NEW DELHI: A two-year-old girl who weighed nearly 45 kg and was wheelchair-bound was operated upon for removal of a part of her stomach at a private hospital in Delhi, with the hospital claiming she could be the youngest bariatric surgery patient in the country in over a decade.
Doctors at the Max Super Speciality Hospital in Patparganj performed the surgery.
"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.
The procedure of bariatric surgery 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 Manpreet Sethi, Consultant, Paediatric Endocrinology, 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 that age having normal growth milestones weighs between 12 and 15 kg.
Sethi said that her condition worsened to the extent that she developed significant obstructive sleep apnoea with multiple pauses in her breathing during sleep and she was unable to sleep lying down on her back.
"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, HOD at the Max Institute of Minimal Access, Bariatric & Robotic Surgery, said it was a "multi-disciplinary" team decision to take the girl under the knife.
"We had a detailed discussion with the paediatricians, endocrinologists and the family, along with a thorough review of 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.
Bindal said that the non-availability of any referral literature or technical video of such a procedure 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 HOD, 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, Khayati 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.
The girl's father said that 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.
With the increase in her weight, her diet had also increased but now she eats quite less, he added.