by Suman Gupta
Mumbai: A team headed by Dr Aparna Govil Bhasker, consultant bariatric and laparoscopic surgeon at Namaha Hospital in Kandivali west in Mumbai successfully conducted a bariatric weight loss surgery on a 38 years old man weighing 262 kgs. The patient also suffered from type 2 diabetes, high blood pressure, severe obstructive sleep apnoea OSA), cellulitis of abdomen and both legs, breathlessness, gout and varicose veins. The patient underwent a laparoscopic sleeve gastrectomy in December 2022 at Namaha Hospital in Kandivali West. He has already lost 41 kg in 4 weeks after the surgery and currently weighs 221 kgs.
Mr. Kalpesh Limbachiya, a resident of Kandivali suffered from morbid obesity. He kept trying multiple diets and exercise regimes. Every time he would lose weight it would come roaring back within a short span of time. During Covid pandemic due to all the restrictions, he could not continue with the rigorous exercise regime and regained weight very fast. He started struggling to perform his routine activities. In December 2022, he reached his highest weight of 262 Kgs. Along with weight gain he developed multiple other diseases as mentioned above. He could barely walk and was dependent on his family members for everything. Due to his declining health, he had to leave his job as well.
The family then started looking for solutions and were referred to Dr Aparna Govil Bhasker, a bariatric surgeon at Namaha Hospital in Kandivali West. Along with her team, she guided him about bariatric surgery which is currently the only proven method for effective weight loss in such patients and can help to improve the quality of life.
Dr Aparna Govil Bhasker said, “When we first consulted Mr. Limbachiya, he could barely walk. He was extremely breathless and had cellulitis on his legs and lower abdomen. He had multiple co-morbidities and was extremely nervous. Due to excessive abdominal fat and fragile metabolic condition, he was at the tipping point. Bariatric surgery was the only option for him.”
To prepare him for surgery, he was kept on a high protein liquid diet for 4 weeks prior to the surgery under the supervision of bariatric dietician Ms. Mariam Lakdawala. “Patients with severe obesity need to be optimized nutritionally before they are taken up for surgery” said Ms. Lakdawala.
Dr. Tejas Mehta, physician at Namaha hospital, treated Mr. Kalpesh Limbachiya for all the other co-morbidities like type 2 diabetes and obstructive sleep apnoea (OSA) etc. “Sleep apnoea is one of the most commonly associated medical condition with severe obesity and it is usually undiagnosed”, said Dr. Mehta. “These associated conditions need to be controlled before the surgery to aid recovery post-surgery.”
The patient underwent a bariatric surgery in the form of Laparoscopic Sleeve Gastrectomy on December 20, 2022. Dr Aparna Bhasker added, “The surgical procedure was technically very difficult due to excess fat in the abdomen and large size of the liver. The surgery lasted for 3 hours, after which the patient was kept in the ICU for a day so that he could be monitored closely. The anaesthesia team of Dr. Yogen Bhat and Dr. Kalpesh Shah successfully managed this case. “Carbon dioxide retention can be a major challenge in such cases during anaesthesia and it has to be managed properly”, said Dr. Bhat.
After surgery, the patient was made to walk at the earliest to increase blood circulation in his legs so that any kind of clot formation could be prevented. After 24 hours he was started on a liquid diet orally.
Dr. Munjal Kapadia, the owner of Namaha Hospital said, “This was a very challenging case and one of the heaviest patients in western suburbs. We had to be mindful about the weight bearing capacity of all beds and tables. Most hospital beds have a weight-bearing capacity from 130 kg to 200 kg. Special extensions had to be arranged for the operation theatre table so that he could fit on it. Namaha hospital is one of the major bariatric surgery centres in the western suburbs and I am happy that we could manage this challenging case successfully.”
The patient was discharged on the fourth day after surgery. He has lost 41 kgs in the last 1 month. He is already feeling much lighter, the cellulitis has resolved and he is able to walk for longer distance. He is hoping to lose more weight in the upcoming months.
Obesity can be a debilitating disease. “Though obesity is rising across the world, it is rare to see patients with such high weight. They constitute less than 5% of all patients with obesity. The objective of the surgery is to help to lose weight and improve quality of life so that he can get back to work and lead a normal life. The surgery will also help to improve type 2 diabetes, high blood pressure, obstructive sleep apnoea, breathlessness, gout, varicose veins, etc.
Contrary to common belief, obesity is not just due to excessive diet and lack of exercise. 70% of obesity can be attributed to genetics. It is essentially a disease caused by neuro-hormonal dysregulation and the disease severity varies from person to person. Even in this case, patient had continuously made efforts to lose weight. Beyond a point it is unfair to expect them to indulge only in rigorous exercise and deny proper treatment. Bariatric surgery is the only effective weight loss option for such patients and works as a tool to help them to get to a target. A healthy lifestyle is important after surgery to maintain weight loss,” said Dr Aparna Bhasker.
“I am thankful to Dr Aparna Bhasker and her team for saving my life. I have already lost significant amount of weight and will continue to follow a healthy lifestyle. My comorbidities are getting controlled and I feel much lighter now. I am happy that I can move freely again,” concluded the patient Mr. Kalpesh Limbachiya.
