Minimally invasive bariatric surgery is one of the safest, least invasive surgical weight loss options available today. At WakeMed, we specialize in offering a variety of options, so we sat down with the Medical Director of WakeMed Bariatric Surgery & Medical Weight Loss, Bala Thatigotla, MD, MBA, FACS, FASMBS, DABOM, to learn more about this incredibly innovative option — that consistently leads to faster recovery time, less scarring and less shock to the body overall.

Tell me a bit about your medical background and education.

I have 12 years’ experience in performing a wide range of advanced laparoscopic and robotic surgeries, specializing in bariatric procedures, such as Roux en y gastric bypass, sleeve gastrectomy, biliopancreatic diversion with duodenal switch, along with complex revision bariatric surgeries. I’m especially interested in minimally invasive laparoscopic and robotic techniques.

My medical training started in Tirupati, India at Sri Venkateswara Medical College. I then moved to the United States to continue my education. After completing my residency in general surgery at The Royal College of Surgeons of Edinburgh, United Kingdom and Albert Einstein School of Medicine/Bronx Lebanon Hospital Medical Center, I completed a fellowship in advanced laparoscopic bariatric and robotic surgery at Vanderbilt University Medical Center.

Today, I’m board certified in general surgery, bariatric surgery, obesity medicine and health care quality management. Before joining WakeMed as the Medical Director of Bariatric Surgery & Medical Weight Loss, I held several leadership positions, including Director of Bariatric Surgery, Chairman of Surgery, Associate Vice President of Medical Affairs and Medical Director of the surgical service line. I’ve been a member and leader of various professional surgical organizations and have been honored with various teaching, quality and patient choice awards.

Why are you especially passionate about bariatric surgery?

During my residency, I realized my passion for bariatric surgery. No other surgery can fix several problems at one time. For example, if somebody has colon cancer and has the colon removed, in the early stages of the disease, this could resolve the cancer. That surgery addressed one health problem.

If someone has chronic conditions, such as diabetes, high blood pressure or sleep apnea, there are medical management options to help address these issues — though there is no cure. The common factor in many of these conditions is high body mass index (BMI).

Addressing obesity can effectively address numerous problems, including decreasing incidence of cancers, improving quality of life, improving blood pressure as well as controlling diabetes, sleep apnea, metabolic symptoms and more.

Bariatric surgery can result in tremendous health outcomes for patients. It provides a holistic approach for the management of several chronic health problems in “one shot.”

This is also inspiring since it doesn’t touch one person and one body, but it changes the legacy of a family and puts a dent in the obesity epidemic within the community.

How is bariatric surgery a community service?

Bariatric surgery is a service to the community because when we address this health problem effectively for one person, the family unit is impacted. People who have undergone bariatric surgery feed their children better and model healthy relationships with food. This then helps children become healthier — curbing the significant uptick in childhood obesity. Additionally, as friends and family in the community see this transition, they are inspired to seek a healthier lifestyle for themselves.

Bariatric surgery addresses disordered eating habits that are normalized within the culture, such as emotional overeating; consuming processed and fast foods; celebrating with high-fat, high-sugar foods; and insisting children eat all of their food while ignoring hunger and satiety cues.

What’s more, there is a direct link between obesity and many cancers, including ovarian cancers, breast cancers, colon cancers and pancreatic cancers. When we effectively address obesity, we at least decrease incidence of those cancers in the future, improving the patient’s quality of life and improving their productivity within the community.

Obesity also carries a greater burden on health care systems. If we decrease the number of visits to clinics and hospitals for comorbidities by performing bariatric surgery and providing patients with health literacy regarding healthy eating, people suffering from any number of ailments often see an improvement in their overall physical and mental well-being.

What role does mental health play in mindful eating post-surgery?

When patients come to the first pre-operative consultation, they are often depressed and tired. These mental health challenges are caused by stress hormone chemical reactions. Following surgery, I find my patients to be of a completely different mindset. They feel happy, empowered and motivated. Patients may not see a significant difference when looking in the mirror a month post-surgery, but mentally they know they are not the same person.

