An uncomplicated ovarian cyst can be managed routinely using laparoscopic technique by most surgeons without undue complications. But this patient was no routine case. She weighed a whopping 120 kg and stood 5’4’’ tall.
TFM Desk
Leveraging its vast medical expertise and technological advantage, Shija Hospitals & Research Institute (SHRI) has consistently delivered finest clinical outcomes. The availability of a multidisciplinary team, laparoscopy, and an ICU unit at SHRI significantly improved the life of a “morbidly obese woman”.
On April 9, 2022, a 45-year-old woman visited the hospital’s Gynecology OPD with a right ovarian cyst. An uncomplicated ovarian cyst can be managed routinely using laparoscopic technique by most surgeons without undue complications. But this patient was no routine case. She weighed a whopping 120 kg and stood 5’4’’ tall.
According to a press note, the woman was a known hypertensive and had symptoms of acid reflux (acidity/gastritis). A normal BMI falls in the range of 18.5-24.9 with the least risk of developing health problems. The patient with a calculated BMI of 45.45 fell under Class 3 obesity with extremely high risk of developing health problems. The patient was initially scheduled for surgery in another hospital in the city, but unfortunately the procedure was abandoned due to a complication developed during the induction of anesthesia.
Despite the fear looming over her, she was determined to get the procedure done, so she visited SHRI for the surgery. Managing a morbidly obese patient in the OT is not a routine case in Manipur. So a well-planned management technique was tailored by both the gynaecologist, Dr. Phijam Dhaneshwor and the anaesthesia team led by Dr. Kennedy Taiyenjam and Dr. Dinesh Thounaojam. Preoperatively, she was evaluated by the cardiologist, Dr. Sumidra Laishram to look for her baseline heart function. She was put on low molecular weight heparin (blood thinner) to reduce the chances of clot formation and other complications which can occur in obese patients. Despite all these preparations, the patient and her family were explained of the need of ICU admission postoperatively.
Apart from the difficulties likely to be faced by the surgeon, the anaesthesiologist can also face significant difficulties in the operating room when dealing with such obese patients. Almost routinely in such difficult cases, a team of anaesthesiologists work together to manage the case rather than manage single-handedly.
Although general anaesthesia is likened to a “sleep” for the public, it is no natural sleep with all the normal physiology getting altered with maximum impact on the respiratory system (lung). Induction of anaesthesia and reversal are considered the most crucial steps, both of which were done skillfully in this case. The surgical procedure required a certain position for better visualization of the organs, but the gynaecologist had to compromise on it due to the anticipated problems expected in the obese patient with extremes of positioning. Despite the surgical position limitations, the gynecologist successfully removed the ovarian cyst (laparoscopic) on 15|04|2022.Patient was shifted to the ICU and removed from the ventilator after few hours. Early mobilization and physiotherapy were initiated the very next day. The patient’s condition gradually improved with the treatment provided and was discharged from the hospital on 17|04|2022. The family’s joy knew no bounds, and they expressed their deepest gratitude to the medical team for the treatment.
The management of Shija applauds the treatment team’s dedication and cooperation, as well as the fact that the operation went smoothly thanks to the hospital’s multidisciplinary team, laparoscopy, and intensive care unit.