New Delhi: A 2-year-old girl, who weighed 45 kg and was confined to a wheelchair, underwent an operation in a Delhi private hospital that involved the removal of a portion of her stomach. According to the hospital, she might be the youngest patient to undergo bariatric surgery in over a decade.
Surgery was performed at the Max Super Speciality Hospital in Patparganj. ‘Since bariatric surgery for children is rare, this case can be termed to be the youngest bariatric surgery patient in India in over a decade. The procedure had to be conducted as a medical emergency,’ the hospital said in a statement.
A bariatric surgery procedure gives patients a feeling of fullness and reduces their hunger, which leads to weight loss and significant health improvements. This is due to the fact that the new stomach pouch holds less food than a normal stomach and reduces food intake.
Paediatric Endocrinology consultant, Dr. Manpreet Sethi, said, ‘The child was normal at the time of birth and weighed 2.5 kg. However, she started gaining weight rapidly soon after birth and weighed 14 kg at six months. She has an elder brother who is eight years old and has normal growth milestones for his age. Her weight progressively increased over the next year and a half reaching 45 kg at 2 years and three months.’ A child of that age with normal growth milestones weighs between 12 and 15 kilograms.
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Dr. Sethi stated that her condition worsened to the point where she developed significant obstructive sleep apnea with multiple pauses in her breathing during sleep. She was also unable to lie on her back to sleep. ‘While it was a tough decision to take, we finally decided to go ahead with the bariatric surgery as it seemed the only way to save her life. She had become so obese that even her parents could not lift their two-year-old child anymore and she was wheelchair-bound since the age of one year and 10 months,’ he said.
Dr. Vivek Bindal, head of the Max Institute of Minimal Access, Bariatric & Robotic Surgery, said the decision to operate on the girl was made by a ‘multidisciplinary’ team. ‘We had a detailed discussion with the paediatricians, endocrinologists and the family, along with a thorough review of the literature before taking up the child. She has undergone laparoscopic gastric sleeve surgery or sleeve gastrectomy where a portion of the stomach is removed surgically,’ he said.
A challenge, according to Dr. Bindal, was the lack of any referral literature or technical videos that could describe such a procedure in a small child, as well as the fact that staplers and instruments were designed for adults. ‘The abdominal cavity in a two-year-old child is very small, irrespective of her weight. Added to this, the blood volume in children is very small, and so is the allowable blood loss,’ he added.
In addition to the procedural challenges, Dr. Arun Puri, Senior Director and HOD of Pain Management and Anaesthesia, said it was difficult to administer anaesthesia during the procedure. ‘To help find the child’s veins under the layers of fat, managing bleeding and taking care throughout the procedure and ventilation post-op required great detailing before the surgery. The surgery went well and the child came out of anaesthesia, uneventfully. There were no previous guidelines about this kind of a surgery as these are very rare cases. In the other few and known cases, such obesity has proved to be fatal for children,’ he said.
As part of her post-surgery rehabilitation, the girl is on a special diet to reduce her weight gradually while maintaining her nutritional needs. Her weight is expected to drop over the next year and she will grow into a normal adult. A clinical team will be closely monitoring her condition. Furthermore, she is undergoing rehabilitation to help her build strength in her limbs so she can walk.
According to her father, the battle is still half-won and they have a long way to go. ‘She will achieve the developmental milestones other children achieve at earlier stages at the age of three-and-a-half years. The last two years have been quite difficult for us and even the decision of her surgery was a tough one since there was no precedent for such a procedure in a child her age,’ he said. Her diet had also increased as her weight increased, but now she eats much less, he added.
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