Head - General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon, India
Part 9 of 9 in Diagnosis and Management of Obesity and Metabolic Syndrome: The Role of Bariatric Surgery
Beyond Bariatric Surgery: When to Refer a Patient for General and GI Surgery
September 6, 2026
Bariatric surgery is only one part of Dr. Rakesh Durkhure's practice at Artemis Hospitals. For doctors deciding which patients to refer onward, he outlines the wider range of general and gastrointestinal surgical cases his service also covers.
Hernias and Stomach Conditions
Beyond obesity surgery, referrals include hiatus hernia, where the stomach moves up from the abdomen into the chest, gallbladder stones, particularly complicated cases where a stone has slipped into the bile duct, and problems affecting the colon or small intestine.
Complex and Recurrent Hernias
Complex abdominal hernias, including inguinal and umbilical hernias, are also within scope, including cases where a local doctor has already repaired a hernia and it has recurred, requiring a more complicated redo repair.
Rectal and Colorectal Conditions
The service also covers rectal prolapse, where the rectum protrudes outward, complex piles and haemorrhoids, and fistulas near the back passage. According to Dr. Durkhure, these cases can be managed with the patient sent home with a satisfactory outcome.
How Jivo Healthcare Structures the Referral
Referring doctors are asked to compile a case file covering the patient's investigations and their own clinical opinion before an online consultation is scheduled, rather than sending a patient in without that groundwork. That case file is shared in advance so the consultation can focus on next steps rather than starting from scratch.
← Cost of Bariatric Surgery in India Versus Lifelong Medication | Series index
This article is based on a Jivo Masterclass session conducted by Dr. Rakesh Durkhure, Head - General, MI & Bariatric Surgery, Artemis Hospitals, Gurgaon, India. The article has been summarised with the assistance of an AI tool from the original masterclass recording. Watch the full Masterclass recording
This guide is based on a live Jivo Masterclass: Dr. Rakesh Durkhure taught doctors across Africa on May 4, 2025.
FROM THE LIVE Q&A
Dr. Robert Tabukanga
What are the early signs of obesity?
Dr. Rakesh Durkhure
A waistband that keeps needing loosening is the earliest sign. A partner reporting loud snoring at night is another. And marked breathlessness after something as minor as running 100 metres is a third.
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Frequently Asked Questions
How affordable are these surgeries?▼
Door to door, from hospital admission to discharge, the cost runs about $5,500 to $6,000. It varies by roughly $500 to $1,000 depending on the patient's body weight, diabetes management and breathing problems.
What is the relapse rate after the different weight-loss surgeries?▼
Relapse is highest with the intragastric balloon: because it has to be removed after four to six months, about 80% of patients regain the weight. With sleeve gastrectomy, around 40% of patients report weight relapse within two years. With gastric bypass, only 5 to 10% of patients report weight regain, which is why I recommend bypass specifically when a patient's weight is above around 125 kilograms.
Does that cost range apply to all four surgical options, or just the one with the lowest relapse rate?▼
That figure is for the option with the lowest relapse rate, gastric bypass. The other options cost somewhat less, roughly $1,000 less.
What is the risk of internal hernia following surgery, and what about the risk of leakage?▼
I can say with complete confidence that I have never seen an internal hernia, because every possible site where one could form is repaired during surgery. Leakage is the most feared complication, and we haven't seen that either, because we run a puncture test during surgery to check for any leak before closing. I also record the video of every surgery and give it to the patient at discharge, so they can show it to their own doctor back home.
Given that some patients trust surgery while others fear relapse, how can African doctors approach counseling patients on this?▼
Dr. Durkhure pointed to his own track record: he has operated on patients referred from Kenya, Nigeria, Mozambique, Ghana, Chad, Rwanda, Burundi and Congo. Those success stories can be shared directly with patients, and follow-up online consultations can address whatever questions remain.
What conditions besides bariatric surgery does Dr. Durkhure treat?▼
Hiatus hernia, gallbladder stones including complicated cases involving the bile duct, colon and small intestine problems, complex and recurrent abdominal hernias, rectal prolapse, haemorrhoids and fistulas.
What should a referring doctor prepare before an online consultation?▼
A case file with the patient's investigations and the referring doctor's own clinical opinion, shared in advance of the consultation.
In This Series: Diagnosis and Management of Obesity and Metabolic Syndrome: The Role of Bariatric Surgery
- 1.Diagnosis and Management of Obesity and Metabolic Syndrome
- 2.Metabolic Syndrome: The Five Components and the Early Warning Signs of Obesity
- 3.Who Qualifies for Bariatric Surgery? Patient Selection Criteria
- 4.Intragastric Balloon, Sleeve Gastrectomy or Gastric Bypass: Comparing the Weight-Loss Surgery Options
- 5.How Bariatric Surgery Reverses Type 2 Diabetes
- 6.Bariatric Surgery Outcomes: What the Data Shows on Sleep Apnea, Blood Pressure and Quality of Life
- 7.Inside a Safe Bariatric Surgery Program: Team, Technique and Complication Rates
- 8.Cost of Bariatric Surgery in India Versus a Lifetime on Weight-Loss Medication
- 9.Beyond Bariatric Surgery: When to Refer a Patient for General and GI Surgery