Bariatric Outreach Program 2025

Case Summary: Morbid Obesity with Previous Abandoned Laparoscopic Bariatric Surgery

Patient Profile

A 57 year old female patient presents with a 5-year history of progressive weight gain. Currently, she experiences significant bilateral joint pain and severely limited mobility, restricting her physical activity to only basic daily household chores.She reports a history of loud snoring and is currently dependent on a BiPAP machine for sleep, indicating significant Obstructive Sleep Apnea (OSA) or Obesity Hypoventilation Syndrome.An attempt of Bariatric Surgery was made 2 years ago outside, but the procedure was abandoned (due to dense adhesion). Aadhar Hospital organised Bariatric Outreach Program 2025 on 14^th December 2025, and this patient was re-evaluated and selected as one of 10 surgical candidates.

Clinical Assessment

Past Medical & Surgical History

• Metabolic/Endocrine: Type 2 Diabetes Mellitus (T2DM), Hypothyroidism, and Hypertension.
• Surgical History:Laparoscopic Hysterectomy: Performed 8 years ago.
• Abandoned Bariatric Surgery:2 years ago, patient was posted for bariatric surgery outside, but the procedure was abandoned due to dense adhesion.

• Adequate cardiopulmonary fitness for surgery
• Upper GI endoscopy: Within normal limit
• Ultrasound abdomen: Fatty liver (Grade II)
• Counselling regarding possible modification of procedure was done

Procedure

After creating pneumoperitoneum with optical trocar, port insertion done under vision. Dense adhesions were found. Slow, meticulous adhesiolysis using sharp dissection and energy device. Greater curvature mobilized starting 4–6 cm proximal to pylorus up to angle of His with division of gastroepiploic and short gastric vessels. Complete posterior fundal mobilization confirmed. A 36 Fr bougie positioned along lesser curvature. Sleeve gastrectomy performed using linear staplers with appropriate cartridge selection. Intra operative blood loss was minimal and no conversion was required.

Despite the documented history of dense adhesions, renowned bariatric surgeon Dr. Mahendra Narwaria and Dr. Deepak Mittal along with our team successfully performed a Laparoscopic Sleeve Gastrectomy for this patient. Post-operatively patient was ambulated 4 hours after surgery. Clear liquids were allowed from POD-1. Patient recovered well and was discharged on POD-2.