As promised in my last blog I would like to educate people about weight loss procedures. Weight loss procedures are advised to those whose weight loss attempts have gone into vain and people who have co morbidities like thyroid, diabetes, dyslipidemia, high blood pressure. Now, let’s know what are these procedures.


There are two types of non surgical weight loss procedure :-

  1. Endoscopic Sleeve Gastroplasty
  2. Endoscopic Intragastric Balloon

Endoscopic Sleeve Gastroplasty (ESG)

It is a procedure similar to gastric sleeve surgery but is non surgical. The entire procedure is done through mouth via endoscopic suturing system which doesn’t require any incision. Using this technique, size and volume of the stomach are reduced to much less than it’s original capacity because of which limited intake of food is there.

Endoscopic Sleeve Gastroplasty

Benefits of ESG :-

  • This procedure is for 50 minutes.
  • After 4-5 hours of procedure, a patient starts walking and patient can be discharged within a day.
  • After getting discharged from the hospital, a patient can perform normal activities from the next day itself.
  • Since it is a non surgical endoscopic procedure, it leads to less pain and discomfort.
  • ESG leads to significant weight loss.
  • It potentially lowers the risk of serious weight-related health problems, including: GERD, Heart disease, Hypertension, Obstructive Sleep Apnea, Type 2 Diabetes.

Endoscopic Intragastric Balloon

It is a non surgical procedure to help lose weight who suffer from obesity and morbid obesity. It is an endoscopic procedure, during which a balloon is inserted in the stomach, occupying about half of it. The balloon remains in the stomach for maximum of six months and it is meant to increase the feeling of satiety and limit food intake. Weight loss can lower your risk of potentially serious weight-related health problems, such as:

  • Heart disease and stroke
  • High blood pressure
  • Sleep apnea
  • Type 2 diabetes

Now I will be sharing information on  Surgical Weight Loss Procedures.

Bariatric/ Obesity Surgery And Robotic Surgery

There are two types of Bariatric Surgeries:-

  1. Laparoscopic /Robotic Sleeve Gastrectomy
  2. Laparoscopic / Robotic Roux-en-Y Gastric Bypass
  3. Mini Gastric Bypass

Laparoscopic /Robotic Sleeve Gastrectomy

  • This is a surgical procedure, the capacity of stomach is reduced to approximately 60-100ml, so the patient feels full early during a meal. It also shifts the hormonal balance so he/she feels less hungry between the meals.
  • In Sleeve Gastrectomy, the stomach is divided along the greater curvature to create a 60-100ml sleeve of stomach using endoscopic staplers. The staple line is always oversewen for extra security and safety to prevent any leak or bleed from staple line. The integrity of the pouch is checked using intra-operative gastroscopy. The excised portion of stomach is removed in a plastic bag. A small abdominal drain is usually left which is taken out after 48-71 hrs.
  • In our own series of patients who underwent LSG, there is a weight loss to the tune of 70-95% of excess body weight.  Resolution of Diabetes occurred in 78.94%, resolution of Hypertension occurred in 72% and OSA (Obstructive Sleep Apnoea) improved in 93% patients. Mean quality of life index improved from 2.7 to 8.2 (out of 10).

Laparoscopic / Robotic Roux-en-Y Gastric Bypass

  • It is also an effective procedure for resolution of diabetes, sleep apnoea and control of hypertension. In this, a small gastric pouch of 15-20ml is created.
  • The intestinal architecture is then changed so that a large portion (175-250 cm) of small intestine is bypassed, before the digestion and absorption of food starts. This results in malabsorption of food and subsequent drastic weight loss. In the end, the integrity of pouch is checked using per-operative gastroscopy. A small abdominal drain is usually left which is taken out after 48-96 hours.

Mini Gastric Bypass

  • In this surgical procedure a 40-50ml stomach pouch is created.
  • Loop anastomosis of jejunum is done with stomach pouch.
  • 150-250 cms of intestine is bypassed.

The staple line is always over sewn for extra security and safety to prevent any leak or bleed from staple line. The integrity of the pouch and anstomosis is checked using intra-operative gastroscopy.


These procedures can be performed laparoscopic or by robotic surgery. Robotic surgery is the most advanced platform to perform these procedures.

The Surgeon recommends which surgery is best for you depending on your medical condition.


Dt Garima Kapoor
Dt. Garima Kapoor, Dietitian