Brain research proves this point. A team of scholars found “a reduction in body weight of 1% led to the participants’ brain age being nearly nine months younger” (Gidon, et. al 2023). Additionally, an improvement in cognitive function supports improved mood.

Furthermore, many of my patients with obesity have reported discrimination in various areas of their lives, including the workplace, often due to their physical or mental health limitations. Weight loss addresses these challenges and helps improve their relationships professionally and personally.

More specifically, in their personal lives, many suffer with fertility challenges due to conditions, such as polycystic ovarian syndrome and urinary incontinence. Significant weight loss often makes it possible for patients to comfortably resume intimacy and conceive.

Tell me about your experience performing minimally invasive bariatric surgery.

I’ve performed minimally invasive bariatric surgery for 12 years. I remember my residency days when we would do open surgeries — which took more time and required patients to remain in the hospital for a longer period of time. With minimally invasive techniques, the surgeries take less time, result in less pain, lead to fewer complications, are more precise and typically allow discharge home the same day.

The surgeon’s time to perform minimally invasive surgeries is variable from one surgeon to the next. That in mind, in general, the following is true:

• Sleeve gastrectomy surgery typically takes up to half an hour.
• Gastric bypass surgery typically takes about 90 minutes.
• The duodenal switch procedure takes somewhere between two and two-and-a-half hours.
• Revisional surgeries are more complicated and can take upwards of four hours.

How much weight can a patient expect to lose?

Weight loss after bariatric surgery is variable based on the type of surgery as well as the patient’s adherence to aftercare following the surgery. This includes nutritional adherence as well as long-range lifestyle changes, to include exercise.

• With the sleeve gastrectomy, the average weight loss is about 60 to 65 percent of excess body weight.
• Gastric bypass patients can lose around 70 percent of their excess body weight.
• The duodenal switch leads up to 80 percent of excess body weight.
• With revisional surgeries, the weight loss is not as as much as they experienced with their initial surgery because the body is already metabolically challenged by the previous surgery/surgeries. Hence, there’s a lot of variability in weight loss after the original surgery, falling somewhere around 40 to 50 percent.

Do most patients qualify for minimally invasive surgery?

Yes. At WakeMed, we have a well-trained team of surgeons, exceptional care teams and robotic technology that makes minimally invasive bariatric surgery possible for most patients. With our next-generation technologies, we offer progressive procedures with the highest quality standard.

What is the average recovery time for minimally invasive surgery?

About 30 percent of patients can be discharged on the day of surgery depending on the complexity of their health problems, and for the remaining patients, the average length of stay is around 1.6 days. That recovery window depends on a number of variables. For example, patients with preexisting health problems will need more time to recover. That said, following discharge from the hospital, most people are back to living their lives within 10 days.

Adjusting to the dietary restraints after surgery can be difficult for patients — the progression is slow and requires adaptation to their regular diet.

The initial transition happens for the first two weeks following surgery. Patients start with a liquid diet to give their intestines a chance to heal. This does not come as a surprise to them. Dietititians navigate bariatric patients through extensive preoperative consultation.

Following the first two weeks on liquids, they move up to pureed foods, which are similar to baby food in texture and consistency. After a week of eating this way, they move to the soft diet and by week four to a regular diet. Yet, the way patients eat has to change for their lifetime after this surgery because their stomach is smaller.

We encourage patients to use a spoon to determine serving size. We also encourage them to completely chew and swallow before taking another bite. By eating mindfully, patients have better control. This helps to control how many calories they are taking in and also helps the brain have enough time to signal the stomach that it is full.

What follow-up care is available to patients after they fully recover from surgery?

We partner with our patients for a lifetime because obesity is a chronic condition. We offer monthly support groups, so they can spend time with peers who have also had (or are getting ready to have) bariatric surgery.

Eventually, as patients experience life after bariatric surgery as their new normal, we may see them annually. Some patients have been seeing us for more than 20 years post-surgery.

They also continue to receive dietary support. The goal is to ensure they remain on track nutritionally once they are able to sustain the weight loss for a long duration.

We remain available to answer questions by phone or through MyChart.

What robotic surgery machines do you use?

