Question 1

What are the early signs of obesity?

Dr. Rakesh Durkhure · Accepted Answer

The very earliest sign is that your waist belt starts to feel tight. Another is your partner telling you that you snore too much in bed. A third is feeling very breathless after running 100 metres or so.

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 procedures?

Dr. Rakesh Durkhure · Accepted Answer

Of the three procedures I showed, relapse is highest with the intragastric balloon: because the balloon has to be removed after four or six months, the weight comes back in 80% of cases. After sleeve gastrectomy, about 40% of patients complain of weight relapse after two years. After gastric bypass, hardly 5 or 10% of patients complain of weight relapse. So I suggest bypass if the weight is above about 125 kilos.

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?

Dr. Rakesh Durkhure · Accepted Answer

Frankly, and with my hand on my heart, I have never seen an internal hernia, because we repair every possible site of internal hernia, 100% of the time. If anyone asks about leakage, the most dreaded complication: we have not seen any, because during surgery we do a leak test and check for any leak. I also record a video of the surgery and give it to the patient, because your patients cross two oceans and two continents to reach me, so that they can show it to you or to any other gastrointestinal surgeon in their own country.

Question 6

Patients often hold firm beliefs about surgery or fear relapse. How can African doctors counsel them?

Dr. Rakesh Durkhure · Accepted Answer

Through the results of the African patients I have already operated on. Patients have come to me from Kenya, Nigeria, Mozambique, Ghana, Chad, Rwanda, Burundi and Congo. Doctors can show patients these success stories, and we can take the patient's questions further in online consultations to counsel them.

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.

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