Question 1

What are the early signs of obesity?

Dr. Rakesh Durkhure · Accepted Answer

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.

Question 2

How affordable are these surgeries?

Dr. Rakesh Durkhure · Accepted Answer

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.

Question 3

What is the relapse rate after the different weight-loss surgeries?

Dr. Rakesh Durkhure · Accepted Answer

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.

Question 4

Does that cost range apply to all four surgical options, or just the one with the lowest relapse rate?

Dr. Rakesh Durkhure · Accepted Answer

That figure is for the option with the lowest relapse rate, gastric bypass. The other options cost somewhat less, roughly $1,000 less.

Question 5

What is the risk of internal hernia following surgery, and what about the risk of leakage?

Dr. Rakesh Durkhure · Accepted Answer

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.

Question 6

Given that some patients trust surgery while others fear relapse, how can African doctors approach counseling patients on this?

Dr. Rakesh Durkhure · Accepted Answer

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.

Question 7

How does the cost of surgery compare with the lifetime cost of medical management, in terms of return on investment?

Dr. Rakesh Durkhure · Accepted Answer

Ozempic and Mounjaro cost about $500 a month in India and have to be taken indefinitely. The cost of surgery is recovered within about a year of what that ongoing medication would have cost. After that, the only requirement is vitamins and good nutritious food.

Question 8

Beyond bariatric surgery, what other conditions can African doctors refer to your service?

Dr. Rakesh Durkhure · Accepted Answer

The scope goes well beyond bariatric surgery. It includes hiatus hernia, where the stomach moves from the abdomen into the chest, gallbladder stones, particularly complicated cases where a stone has slipped into the bile duct, and problems of the colon and small intestine. It also covers complex abdominal hernias, including inguinal, umbilical, and recurrent hernias that have come back after a local repair, as well as rectal prolapse, complex piles and haemorrhoids, and fistulas near the back passage. All of these can be managed and the patient sent back with a satisfactory outcome.

Diagnosis and Management of Obesity and Metabolic Syndrome: The Role of Bariatric Surgery

Questions Doctors Asked Dr. Rakesh Durkhure