Delhi: Wheelchair-bound 2-year-old undergoes bariatric 'weight loss' surgery

A wheelchair-bound specially-abled two-year-old child, weighing just 45 kg, underwent a complicated bariatric surgery at a hospital in Delhi. The medical procedure is designed to treat patients with excessive and severe obesity and involves restricting the food intake in order to decrease the absorption in the stomach and intestines. This leads to weight loss. On Tuesday, doctors at the Max Super Speciality Hospital in Patparganj performed the procedure on a girl child, whom they called the youngest bariatric surgery patient in India in over a decade, PTI reports. 

"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, accesses by PTI. 

According to the medics, bariatric surgery would give the 2-year-old child a “feeling of fullness” and will eliminate hunger. The surgery involved installing a smaller stomach pouch with lesser volume than normally seen in 2-year-olds so that the stomach absorbs less food. "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,” Dr Manpreet Sethi, Consultant, Paediatric Endocrinology, meanwhile told the agency. He added, that the girl has an elder brother, an eight-year-old, who 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,” the doctor stated. 

At 2 years of age, a child must ideally weigh somewhere between 12 and 15 kg, known as the normal growth milestones. Anything overly in kids or below the prescribed weight can lead to other health complications. Due to her being overweight, the child’s condition worsened and she suffered from obstructive sleep apnoea. Additionally, the baby was unable to lie on her back, and took long pauses during breathing while asleep, exceedingly worrying the family. 

"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," Sethi said.

A "multi-disciplinary" team took the crucial decision of performing the complex surgery on the child. "We had a detailed discussion with the paediatricians, endocrinologists, and the family, along with a thorough review of the 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," Dr Vivek Bindal, HOD at the Max Institute of Minimal Access, Bariatric & Robotic Surgery, said.

Limited instruments for babies, no referral literature 

Since there are limited medical instruments designed for babies for the surgery and even lesser referral literature on it, the procedure was a challenge, he added. Plus, there were numerous worries as the abdominal cavity of the two-year-old child was relatively smaller in size, and children have smaller blood volume therefore the blood loss was what concerned the medical fraternity. 

“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,” Dr Arun Puri, Senior Director and HOD, Pain Management and Anaesthesia told PTI.

“The surgery went well and the child came out of anaesthesia, uneventfully. There were no previous guidelines about this kind of surgery as these are very rare cases. In the other few and known cases, such obesity has proved to be fatal for children," he continued. 

The child’s dad called the surgery a battle half-won, adding that there was still 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 father of the girl child said. He informed that the last two years for the family have been tough and the decision for the child’s surgery was a difficult one to make. “With the increase in her weight, her diet had also increased but now she eats quite less,” he told PTI.