Abu Dhabi: A 28-year-old Emirati who had suffered a stroke, and was left in a coma following a bariatric surgery, has survived — thanks to a series of procedures that also removed a part of his small and large intestines.
The patient, Abdulla, had initially undergone the bariatric surgery to improve his quality of life. Although the procedure was supposed to have involved only a few hours of intervention at the operation theatre, followed by a swift recovery, in reality, the entire treatment turned out to be quite a nightmare for the patient as what followed were several weeks of physical and mental ordeal and a month-long coma.
“You don’t go into a routine surgery like this expecting it to turn into a stroke, especially at my age. I remember the pain that I felt right after the surgery, which wasn’t normal at all. I could feel it course through my body. It kept on increasing to a point that I could not handle it anymore. That is when I realised that something was wrong,” Abdulla said.
Dr Matthew Kroh, the Chief of the Digestive Disease Institute at Cleveland Clinic Abu Dhabi (CCAD), said Abdulla was transferred to the hospital needing an immediate reoperation. “I received a call from surgeons at the hospital where Abdulla had the surgery explaining that he had entered a life-threatening situation and that it would require multidisciplinary expertise to save him,” Dr Kroh added.
Injury to diaphragm
Abdulla’s operation was complicated by an injury to the diaphragm and required an urgent reoperation, which included the resection of 150 centimetres of his small intestine and part of his colon, as well.
“This was a life threatening event and a very unusual complication, which led to a severe outcome for such a young patient,” he says.
“He recovered from that but had a major pulmonary aspiration event where his stomach contents went into his lungs and hardened them. This resulted in a severe lung infection and eventually a drop in his blood pressure and hypoxemia. He was immediately transferred to CCAD’s intensive care unit, where our team determined that his condition had deteriorated to such an extent that he would have to be placed on an extracorporeal membrane oxygenation (ECMO) machine,” Dr Kroh said.
Abdulla’s oxygenation got better with the quick intervention, and the infection in his lungs began to clear up, but the connection of his intestines fell apart.
“He then had a severe infection in his abdominal cavity that required several operations as an additional section of the colon needed to be resected. We had to wash his insides out and put his bowel back together. All this [was done] while he was still on the ECMO machine,” the doctor explained.
During the staged operation, which took place over six weeks, he was supported by parenteral nutrition. As Abdulla slowly recovered and regained strength, he was removed from breathing support, extubated and began eating on his own.
Abdulla dropped from 150kg to 102kg since the surgery but says that it has been an arduous journey with still a long way to go.
“The stroke affected my hands and legs, and the doctors at CCAD conducted physical therapy while I was still in intensive care. I have regained a lot of my mobility but will require more therapy. I am in constant touch with Dr. Kroh to ensure that my nutrition is on track. There are no words to describe my gratitude for him and his team, and even thanking them a million times is not enough,” he said.
“Abdulla has done exceedingly well through these surgeries. It underscores his will and our commitment to provide integrated care to treat the sickest of the sick. Abdulla has a lot of life ahead of him and we will make sure he is back to doing all his daily tasks and activities that he enjoys with minimum discomfort soon,” Dr Kroh added.
What is bariatric surgery?
Bariatric surgeries are weight-loss procedures that involve making changes to the digestive system. They are done when diet and exercise haven’t worked in facilitating weight loss, or when a patient has serious health problems because of their weight.
Some bariatric procedures limit how much a person can eat, while others work by reducing the body’s ability to absorb nutrients. Still others do both.
While bariatric surgeries can be beneficial, they are serious surgeries that can pose complications, according to the Mayo Clinic. In addition, patients also have to implement permanent healthy changes to their diet, and undertake regular exercise, to ensure the long-term success of the surgery.
Types of bariatric surgery
Gastric bypass: This is one of the most common types of bariatric surgery. It limits the amount of food the stomach can hold, while also restricting the absorption of calories and nutrients. Essentially, the stomach is divided into two, and both parts are connected separately to different segments of the small intestine – the latter portion of the small intestine is connected to the smaller stomach pouch, while the beginning portion of the small intestine is connected to the bigger stomach portion.
Sleeve gastrectomy: This involves the removal of approximately 80 per cent of the stomach. What is left is a tube-shaped pouch, or a sleeve. Now that the stomach is smaller, it cannot hold as much food. It also reduces the production of the hormone ghrelin, which regulates the appetite.
Gastric band: The adjustable gastric band involves placing an inflatable band around the top portion of the stomach, which creates a smaller pouch above. In this way, less food can be stored in the stomach, and patients achieve fullness faster. The band is reduced in size over time with repeated adjustments.
Duodenal switch: The biliopancreatic diversion with duodenal switch has two parts to it. First, a portion of the stomach is created to form a tube-shaped pouch. Second, a major portion of the small intestine is bypassed when connecting the stomach pouch. This helps restrict the amount of food the stomach can hold and promotes fullness faster. It also reduces the absorption of nutrients.
Who is eligible for bariatric surgery?
Physicians look at a number of factors when deciding on patient eligibility for bariatric surgery, including:
Body mass index (BMI).
Comorbidities like diabetes, hypertension, hypercholesterolaemia, asthma, obesity, etc.
Phsychological profile to deal with changes required after bariatric surgery.
Previous weight-loss attempts.
Eligibility is decided by licensed physicians based on standards approved by health regulators.