Successful Mini Gastric Bypass for Morbid Obesity with Breathing Difficulty in a 30 Y.O. Male

Chief Complaints

A 30-year-old male patient with a body mass index (BMI) of 45.2 presented to the Bariatric and Metabolic Surgery Department at PACE Hospitals, Hitech City, Hyderabad, with uncontrolled weight gain associated with shortness of breath for the past 10 days.

The patient was a known case of morbid obesity with restrictive chronic obstructive pulmonary disease (COPD), dyspnea on exertion, and fatty liver. These associated conditions were considered during preoperative evaluation and bariatric surgery planning.

On general examination, the patient was conscious, coherent, cooperative, and hemodynamically stable. Respiratory examination was performed to assess air entry, breathing effort, wheeze, and oxygen status before surgery. Abdominal examination was soft and non-tender, with no guarding or rigidity. Systemic examination was performed as part of the preoperative fitness assessment.

Upon admission to PACE Hospitals, the Bariatric and Metabolic Surgery team evaluated the patient for uncontrolled weight gain associated with shortness of breath for the past 10 days. A detailed review of the patient’s medical history, respiratory symptoms, obesity-related risks, and fatty liver status was undertaken as part of the preoperative evaluation.

Clinical assessment confirmed morbid obesity with a BMI of 45.2 kg/m², along with restrictive chronic obstructive pulmonary disease, dyspnea on exertion, and fatty liver. These associated conditions were considered important in treatment planning because excess body weight can worsen breathing difficulty, reduce exercise tolerance, and contribute to fatty liver changes.

Routine investigations, including complete blood count, blood sugar profile, serum biochemistry, electrolytes, renal function tests, liver function tests, lipid profile, thyroid profile, urine analysis, chest X-ray, ECG, abdominal ultrasound, respiratory assessment, and pre-anaesthesia evaluation, were performed to assess the patient’s overall condition and surgical fitness.

Based on the confirmed diagnosis and preoperative evaluation, the patient was advised to undergo Morbid Obesity Treatment in Hyderabad, India, under the expert care of the Bariatric and Metabolic Surgery Department.

After detailed consultation with Dr. Suresh Kumar S (Surgical Gastroenterologist, Bariatric and Metabolic Surgeon), the patient’s obesity severity, breathing difficulty, restrictive COPD, fatty liver, and overall fitness for bariatric surgery were comprehensively reviewed.

The patient had morbid obesity, associated with shortness of breath and dyspnea on exertion. Considering the impact of excess body weight on breathing, metabolic health, fatty liver risk, and quality of life, bariatric surgical management was considered appropriate.

Routine investigations, respiratory evaluation, fatty liver assessment, obesity-related risk assessment, and pre-anaesthesia evaluation were completed to assess surgical fitness and optimise perioperative safety. Based on the clinical evaluation and preoperative assessment, it was determined that Laparoscopic Mini Gastric Bypass was the most appropriate surgical intervention.

The patient and family members were counselled regarding the diagnosis, proposed procedure, expected benefits, possible risks, postoperative diet stages, early walking, activity restrictions, travel precautions, regular follow-up, and the importance of long-term lifestyle changes for sustained weight loss and improved metabolic health.

Following the decision, the patient was scheduled to undergo Laparoscopic Mini Gastric Bypass Surgery in Hyderabad at PACE Hospitals, under the expert care of the Bariatric and Metabolic Surgery Department.

The procedure involved the following steps:

• Patient Preparation and Anaesthesia: The patient was taken up for surgery under general anaesthesia. Intravenous antibiotics were administered before the procedure.

• Laparoscopic Access and Assessment: The procedure was performed using minimally invasive laparoscopic techniques. Intraoperative assessment showed that the stomach appeared normal.

• Creation of Gastric Pouch: A small gastric pouch was created along the lesser curvature of the stomach using surgical staplers. This helped reduce the functional capacity of the stomach and support controlled food intake after surgery.

• Small Bowel Measurement and Bypass Planning: A segment of the jejunum was identified approximately 180 cm distal to the duodenojejunal junction as per the planned mini gastric bypass technique.

• Gastrojejunostomy Formation: An anastomosis was created between the gastric pouch and the jejunum. This connection allows food to pass from the smaller stomach pouch directly into the small intestine, supporting weight loss and metabolic improvement.

• Completion of Procedure: The surgical site was checked, hemostasis was confirmed, and the procedure was completed successfully without reported intraoperative complications. 
  

The procedure remained uneventful, and the patient was shifted for postoperative observation. During hospitalization, he received supportive care, including medicines for infection prevention, gastric protection, pain relief, intravenous fluid support, and overall postoperative recovery.

After 48 hours of surgery, the patient was started on a liquid diet, which was gradually increased to full oral liquids by the fourth postoperative day. Early walking without assistance was encouraged to support faster recovery, improve breathing comfort, and reduce postoperative risks. The patient tolerated oral intake well and was discharged in a hemodynamically stable condition.

Upon discharge, the patient was prescribed medicines for gastric protection, pain relief, liver support in view of fatty liver, nutritional support, and other supportive care as required. He was advised to take all prescribed medicines as directed by the bariatric surgery team.

The patient was advised to follow the diet plan explained by the medical team, including a liquid and puréed diet for one week, followed by a soft diet as advised. He was instructed to eat slowly, take small portions, maintain hydration, and follow all dietary instructions carefully. He was also advised to take bed rest for 2 weeks, avoid strenuous activities for two months, and avoid long-distance travel for the next 2 months.

The patient was advised to report to the emergency ward at PACE Hospitals in case of development of symptoms like bleeding, fever, severe abdominal pain, persistent vomiting, breathing difficulty, wound-related concerns, or any sudden deterioration after discharge.

The patient was advised to return for a follow-up visit with Weight Loss doctors in Hyderabad at PACE Hospitals after 1 week.

This case highlights the successful management of morbid obesity with a BMI of 45.2 kg/m², associated dyspnea on exertion, restrictive COPD, and fatty liver through laparoscopic mini gastric bypass surgery. The procedure was completed without reported complications. The patient tolerated oral liquids well, was encouraged to walk without assistance, and was discharged in a hemodynamically stable condition with diet instructions, medications, activity restrictions, travel precautions, and follow-up guidance.