Youngest ever patient weighing 45 kg undergoes weight-loss surgery in Delhi

New Delhi: Doctors at a private Delhi hospital successfully performed a life-saving bariatric surgery on a 2-year-old morbidly obese child weighing 45 kg, with a body mass index of 41.5.

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.

Dr Manpreet Sethi, Consultant, Paediatric Endocrinology, said, "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. She has an elder brother who is eight years old and 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."

A child at 2 years, having normal growth milestones, weighs between 12 to 15 kgs. Since bariatric surgery for children is rare, this case can be termed the "youngest bariatric surgery patient in India" in over a decade. The procedure had to be conducted as a medical emergency, doctors at the Max Super Speciality Hospital, Patparganj, said.

At 2.5 kg, Khayati weighed normal at the time of birth. However, she started gaining weight rapidly soon after birth and weighed 14 kg at six months.

Her weight progressively increased over the next year and a half, reaching 45 kgs at 2 years and 3 months.

Her condition worsened to the extent that she developed significant obstructive sleep apnoea with multiple pauses in her breathing during sleep and she was unable to sleep lying down on her back. She was also wheelchair bound since the age of 1 year and 10 months.

"While the lower age limit of bariatric surgery in children is 12-15 years; in her case the surgery was a medical emergency. We had a detailed discussion with the paediatricians, endocrinologists and the family, along with a thorough review of literature before taking up the child," said Dr Vivek Bindal, HOD, Max Institute of Minimal Access, Bariatric and Robotic Surgery, in a statement.

"The greatest challenge in her case was the non-availability of any referral literature or technical video of such a procedure in a small child. Also, the staplers and instruments are designed for adults. The abdominal cavity in a 2-year-old child is very small, irrespective of her weight. Added to this, the blood volume in children is very small, and so is the allowable blood loss," Bindal said.

Khayati underwent laparoscopic gastric sleeve surgery or sleeve gastrectomy where a portion of the stomach is removed surgically.

The procedure gives a feeling of fullness to patients and reduces their hunger, causing weight loss and significant improvements in health. This is owing to the fact that the new stomach pouch holds smaller volume than normal stomach and reduces the amount of food intake.

After the procedure, Khayati has been able to take enough liquids and soft diet without any issues, the doctors said.

"While we anticipated non-invasive respiratory support, she fortunately did not show any respiratory compromise and she was quite comfortable, post op. Her sleep apnoea became better within few days of surgery, and she could be shifted out in just four days post-surgery from ICU," said Dr Rajiv Uttam Associate Director Paediatrics, HOD Paediatrics Intensive Care.

Post-surgery, Khayati has been put on a special diet to gradually decrease her weight while maintaining the child's nutrition requirements. She is expected to lose weight over the next year and grow up as a normal adult. She will be closely monitored by the clinical team. She is also undergoing rehabilitation to help her build strength in her limbs so she can begin walking, the doctors said.