00:00This patient is a 32 year young male gentleman, when he comes to us,
00:06209 kgs.
00:08He talks about 209 kgs.
00:11We don't want to know how big weight we don't want to tell you.
00:14But the patient's breathing difficulty,
00:18we don't want to take the breath.
00:20We don't want to take the breath from high pressure.
00:23We don't want to say CPAP.
00:31We don't want to take the breath.
00:35We don't want to take the breath.
00:48We don't want to take the breath.
00:55foreign
01:10foreign
01:20be given lifelong, so we can see some time we can see, and if the infection doesn't
01:26happen, we can see that it is a multi-trug resistant infection. So, the VLCD diet
01:32tells us, which is 198 cm, which is the wall of the wall, 178 cm. So, this is extremely
01:41difficult, which is the surgical case, which is the operable case, which is the surgery
01:48treatment. So, at the end of 32 days, after the VLCD diet and tracheostomy CPAP
01:54therapy, we have taken them in the last month of 24 days, and the patient is
02:03off any support, CPAP needs to be received, and we expect that their weight is
02:18between 65 to 75 kgs at the end of one year.
02:23Sir, don't you know, it's 169 kg. So, it's more than that? Yes, yes.
02:30Yes, that's why we have done surgery, which we have done surgery, which we have done
02:34one anatomosis gastric bypass, which we have done surgery, which we have done
02:40with high protein diet, and this is why we expect that his weight is 65 to 75 kgs
02:49is okay for his 168 cm. So, we expect around 80-90 kgs he will lose at the end of
02:53one year, which
02:53is necessary. 65-75 kg is okay for his 168 cm height. His height is 168 cm height. His
03:02needs is a high quality treatment. So, we have the area that we have led, which we have
03:13had the large portion of that training and also also the training that they have
03:14come with. So, basically we have the procedure and the patient needs to work. So, we have
03:17the care that we have the patient needs to be treated. This is another patient because WE
03:32would receive the surgery. That's why we have the care that we have the care. We could
03:32we do medically.
03:34The bariatric surgery depends on which one of the types of surgery.
03:40The simplest surgery is for sleeve gastric.
03:42The size is a little less than 80% of the pain.
03:48After that surgery, it is a little harder and harder.
03:54the skin of the skin is a lot of weight gain.
04:06The body of the skin is not the body of the skin, but the body of the skin is not
04:16the body of the skin.
04:21So, what happens is that the weight loss is faster than the weight loss, and the weight loss is higher
04:29than the weight loss.
04:36But the weight loss is higher than the weight loss.
04:45It is more than 50-60% of the surgery.
04:49The surgery is very high.
04:53The ones who are very obese,
04:56super obese,
04:57the BMI is less than the sleeve gastrectomy.
05:01It is not possible to achieve weight.
05:03If there is a bypass surgery,
05:06the target of the surgery is less than the sleeve.
05:09It is more complicated,
05:15What is the challenge for surgery?
05:19The challenge is that when patients come to us, they have a breathing problem and they have a treatment.
05:31So, when they were in ICU, they were infected.
05:38Infections were treated.
05:39Infections were treated.
05:40Infections were treated with ventilated patients.
05:43Resistant infections were treated.
05:45In the community, they were not very simple.
05:49Resistant infections were treated with higher antibiotics.
05:54They started to get a long period of time,
05:57so that the infection was controlled.
05:58The first thing was that it was a problem.
06:01The other thing was that diet.
06:03The first thing was very low-calorie diet.
06:06Now, the diet is normally,
06:09patients who come to clinic,
06:11we say that 5-600 calories,
06:13as much as you can do,
06:14so that our target is 1-1 kg per week.
06:18But very low-calorie diet is 800 calories to less.
06:23Maybe 600-500 calories, 600 calories.
06:25So, this is the main symptoms of it,
06:28if the weight is very low,
06:29the people of the body can maintain the basic functions.
06:32This is the basis of the body.
06:35So, this is the basis for oxygen.
06:37It's great to not consist of all these ways.
06:55It is easy to do with surgery.
06:57So, when patients come to us,
07:01we don't have surgery immediately.
07:04The first patient has low-calorie diet
07:06or very low-calorie situation.
07:08He has put a few weeks on it,
07:11so that the baseline of the weight is less
07:13and then it will be surgery.
07:15Our involvement is before surgery,
07:18and after surgery,
07:19when the patient comes to surgery,
07:22they were in a very respiratory distress.
07:26So, their oxygen and carbon dioxide levels were abnormal.
07:30We have tried to provide non-invasive ventilation
07:33to support them.
07:35It has not been managed.
07:36So, we had to provide invasive ventilation.
07:38So, we had to put a tube in the airway,
07:42which was very challenging because
07:45there was so much fat in the neck,
07:48chest wall, abdomen.
07:49We started positioning,
07:51surgery of trichostomy,
07:52everything was very difficult.
07:53We had to keep them in ICU.
07:55Because they had pneumonia,
07:57the pneumonia was anti-drug resistant bacteria.
08:01They had to treat them.
08:02So, after 3-4 days,
08:05we would have used them to have a high-dependent area.
08:08After that,
08:09when they got the proper bariatric surgery,
08:12intraoperatively during the surgery also it was very difficult to get him ventilated
08:17in his lungs the chest and abdomen are very tight because of the fat
08:23during the surgery also we had a lot of difficulty in maintaining his oxygen levels and carbon dioxide levels of
08:29the blood
08:30but with proper management with proper planning and with a multidisciplinary approach
08:34we had all the challenges overcome post-operatively gradually we reduced ventilation and now he is fit for the surgery
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