• Fortis Hospitals, Bangalore has successfully treated cases of Type 2 diabetes along with severe obesity by performing the GASTRIC BYPASS SURGERY. Gastric bypass surgery essentially makes the stomach smaller and allows food to bypass to bypass the large part of stomach and part of the small intestine.
• Not many people are aware that patients suffering from Type 2 diabetes & severe obesity can opt for surgery for remission of diabetes
• Patients with Type 2 diabetes and a BMI > 32 kg/m2, and who are inadequately controlled by lifestyle and medical therapy are only eligible for such a surgery. Potential patients should have failed a multidisciplinary program of lifestyle and pharmacotherapy for SUFFICENT DURATION OF TIME.
• The surgery for adolescents can be recommended with BMI > 40 kg/m2 or > 35 kg/m2 with severe co-morbidities including Type 2 diabetes
• Post-operative therapy and regular follow-up is essential for best results and complete success
  

Case Highlights

• 65-year-old patient Vijayalakshml was admitted to Fortis Hospitals with a history of hypertension and diabetes mellitus for the past 10 years, and bronchial asthma for the last 15 years.
• Her blood sugar was fluctuating and never in control in spite of being treated with oral antidiabetics and insulin injections.
• She was also morbidly obese with a BMI of 41.2. Vijayalakshmi was an ideal candidate for gastric bypass surgery according to IDF Guideline. Experts at Fortis Hospitals performed the laparoscopic gastric bypass with Roux en Y Anastomosis under general anesthesia after obtaining a detailed written and signed consent from the patient.
• Three months after the surgery, Vijayalakshmi has lost weight and her BMI has dropped to 35. Her blood sugar is normal and she takes only one oral antidiabetic drug a day. Her blood pressure too is under control without any medications.

Bangalore August 11, 2011: Fortis Hospitals, Bangalore today highlighted treatment of Type 2 diabetes with surgical procedure showcasing a case of a 65 year old lady who was suffering from uncontrolled Type 2 diabetes and severe obesity and her diabetes. Lead surgeon Dr. Shabeer Ahmed, Consultant Surgical Gastroenterologist and Minimal Access Surgeon performed gastric bypass surgery for remission of diabetes. Not many are aware that gastric bypass surgery when performed by experts under the right conditions and guidance can result in the possible treatment of Type 2 diabetes & severe obesity.

Type 2 diabetes is progressive in nature and normally coupled with obesity which can have life-threatening consequences, as was evident from the case in point. The patient, 65-year-old Vijayalakshi, was admitted to Fortis Hospitals, Bannerghatta, with a history of hypertension and diabetes mellitus for the past 10 years, and bronchial asthma for the last 15 years. Her blood sugar was always fluctuating in spite of being treated with oral hypoglycemics and insulin injections. Hypertension was poorly controlled even with regular anti-hypertensives and to further worsen the situation, Vijayalakshmi was morbidly obese with a Body Mass Index (BMI) of 41.2 – normal adult human body’s BMI is between 20 and 25.

Talking about the treatment of diabetes and obesity, Dr Shabeer Ahmed said, “The continuing mortality in persons with diabetes is a sign that the answer to best management for Type 2 diabetes for maximizing metabolic control is still elusive. Given this scenario, the option of stomach intervention needs to be considered in appropriately selected individuals. Laparoscopic gastric bypass procedure was considered as the treatment of choice for Vijayalakshmi as she had obesity with diabetes mellitus.”

Vijayalakshmi was counseled before the surgery wherein the details, types, advantages (reduce obesity, treatment of diabetes and hypertension), risks, complications of the surgery, pre-operative and post-operative care were discussed in detail. Dietary counseling was also given. The pre- operative work up for the surgery was done by Prof. Dr. C V Harinarayan, Consultant Endocrinologist, Fortis Hospitals. She was then admitted and laparoscopic bypass procedure with Roux en Y Anastomosis was performed on her under general anesthesia.

After the surgery, Vijayalakshmi’s blood sugar started reaching near normal range and was steady on the 3rd post-operative day. Insulin injections were slowly tapered and finally weaned off on the 5th post-operative day. Three months after the surgery, Vijayalakshmi now has lost 35 kgs, her BMI has come down to 32 and her blood sugar is completely normal. She does not take any medication for hypertension while has only one oral hypoglycemic once a day.