At WakeMed, we use the state-of-the-art, latest iteration, robotic-assisted surgical device manufactured by Intuitive. It helps us navigate even the most difficult surgeries with the least struggle. It is highly precise and serves as a human arm able to go into the deep spaces within the body and magnify tissue for the most precise view of the patient. This is critical since all bodies have some variation.

Moreover, use of the machine means surgery is not limited by a physician’s human capacity. For example, there are no challenges with hand trimmers in minimally invasive surgery. This can result during open surgery since a high body mass index thickens the wall leading to the belly.

Robotic surgery is also a consistently safer surgery and eliminates burnout for surgeons, leading to highly seasoned surgeons remaining in the field for a longer time as they experience better attention, more stamina, more efficiency and less tiredness using the technology.

Do you believe minimally invasive bariatric surgery should be a top choice for people with obesity?

I absolutely believe that bariatric surgery should be both a top choice and early choice in a person’s weight loss journey.

Minimally invasive bariatric surgery is safe, effective and results in fewer long-term complications.

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About Bala Thatigotla, MD, FACS, FASMBS

Dr. Bala Thatigotla is a bariatric, gastrointestinal, general and robotic surgeon with over a decade of experience in performing a wide range of advanced laparoscopic and robotic surgeries. He specializes in bariatric procedures such as Roux en y gastric bypass, sleeve gastrectomy, biliopancreatic diversion with duodenal switch, along with complex revision bariatric surgeries. Dr. Thatigotla has an extensive amount of experience performing procedures for diseases of gallbladder, bile duct, esophageal, gastrectomy, colon surgeries and hernia procedures using minimally invasive laparoscopic and robotic techniques.

Dr. Thatigotla believes in a well-rounded, comprehensive, holistic patient care approach. From the very first interaction and throughout the patient’s health care journey, he strives to make patients feel supported and heard. Outside of work, Dr. Thatigotla enjoys playing tennis, long distance road biking and traveling.

Specialty Procedures

Bariatric and Metabolic Surgery:

• Laparoscopic and Robotic Roux En Y Gastric bypass
• Laparoscopic /robotic sleeve gastrectomy
• Gastric band removal
• Laparoscopic /robotic biliopancreatic diversion-duodenal switch
• Revision Bariatric surgery

Robotic Surgery:

• Robotic Bariatric surgery :Roux En Y gastric bypass,BPD-DS,Revision surgeries
• Robotic paraesophageal hernia/fundoplication for Acid reflux surgery/heller myotomy
• Robotic cholecystectomy
• Robotic abdominal wall hernia : component separation with TAR,incisional, ventral and inguinal
• Robotic Colo rectal procedures
• Robotic pancreas and biliary procedures

Foregut:

• Laparoscopic and robotic paraesophageal hernias
• Fundoplication for Gastro Esophageal reflux disease, Heller myotomies.

Biliary-pancreatic surgeries:

• Laparoscopic/robotic Common bile duct procedures
• Laparoscopic/robotic pancreas procedures for non-cancerous conditions

Colorectal:

• Laparoscopic and robotic colorectal procedures

• Laparoscopic adrenalectomies

• Metabolic surgery
• Robotics in general /GI surgery

About WakeMed Bariatric Surgery & Medical Weight Loss

WakeMed Bariatric Surgery & Medical Weight Loss includes an experienced bariatric surgery team of surgeons, anesthesiologists, nurses, technicians and support staff who have expertise in the most advanced surgical techniques to provide our patients with positive health outcomes.

Rather than sending patients to numerous professionals, our program offers a comprehensive, unified and personalized approach. Our team of experienced and knowledgeable professionals will partner to provide you with all of the individual attention, compassion, resources and support you need along your journey to better health and vitality.

Led by expert board-certified bariatric surgeons, members of our weight loss surgery program will participate to use their expertise to meet your healthcare needs. These individuals include your bariatric coordinator (also called a navigator, or advocate), nurses, dieticians/nutritionists and exercise/health and fitness specialists. They will work closely with you to answer questions, gather information, guide your recovery and make plans to support you before, during and after bariatric surgery.