Delhi: 2-year-old weighing 45kg undergoes bariatric surgery

NEW DELHI: A two-year-old girl who weighed nearly 45 kg underwent weight-loss surgery at a private hospital in Delhi recently. The surgery involved removing part of her stomach using a minimally invasive technique.
A child of two years having normal growth milestones weighs between 12 and 15 kg, doctors said. They added that the two-year-old girl, daughter of a chartered accountant from East Delhi, weighed thrice as much and despite a series of tests, including complete genetic testing, they couldn’t figure out why.
Dr Manpreet Sethi, consultant, paediatric endocrinology at Max Patparganj, said the child’s parents and her sibling aren’t overweight. “Her elder brother, who is eight years old, has normal growth milestones for his age,” she added.
Khyati, the child, also weighed normal at the time of birth and weighed 2.5 kg, doctors said. However, she started gaining weight rapidly soon after birth and weighed 14 kg at six months. Her parents consulted many doctors but to no avail. At the age of one year and six months, the girl became wheelchair-bound and developed sleep disorder due to her excess weight.
“Surgery is never a preferred option for weight loss in small children. But in this case, it was needed to save the child’s life,” Dr Vivek Bindal, head of the Max Institute of Minimal Access, Bariatric & Robotic Surgery, said.
The procedure of bariatric surgery in which surgeons remove part of the stomach gives a feeling of fullness to patients and reduces their hunger, causing weight loss and significant improvements in health. This is owing to the fact that the new stomach pouch holds smaller volume than normal stomach and reduces the amount of food intake.
Dr Bindal said that the non-availability of any referral literature or technical video of weight loss surgery in a small child was a challenge as also the fact that the staplers and instruments are 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.
Talking about other challenges faced by the team, Dr Arun Puri, senior director and head of the department of pain management and anaesthesia, said it was a huge challenge 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.
Post-surgery, Khyati has been put on a special diet to gradually decrease her weight while maintaining the child’s nutrition requirements. She is expected to lose weight over the next year and grow up as a normal adult. She will be closely monitored by the clinical team. She is also undergoing rehabilitation to help her build strength in her limbs so she can begin walking.