“Surgery for the severely obese with Type 2 diabetes should be considered early as an option for eligible patients, rather than being held back as a last resort. Type 2 diabetes is a heterogeneous disorder and while its causes have yet to be fully explained; obesity is considered the primary risk factor. It has been estimated that the risk of developing Type 2 diabetes is increased 93-fold in women and 42-fold in men who are severely obese rather than of healthy weight,” added Dr. Shabeer Ahmed.

“Strategies like lifestyle interventions to promote weight loss and increased physical activity have very limited success in controlling blood glucose levels among the severely obese, with many of these patients not achieving targets. A number of these medications used for treating Type 2 diabetes, including insulin, themselves can result in weight gain,” said Prof. Dr. C V Harinarayan, Consultant Endocrinologist, Fortis Hospitals.

“The global prevalence of Type 2 diabetes is rising dramatically, driven by an ‘obesogenic’ environment that favors increasing sedentary behavior and easier access to attractive calorie-dense foods acting on susceptible genotypes. The most recent global predictions by the International Diabetes Federation (IDF) suggest that there are 285 million people with diabetes currently worldwide” added Dr. C V Harinarayan.

This is set to escalate to 438 million by 2030, with a further half billion at high risk. Diabetes is looming as one of the greatest public health threats of the 21st century. Type 2 diabetes is a risk factor for heart damage: both micro-vascular (eye failure; kidney damage and brain disease) and macro-vascular (premature and more extensive heart and brain). Premature deaths in diabetes result from such complications.

Case 2-

Mrs. Reshmi Begum, a 43 year old lady from Bangalore was suffering from diabetic mellitus from the past 15 years. She approached Fortis Hospitals in April 2011 for her diabetes along with hypertension and ischemic heart disease for which she had undergone CABG in 2010. During her evaluation process it was found that she had uncontrolled blood sugar levels varying between 25- 493 for which she was taking 70 units of insulin shots daily. An overweight with a BMI of 45 (Height 155 cms/ weight 110 kg) she was very much concerned about her health.

After her consultation, Mrs. Reshmi was advised with Laparoscopic gastric bypass surgery for both her diabetes and obesity. She agreed for the same and a preoperative checkup was organized. Patient was also counseled about the post operative care and dietary modifications which she would require later.

Post operatively her blood sugars were under control, it varied between 100 – 200 mg. She recovered from the surgery on fifth post operative day and was discharged on 19th April as her insulin requirement dropped drastically with sugar level coming under 100mg without insulin.

A Dietician was kept to monitor her diet and the review done after two weeks revealed that she has lost weight along with the diabetes. At the end of 2 months her diabetes was completely under control and she has lost about 32 kg of weight.

Chennai, June 29, 2011: Fortis Malar Hospital today announced the successful removal of a tumor in a new born baby in the city. Leading cardiologist Dr. K R Balakrishnan, Director – Cardiac Sciences, Dr. Nandkishore Kapadia, Senior Cardio Thoracic Surgeon & Dr. Suresh Rao, HOD – Cardiac Anesthesia & Cardiac Critical Care performed a rare surgery on Baby Asiffa, 20 day old baby with a very large tumor in one of the chambers of the heart.

On becoming blue and breathless, the baby was rushed to Fortis Malar hospital where she was diagnosed with a tumor in the heart. The procedure involved administering anesthesia which was critical as the baby was just a few days old. The tumor blocking the right side of the heart lead to a collapse of the child as oxygen levels were dangerously low.

On becoming blue and breathless, the baby was rushed to Fortis Malar hospital where she was diagnosed with a tumor in the heart. The child collapsed since the tumour blocking the right side of the heart led to dangerously low oxygen levels. The procedure involved administering anesthesia which was critical as the baby was just a few days old.

The baby’s body temperature was cooled to 15 degree Celsius and the circulation was stopped and under suspended animation the tumor was completely removed. The tumor was a leiomyoma- a benign tumor (a tumor commonly seen in the uterus of women).

