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HindustanTimes Mon,22 Sep 2014

Check that weight for safe surgery

Rhythma Kaul, Hindustan Times  New Delhi, April 08, 2013
First Published: 01:58 IST(8/4/2013) | Last Updated: 03:27 IST(8/4/2013)

It took a dozen people, six doctors and six nurses, to shift Rajpal Gandhi, 55, from a trolley to the operation table. Reason: The 5-feet-6-inches-tall Gandhi weighed 250 kg.

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A team of 20 doctors, nurses and paramedics at the Sir Ganga Ram Hospital pulled a feat of sorts recently when they fixed his broken spine in a 10-hour-long surgery. Normally, the surgery takes just about three hours.

Beginning with the anesthetists, who were worried whether they will be able to intubate his almost non-existent neck, to whether the OT table will be able to bear his weight, to surgical instruments not being long enough to reach the spine and the implants (screws) used not being strong enough to hold the broken bones together, there was a long list of inhibitions from the start.

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"For spine surgeries, we normally use the C-arm machine to get real-time images, but in his case we couldn't use the machine as radiation got absorbed by his body fat," said Dr Satnam S Chhabra, chairman, department of neurosurgery, Ganga Ram, who led the surgical team of Dr Anshul Gupta and Dr Divyam Sharma. Normally, it takes 15 minutes to give anesthesia, but in his case it took nearly an hour.

The biggest handicap for the doctors was there was no MRI scan of the spine. Although, once, an imaging institute had agreed to take the scan, Gandhi had got stuck in the machine and was pulled out with great difficulty. "The diameters of the machine was 70 inches and my girth is about 75 inches," said Gandhi. Quiz: Is your BMI equal to or greater than 30?

Gandhi is just one of those many severely obese people who are at a higher risk when it comes to performing tests and procedures."It is difficult to perform any scan x-ray, ultrasound and MRI on people who weigh above 140 kg. The only option is a CT scan; that too doesn't provide a good quality image," said radiologist Dr Harsh Mahajan, whose Mahajan Imaging Centre in south Delhi receives at least five morbidly obese people in a month.

"We have increased the bore of our machines and added more sturdy tables but those are also not apt for obese people," Dr Mahajan added.

In the West, for people weighing over 200 kg, hospitals use animal scanners to get the images.

Most Indians don't have equal fat distribution, with most of the fat concentrated around the abdomen. Surgeons dread operating upon such people. "Reaching the abdomen in a person with fatty or enlarged liver is a nightmare as it obstructs the view. Minimally excess surgeries are a challenge, not to mention the co-morbid conditions such as diabetes or hypertension that need to be controlled before the operation," said Dr MC Misra, chief, AIIMS Trauma Centre.  

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Child birth among obese women is also a high-risk affair, with chances of a cesarean being nearly three times higher. "We have to cut through the fat to reach the uterus and fat tissue is more prone to infection. Post-operative chances of death are also higher," said Dr Suneeta Mittal, director, obstetrics and gynecology, Fortis Memorial Research Institute.

"Fat necrosis or damage to fatty tissue during surgery results in melted fat oozing out of the stitches that doesn't allow the wound to close properly. Also, the tissues aren't strong enough, so the risk of hernia recurrence is also high in these people," Dr Misra added.   

Not to mention, the risk of osteoarthritis, coronary heart disease, disturbed sleep pattern, stroke, cancers of breast, colo-rectal, and endometrial is high among obese people.

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