KIMS Doctors remove 12 kg polycystic liver from 50-year-old woman

Hyderabad: A liver weighing 12 kg is too preposterous a thought and hard to believe even by the best of medical brains. And if the patient is a woman with polycystic liver and kidney disease, then saving her life will present itself as a major challenge for surgeons. 

A miracle, by way of simultaneous liver and kidney transplantations, was performed by a team of reputed surgeons, including three liver transplant surgeons and a kidney transplant surgeon, in the first week of November at KIMS Hospitals in Hyderabad.

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According to available data, this was the first time in India that an operation was successfully performed on a liver that weighed 12 kg. The patient whose life was saved and restored to normalcy is a 50-year-old housewife, Ms. Usha Agarwal, from Siliguri in West Bengal. The liver was so gigantic that it occupied her entire abdomen displacing the intestines. In normal healthy circumstances, a liver weighs a maximum of 1.5 kgs and occupies the right upper quadrant of the abdomen.

It was difficult for her to walk with such a heavy liver and collection of water (Ascites) in the belly and hernia. She started feeling heaviness in 2019, which was when she was advised of transplantation.

According to Dr. Ravichand Siddachari, Consultant and Chief of Liver Transplant and HPB Surgery, "Polycystic liver and kidney disease is a hereditary condition in which due to mutations in gene, cysts (fluid-filled cavities) are formed in kidneys and liver. The patients do not develop any symptoms till they are in their 30s. As the cysts grow, they start experiencing the symptoms. They can grow enormously in size while the subsequent collection of water in the belly can lead to hernia and breathing problems. They may need dialysis due to worsening kidney functions. This patient had all these symptoms apart from a huge hernia, which had ruptured."

"Understandably, it was one of the most difficult operations for one to undertake as the liver had occupied the entire abdomen. It was a herculean task to detach the liver from its attachments and also to preserve the important structures required for transplantation. But we succeeded in transplanting a new liver. The new kidney was transplanted through the same cut after creating a pouch in the abdomen (normally additional cut needs to be made for transplanting a kidney)," explained Dr. Uma Maheshwara Rao, Consultant Urologist and Renal transplant surgeon.

The surgeons, who performed two rare transplantations on one individual on the same day, were delighted that the patient had recovered well and had been discharged from the hospital.

"It was one of the most satisfying operations, which not only saved the life of a patient but also helped her in getting rid of all physical and mental anxieties and miseries, once and for all. She can start performing routine activities without any hitch," they said.

The marathon operation, lasting 14 hours, was successfully done by liver transplant surgeons Dr. Ravichand Siddachari, Consultant and Chief of Liver Transplant and HPB Surgery, Dr. Sachin Daga, Senior Consultant Hepatobiliary Pancreas & Liver Transplant Surgeon, Dr. K.N. Paramesha, Consultant HPB & Liver Transplant Surgeon, and Dr. Uma Maheshwara Rao, Consultant Urologist and Renal transplant surgeon. Postoperatively, the patient was tended by Chief Hepatologist Dr.Sharat Putta, and Sr. Consultant Nephrologist Dr.V.S. Reddy

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