For the first time in the world a leiomyoma of the heart has been reported in a newborn. The baby has recovered well and can expect to lead a normal life.

About Fortis Malar Hospitals Ltd (erstwhile Malar Hospitals Ltd):

Fortis Malar Hospitals Ltd, founded in 1992, is established as one of the largest corporate hospitals in Chennai providing quality super specialty and multi specialty healthcare services. Fortis Malar Hospitals, with 180 beds, focuses on providing comprehensive medical care in the areas of cardiology and cardiac surgery, gynaecology, orthopaedics, gastroenterology, neurology, pediatrics, diabetics, and nephrology.

Fortis Malar Hospitals also has a state of the art Cath Lab and multiple dedicated cardiac operation theatres and intensive coronary care units. Several rare and complex Adult and Pediatric Cardiac surgeries, Orthopedics and Joint replacement, Neurosurgery and Plastic reconstruction surgeries have been performed in this hospital. The hospital’s Obstetrics and Gynaecology services are among the busiest in the city, performing many difficult deliveries and surgeries successfully, and are supported by a dedicated Neonatology unit. Fortis Malar Hospitals is a part of the Fortis Healthcare Network.
For further details, please contact

Fortis Malar Hospital
52, First Main Road, Gandhi Nagar, Adyar
Adyar
Chennai – 600 020
India
Emergency No:+91-44-2491-4737
Phone No:+91-44-4289-2222
contactus.malar@fortishealthcare.com

This may seem like something out of a movie, but virtual surgery has just made a mark in Mumbai. 61-year-old Neena Aggarwal is patient who has started walking – after a decade- thanks to this latest advancement. Neena suffered with severe osteoarthritis which resulted in bow shaped legs, and the fact that she weighs 114 kilos, made surgery a risky option.

“Every possible balm she has applied, every possible medication she has tried and it was torture. It has actually been torture for her,” said Neena’s daughter.

Doctors decided to for virtual treatment – performing what’s known as Patient Specific Instrumentation or PSI Knee Replacement surgery – for the first time ever in Mumbai.

What happens during the PSI knee replacement surgery is that the doctor prepares an exact 3D image of the knee on the computer – and that replica helps the doctor to virtually plan for the entire surgery – so that the surgeon knows, what cuts to make, what the alignment should be like – so much so, that the implant sits perfectly on the knee (fitting the model-implant).

This surgery has only been performed in the US, Canada and England, and there are clear benefits, doctors say.

Dr Kaushal Malhan, Knee and Joint Replacement Surgeon, Fortis Hospital says, “Obviously when you are taking lesser time, when you are doing less damage to the tissues , when you are cutting less, when your planning is already done and you already know what you are going to do in theatre, in terms of what angle and placement, I think you are on surer footing, in terms of that, so probably the complications may be lesser.”

Considering one in eight knee replacements in India is unsuccessful, according to the Arthritis Foundation of India, that’s the best news for Neena, even though this sort of surgery costs about Rs 40, 000 more than traditional surgery.

Neena’s daughter says that her not just her mother, but her father is also looking forward to the surgery anxiously and has already planned a post-surgery vacation.

“My dad has already planned a trip with her he’s like, once you are out of the hospital, we are planning a trip to Goa,” said Neena’s daughter.

The 5th National Congress of Indian Society of Hip & Knee Surgeons held in Bengaluru from 8th to 10th April 2011,where Dr Ronen Roy, Fortis Hospitals, Kolkata spoke on “Contemporary strategies in reducing blood loss in TKR”.
Seen in the picture seated in the dias as panelist/speakers are (from L to R) Dr Ronen Roy, Dr Dr Alfred Tria, Dr Lombardi, Dr Hemant Wakankar, Dr Vharat Modi & Dr David Gibson

About Doctor Ronen Roy

Professional qualification
After completing his MBBS from Calcutta Medical College, Dr. Roy went on to finish his FRCS from the Royal College of Physicians and Surgeons,
Glasgow. In the course of his illustrious international career, Dr. Roy has  also served as a full-time lecturer in Orthopaedics and Trauma at the
University of Wales, Cardiff. Even today, he is a member of the faculty for many basic, intermediate, and advanced courses in Joint Replacement Surgery.Dr. Roy has presented many papers and is a member of many national and international associations such as the Asia Pacific Arthroplasty Society(APAS).

