A 37-year-old liver transplant patient (marketing professional from Mumbai) underwent laparoscopic surgery and hernia repair 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 (obesity).
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 up to 15 kgs.
But, eventually, he started gaining weight and was failing at attempts of maintain his diet and exercise regimen. His sugar levels started to become unstable and he was on verge of needing insulin injections for uncontrolled diabetes.
Dr Jayashree Todkar said that when the patient approached them and 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.
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.
Dr Todkar added that metabolic syndrome leads to non-alcoholic liver disease which further causes decreased functioning of the liver/transplanted liver. Hence to optimise 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 .
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 January 31, 2019 he underwent laparoscopic bariatric surgery along with 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 the third day as per the routine bariatric protocol.
Dr Bipin Vibhute, Liver and Multi Organ transplant surgeon at Sahyadri Hospitals, 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.