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Child surgery

Four-year-old undergoes bariatric surgery

Dr Mahendra Narwaria with Rishi Khatau and his father Dipen Khatau
As a result of his condition, Rishi consumed 1,500 calories per day and he also presented with sleep apnoea and breathing problems

An Indian child of four years and 10 months has become the youngest person in the world to have bariatric surgery. The child, Rishi Khatau from Kolkata, was morbidly obese and weighed 44.5kgs (98.1lbs) prior to surgery.

He was also diagnosed with Prader Willi Syndrome - a rare genetic disorder caused by deletion or disruption of genes, and can result in low muscle tone, short stature, incomplete sexual development, cognitive disabilities, behavioural problems, and a chronic feeling of hunger that can lead to excessive eating and life-threatening obesity.

"Rishi suffered severe difficulty in breathing while sleeping wherein his oxygen saturation levels dropped below 60 per cent leaving him gasping for breath,” said Dr Mahendra Narwaria form Ahmedabad-based, Asian Bariatrics Hospital. “Generally, we would avoid bariatric surgery in such a young child but his problem could have been fatal. Exercise and controlling diet was not an option as due to his weight, he could not exercise while his genetic condition made him crave for food.”

As a result of his condition, Rishi consumed 1,500 calories per day and he also presented with sleep apnoea and breathing problems, which became so acute that he could not sleep lying down for more than ten minutes as he would wake up gasping for breath.

“In obese children, the intra-abdominal pressure becomes very high, there is not enough space for the lungs to expand to full capacity,” said Narwaria. “This leads to less oxygen in the body. The disturbed exchange of gases also leads to water retention and hence more weight gain.”

According to the surgical team there were many challenges managing such a young patient both during operation and post-operatively.

“We had to use specific sleeve sizer and smaller stapler to perform the surgery to reduce the size of his stomach to one third,” said Narwaria. “Since he is a growing child, we have not bypassed any portion of his intestine so that he does not suffer any malnutrition. His stomach will grow to its normal size as he grows up.”

At present, Rishi is on a liquid diet and able to consume just 400 calories a day. He is using a non-invasive ventilator (BiPEP) to maintain his oxygen levels. In time, he will receive mashed food before being able to have the normal food. He is expected to lose 60% to 80% of his pre-surgical weight.

The other doctors in the multi-disciplinary team who helped managing this case were Dr Nidhish Nanavati (paediatrician), Dr Ajay Shah (pulmonologist), Dr Vivek Arya (endocrinologist), Dr Yogesh Tank and Dr Parag Gohil (anaesthesiologist) and Ms Devanshi Choksi (nutritionist).

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