A 44-year-old man from Kolkata weighed 190 kg and had a body mass index of 64 when he first arrived at CK Birla Hospitals, CMRI. He was controlling his high cholesterol, hypertension, and type 2 diabetes. He suffered from severe obstructive sleep apnea. He had a lot of swelling in his legs. Additionally, he was experiencing dyspnea, which he had mistakenly attributed to his weight.

His clinical evaluation at CMRI showed that the cause of his dyspnea was more precise. Due to his untreated pulmonary hypertension and right heart failure, the possibility of bariatric surgery was significantly more complicated than it would have been otherwise. He had an umbilical hernia as well. Prior attempts to control his weight with medication had not yielded significant outcomes. The best course of action was surgery, but it couldn’t be done right away.

Before attempting surgical intervention, the patient was admitted for a structured one-week preoperative optimization protocol under the direction of Dr. Sarfaraz J. Baig, Senior Consultant, GI Surgery, and his team. For the sleep apnea, continuous positive airway pressure therapy was started. Sildenafil and diuretics were prescribed to treat pulmonary hypertension and right heart failure. In order to reduce liver volume, improve metabolic parameters, and improve the conditions for surgery, a low-calorie, high-protein diet was initiated. Throughout, a critical care specialist, the pulmonary team, and a dietitian collaborated with the bariatric team to closely monitor the patient’s cardiopulmonary status. His pulmonary function and respiratory condition had sufficiently improved by the end of the week to move forward.

The most popular bariatric procedure, a laparoscopic sleeve gastrectomy, was performed with meticulous attention to the unique technical difficulties the patient presented. He had severe hepatomegaly and a large, thickened stomach due to his extreme obesity, which limited access and exposure during surgery. During port placement, extra caution was needed due to the swelling in his lower abdomen and the umbilical hernia. Direct vision was used to insert each port. Despite these challenges, the laparoscopic procedure was finished in an hour.

After surgery, the patient was monitored in the intensive care unit for 24 hours before being sent home on the second postoperative day in stable condition. He had already shed fifteen kilograms ten days after the procedure. He was breathing better now. His legs were becoming less swollen. He said he was feeling fantastic.

The patient is still trying to lose weight. Bariatric surgery is the start of a long-term process that calls for ongoing multidisciplinary support, dietary modification, and follow-up. He has expressed his desire to resume the active, athletic lifestyle he led prior to his weight becoming a health issue. There is now a practical route to achieving that objective.

Priyanka Dutta