Dr. Jayashree Todkar is India’s First lady Surgeon in Bariatric Surgery, Director, Dept of Laparoscopic Bariatric and Metabolic Surgery at Dr.L H Hiranandani Hospital, Powai & Ruby Hall clinic, Pune. To her credit at a very early age Dr. Jayashree Todkar has treated more than 25000 patients & continues her research & treatment in advanced laparoscopic surgeries, Bariatric surgeries, Trauma, Hernia surgeries & metabolic surgery for T2DM! In an email interaction with Ekta Srivastava, Health Technology.in, Dr Todkar speaks at large about the various aspects of Bariatric surgery in India
Please tell me about your professional journey from general surgeon to an exclusively first lady bariatric surgeon.
General Surgery is a huge subject and it has a huge scope. It does bring a lot of excitement and learning with each new day and new patients. I realized soon that science and surgery has got significant healing impact on multiple diseases and can eradicate then despite of this people are afraid because of the fear of pain after operation .At the same time key hole surgery was coming under horizon with lot of technical advantage and a relatively pain free operation. I decided to venture into it and got myself skilled at a highly reputed University of Strasbourg, France. I was the first Indian to obtain diploma in advance laparoscopic surgery from this university. Many operations which were not tried before with this new technique I and my team tried to develop and reached success. One of them was total key hole operation for a removal of a tumor in the chest just above the heart midst the great vessel (Total thoracoscopic thymectomy).This technique was accepted in the reference library of the surgical video. It was a very satisfying growth in academics and career. And accidently I came across surgery for obesity. I was attracted to learn the operation because the demand of the high surgical skill, but as I started learning and more getting into the subject I understood that obesity is a Huge Disease with little information available to the public and doctors. It can lead to almost 120 healths related disorders and thus we treat obesity the health related quality of life significantly improves. That was the ignition point to jump in this field of obesity surgery in my life. It was a great demand of time dedication to acquire the academic height and the surgical skill. Because of the deep interest in the subject and my passion I could accommodate these things.
What are your thoughts on the various surgical options for weight loss surgery? Have a preference? Is one better than all the rest?
Surgery for obesity precisely the bariatric surgery includes various alterations in the gastrointestinal tract. Because obesity never comes alone and is accompanied by multiple diseases with multi factorial origin one operation may not be suitable for all again the age of a person and the expectation of life and lifestyle plays an important role in the decision making of what surgery will fit whom.
Comment if you will on obesity in India? Why has it become such a prominent health risk? Is it symptomatic of fundamental pathology, food production issues, poverty, and wealth inequality?
Genetically Indians are prone to get obesity and diabetes and are not protected enough. Culturally our food habits high carbohydrate intake preferences of food and very sedentary lifestyle has led to explosion of obesity in an epidemic way.
Who should have bariatric surgery? What are your personal criteria?
Bariatric surgery is proven to be the best scientific tool to treat obesity and related diseases on a long term basis. International federation has laid down the criteria for the bariatric surgeons. Because of a high propensity of severe metabolic diseases like diabetes in Indian population, a consensus meeting was held with all experts from India in 2008 in Delhi. The following criteria are accepted for eligibility of bariatric surgery in Indian Patients.
a. Body Mass Index>37.5
b. BMI>32.5 with any of the obesity related diseases
c. Anybody who is unable to lose weight inspite of multiple attempts and leading to serious obesity relates comorbidities with the judgment of the expert panel.
How the safety has profile in bariatric changed over the past 15 years, for better or worse?
The safety profile in Bariatric has reached a very good index over last 50 years because of technical advances in laparoscopic surgeries, finer diagnostic tools and safe anesthesia agents and technique. Of course with the more understanding of the disease we have understood optimization of the safety of the patient’s early detection and treatment of the potential problems. We follow the strict norms and protocol laid down by international centre of the excellence and we are glad that in our experience over last 12 years in obesity surgery we hardly came across any complications of mortality.
Patient who have had bariatric procedures done develop unique long term complications (internal hernias, difficult to diagnose bowel obstructions, etc). Where these patients are best served? Ought they all to be airlifted to centers with bariatric specialists when they show up in random ER’s?
Fortunately obesity now is known as a medical disease and bariatric surgery as a standard treatment. With the safety precautions the rate of long-term complications is going down drastically and at same time more surgeons are getting introduced and trained in the faculty. Nevertheless, it is strongly recommended that anybody who has undergone bariatric surgery it develops any kind of health related problems the primary surgical unit needs to be in the loop to achieve a safe outcome. Many health conditions belong to obesity and particularly bariatric surgery. And not all doctors are trained in this science so is always advisable to keep the primary unit informed about and involved in the treatments of post bariatric patients. It is a highly specialized job so the care.