Liver transplant patient undergoes laparoscopic bariatric surgery and hernia procedure
Pune 19 February 2019 : A 37 year old liver transplant patient ( marketing professional from Mumbai ) underwent laparoscopic bariatric surgery and hernia procedure at Sahyadri Super Specialty Hospital Deccan recently to get rid of multiple issues affecting his liver function. A multidisciplinary approach with a team led by Dr Jayashree Todkar performed both the procedures on the obese patient suffering from diabetes mellitus , abdominal hernia and metabolic syndrome .
The patient 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 had lost upto 15 kgs. Eventually he started gaining weight and was failing at attempts of diet and exercise.His sugar levels started deranging and he was on verge to need insulin injections for uncontrolled diabetes .
Dr Jayashree Todkar laproscopic , bariatric and gastrointestinal surgeon at Sahyadri Hospitals said that when the patient approached us he had developed a ventral hernia ( hernia of abdominal wall) .Abdominal hernia is also a sign of increased abdominal pressures which tend to rise with obesity. His BMI on first consultation was 32.5 with extra weight of 23kgs. He was a patient with diabetes mellitus, dylipidemia which were indicators of a strong metabolic syndrome, also the transplanted liver showed changes of diffuse fatty infiltration of liver along with raised liver enzymes which suggested that the metabolic syndrome had now again started to assault the transplanted liver. So in order to prevent the further damage to liver a decision was made that he should undergo bariatric surgery to improve metabolism , control / reverse diabetes and safeguard liver and kidney.
After consulting with the liver transplant surgeon, and anaesthetist a plan was decided and he was put on a preoperative regimen at home under the guidance for 15 days and then on 31st Jan 2019 he underwent laparoscopic bariatric surgery + hernia repair. The surgery was challenging due to previous major operation and went well and his post operative recovery was the same as any regular bariatric patient. He was discharged on day 3 as per the routine bariatric protocol.
Liver and Multi Organ transplant surgeon at Sahyadri Hospitals Dr. Bipin Vibhute said that when the patient approached us couple of years back he was suffering with multiple problems including end stage liver cirrhosis. He also had diabetes and was on insulin and dialysis luckily he got liver on time and underwent cadaveric liver transplant. He was also briefed about the risk factors involved. After liver transplant his central obesity and diabetes continued to affect him and he started putting on weight. The fatty acids also had started affecting his liver function. In this case there was no other option than to reduce his weight and correct metabolism Therefore collective decision was taken to go for bariatric surgery.
Dr Todkar added that metabolic syndrome leads to non-alcoholic liver disease which further causes decreased functioning of the liver/ transplanted liver. Hence to optimize the available organs for overweight and obese post transplant patients, bariatric surgery is a highly effective and safe method with a multidisciplinary approach.This can help improve quality, , productivity in life and organ functions .
