its fans and its detractors. On the plus side, the procedure is endoscopic and non-surgical. Insertion is done under sedation and takes just 5 to 10 minutes. It is a day procedure in most practices. It is relatively safe compared to other bariatric procedures.

The device acts by two mechanisms. Firstly it occupies space in the stomach and it's weight also adds to early satiety. Filled with saline it weighs about 500 to 700grams. It is like having 2 or 3 hamburgers in the stomach at all times. The patient is unable to take his usual volume of food. Secondly it slows down gastric emptying so that whatever food eaten takes a long time to leave the stomach. Stomacg peristalsis is markedely reduced.

The disadvantages of the device are the often less than pleasant adaptation period. This can last from a few days to a week or more. The patient has cramps, nausea and vomitting much like the morning sickness of a pregnant woman. After the adaptation, the symptoms usually subside and the patient can eat somewhat normally though a lesser amount.

The second disadvantage is that the device has to be removed after 6 months. After this the patient is left to his own devices to maintain the lost weight. Usually one hopes the patient has learnt to live a healthier lifestyle by then. The device can however be re-inserted in 2 or 3 months after removal. Some patients are using the method of sequential balloons.

The average weight loss is between 12 to 14Kg during the 6 months period. The device is then removed.

This method is popular with many overweight young and middle aged ladies both in Singapore and in Indoenesia. The patient's usually want to keep the fact that they have a balloon confidential as they don't want their husbands to know or their friends to realise that they lost weight by any other means than their own discipline.

One of the pleasant side benefits is that patients who have diabetes, hypertension or high cholesterol often improve on the device.