Expertise
Dr. Roy is an expert in all forms of Orthopaedic Surgery with a special flair for Joint Replacement Surgery, Management of Complex Trauma; and Diagnosis, treatment, and management of Osteoporosis.

About Fortis Hospitals, Anandapur, Kolkata

Providing cutting edge diagnostic facilities and treatment, Fortis Hospitals is one of the most sought after facilities for orthopaedic care in India. In fact, we have the most advanced orthopaedic department in the country. The Bone and Joint care at our Kolkata facility is handled by eminent Orthopaedic and Trauma surgeons, and Rheumatologists backed by skilled para-medics. Possessing the latest in medical technology, it helps us to perform complicated joint replacement surgeries and hip resurfacing procedures accurately. And also treat musculo-skeletal ailments like arthritis and rheumatism through conventional or minimally invasive Arthroscopic surgeries, including the management of complex trauma procedures. Ours is also one of the very few facilities in India to offer Orthopaedic Oncology. The department is equipped to carry out bi-columnar Acetabular and infected joint replacement surgeries including restoration of failed trauma services, and neglected trauma fractures. All, just to put you back on your feet faster and make you walk with your head held high.

Setting yet another milestone in orthopedic surgery, a team of specialists at Fortis Hospitals, Kalyan ,Mumbai led by Dr. Aashish Arbat, Arthoscopic & Joint Replacement Surgeon, corrected a 3 times failed hip of a 49 year old man and put him back on his feet.

Patient Mr Tanaji Palekar, age 49, had a severe fall April 2007 while boarding the bus and fractured his left hip. He was immediately taken to nearby Hospital in Kalyan where implant was used to fix the joint. Post surgery within 3 months he started experiencing severe pain in his left hip and had to consult the doctor. Doctor advised him to undergo a repeat surgery.

A barber by profession working in Kalyan,Mumbai  his economic condition made the second surgery unaffordable for him. “I decided to wait for a few years but my profession demanded constant standing for hours which made the pain unbearable. I had no option but to undergo a second surgery.” He underwent second hip replacement surgery at another hospital in Kalyan. His implant was replaced and bone grafting was done. But even after the second surgery his pain did not reduce.

“Since the past 5 year I have been experiencing difficulty in walking due to continuous pain in my left hip and it was affecting my job. These surgeries were not proving beneficial for me and were creating a hole in my pocket. But I had no option but to consult one more orthopedic doctor so that I could be relieved of the pain and can start working to earn my livelihood.”

Mr Palkar then consulted an orthopedic doctor at a hospital in Mumbai who after referring to his reports said that one more hip replacement surgery won’t be beneficial for him. Mr. Palkar underwent a 3rd surgery where the doctors removed the previous implant which had loosened and left him without replacing with a new implant. This left Palkar in a crippled and painful condition.

“Having undergone three surgeries already and getting to know that one more surgery won’t be beneficial I lost hope of being cured. I thought a fourth correction could never be performed on my hip and I will have to lead a challenged life for the rest of my years.”

According To Dr Aashish Arbat,  They decided to  look for an  evidence based decision to put an American Hip replacement system which was uncemented type (cemented and uncemented are types of Hip replacement systems, Uncemented hip implants have special coating where bone grows on the implant and increases its durability even for life sometimes, but is difficult to do the surgical procedure technically”

Post Surgery the patient  was able to move his hip right for the first time in 5 years.  Says Mr Tanaji Palekar

Post surgery I was able to stand on day 2 and was sent home walking on day 4. I resumed my work later. Dr Arbat kept me on rehabilitation for 4 weeks and closely monitored me for some time until he was sure that my soft tissues are strong enough to make me run and cycle in the future.”

Dr. Arbat is very optimistic that the patient will lead a normal life and will not require another revision in his lifetime.

“My utmost gratitude to Dr. Arbat and the team at Fortis Hospitals for whom I am able to stand in front of you all and have a motivation to lead a healthy life ahead”, added Mr Tanaji.