First laparoscopic bariatric surgery at PIMS performed on patient weighing 200 kilograms

Islamabad
A super-obese patient weighing 200 kilograms, with a Body Mass Index (BMI) of 69, underwent a successful laparoscopic bariatric surgery at the Pakistan Institute of Medical Sciences (PIMS) here last month. Bariatric surgery is a weight-loss procedure performed on obese patients who do not respond to non-surgical treatment.
A team led by Dr. Aatif Inam Shami, who is renowned for his laparoscopic surgical skills, performed this first procedure of its kind at PIMS.
Talking exclusively to this scribe here on Friday, Dr. Aatif said, bariatric surgery is of two kinds namely, restrictive and mal-absorptive. “Restrictive surgery restricts diet intake by reducing the size of the stomach while the mal-absorptive procedure prevents food from being absorbed. Banding and intra gastric balloon were previously employed, but these techniques are now out of vogue as they are too cumbersome, with decreased patient compliance,” the surgeon shared.
The restrictive procedure that has gained wide popularity in the past ten years is Laparoscopic Vertical Sleeve Gastrectomy (LSG). “In the present case, we performed LSG. The patient has lost 20 kilograms within the first month, with overall improvements in wellbeing,” stated Dr. Aatif, who is qualified both from Pakistan as well as the UK.
According to the surgeon, obese patients who have diabetes and hypertension secondary to obesity experience complete remission. On an average, 40 to 60% of excess weight loss is seen in 6 months, and 80 to 100% at 1 to 2 years after surgery.
Obesity, Dr. Aatif added, causes multiple disorders and affects virtually all body organs. “Obese patients are more predisposed to diseases like diabetes mellitus, hypertension, and heart attacks than normal weight population. In addition, they also encounter respiratory problems, joint degeneration, infertility, psychosocial impairments, and above all, lower life expectancy and poor quality of life as compared to normal weight people,” he said. Obesity being the mother of all diseases in fat persons, this procedure could have life-saving implications for many people in Pakistan.
Dr. Aatif maintained that while obesity is traditionally being treated with dietary changes, exercise, and weight loss medicines, remarkable weight loss is seen in patients who add surgery to the above-mentioned interventions.
Responding to a query, Dr. Aatif clarified that obesity is not just defined on the basis of weight but on BMI, which is calculated by dividing weight into kilograms, divided by height in meter squares. “Surgery is offered to patients who have a BMI of more than 40 and have failed or not responded to medical treatment, or where no other treatable cause of obesity is found,” he shared.
The surgeon added that if a patient has diabetes, hypertension or other diseases associated with obesity, then the cut-off value is a BMI of 35. “Recently, for South Asians, this value has been revised as they have more body fat ratio then western races. South Asians also have greater preponderance to heart attacks than Americans and Europeans,” he informed.
Asked about his vision for improvement of laparoscopic surgery at PIMS, Dr. Aatif said he would like to establish a Laparoscopic Surgery Centre par excellence at the Shaheed Zulfiqar Ali Bhutto Medical University-PIMS. Dr. Aatif is actively involved in training of young doctors and is imparting his laparoscopic expertise with great passion. His father Dr. Inam-Ul-Haq Shami was also an eminent surgeon of Islamabad. In 2009, he became the first surgeon to perform laparoscopic surgery in pregnant patients at PIMS. Videos of laparoscopic procedures done by him are also available on YouTube and other websites and have been viewed by thousands all over the world.
A state-of-the-art centre for bariatric surgery at PIMS will cost no more than Rs20 to 30 million. The amount is rather insignificant when compared to the billions of rupees that were squandered at the time of the establishment of an unsuccessful liver transplant centre at PIMS. A little support from the government can also lead to a decline in the cost of the procedure, which is currently in the range of Rs250,000 because of the expensive equipment that has to be procured for the procedure.
The first bariatric surgery at PIMS was performed amidst a host of challenges including, for instance, the lack of a wide enough bed to accommodate the obese patient. Appropriate gear for the patient was also not available, and eventually had to be stitched by his wife. In fact, had it not been for the personal initiative of Dr. Aatif and his team, the surgery would not have been possible.