Liver transplant patient undergoes complex surgeries at city hospital

PUNE: A 37-year-old liver transplant patient recently underwent laparoscopic bariatric surgery and hernia procedure at the Sahyadri Super Specialty Hospital, Deccan Gymkhana to get rid of multiple issues affecting his liver function.

A multidisciplinary approach with a team led by Dr Jayashree Todkar performed both procedures on the obese patient suffering from diabetes mellitus, abdominal hernia and metabolic syndrome. 

Doctors said the patient, who is a marketing professional from Mumbai, had undergone orthotopic liver transplant for chronic liver disease in July 2016. Post-liver transplant, he was put on a strict diet and exercise regimen and lost 15 kg. Eventually, he started gaining weight and his sugar levels started going up and he was on the verge of insulin injections for uncontrolled diabetes. 

Dr Jayashree Todkar said when the patient approached them, he developed a ventral hernia. 

“Abdominal hernia is a sign of increased abdominal pressures, which tends to rise with obesity. His Body Mass Index (BMI) at the first consultation was 32.5 with an extra weight of 23 kg. He was a patient with diabetes mellitus, dyslipidemia, which were indicators of a strong metabolic syndrome, also the transplanted liver showed changes of diffuse fatty infiltration of the liver, along with raised liver enzymes which suggested the metabolic syndrome had started to assault the transplanted liver. To prevent further damage to the liver, a decision was made that he should undergo bariatric surgery to improve metabolism, control/reverse diabetes and safeguard liver and kidney,” said Dr Todkar.

She said after consulting the liver transplant surgeon and anaesthetist, a plan was drawn and he was put on preoperative regimen at home under guidance for 15 days.

“On January 31, this year, he underwent laparoscopic bariatric surgery and hernia repair. His post-operative recovery was the same as any regular bariatric patient. He was discharged on day three as per routine protocol,” said Dr Todkar. 

Liver and multi-organ transplant surgeon at Sahyadri Hospitals Dr Bipin Vibhute said when the patient approached them a couple of years back, he was suffering from multiple problems including end-stage liver cirrhosis.

“His liver dialysis was on time and he underwent a cadaveric liver transplant. He was briefed about the risk factors involved. After the liver transplant, his central obesity and diabetes continued to affect him and he started putting on weight. The fatty acids started affecting his liver function. There was no option than to reduce his weight and correct metabolism. Therefore a collective decision was taken to go for bariatric surgery,” said Dr Vibhute.