Dr Koshy George, Meditrina Hospital, Thiruvananthapuram — Bariatric Surgery failure
Drdrrajeshjm on May 28, 2012
• Patient’s Name: DR.RAJESH JOSEPH, 36 YRS, (Occupation: Radiologist).
• On Feb 13th 2010, I had undergone a right adrenalectomy. Following this surgery, I developed a right subcostal Incisional hernia which was not resolving besides mesh repair in May 2011.
• I was obese with 186 cm height and 124 Kg weight, BMI: 35.8. Since the non-resolution of my hernia was attributed to obesity besides mesh repair, I was advised to undergo Sleeve gastrectomy to reduce my weight. Also I had mild diabetes and sleep apnea which would also reduce if obesity was controlled.
• So I consulted Dr. Koshy George at Specialist hospital, Ernakulam and surgery was planned at Meditrina hospital, Trivandrum. About 2 Lakh rupees was said to be the rate. He had convinced me that after his surgery, within 2 weeks I can go back to work.
• Sleeve Laparoscopic Gastrectomy was done on 09/12/2011 at Meditrina hospital, Trivandrum, by Dr. Koshy George.
• I had Recurrent vomiting on all Post-op days, including hematemesis (Altered greenish blood).
• Was able to tolerate about 40 ml oral fluid/ hour on day of discharge (13/12/2011) without vomiting although with the support of anti-emetic medicines.
• Vomiting restarted one day after discharge on 15/12/2011.
• As per telephonic advise by Dr.Koshy /Dr. Harris I was started NPO from 17/12/2011 due to recurrent vomiting and surviving on IV fluids then onwards. IV line insertion and IV fluids were started at
St. Joseph’s hospital, Kothamangalam.
• Hematemesis (Frank blood) of about 350 ml occurred on (18/12/2011). Informed Dr.Koshy and Dr.Harris. Email was sent with picture of the bloody vomitus. As per the Dr.’s opinion they had a similar patient who had such vomiting and I was advised to take Inj.DEXA (steroid) 16 mg IV(high dose, with which there was relief only for 2 days.
• The doctors (Dr.Koshy /Dr. Harris) were trying to reassure me that everything is due to my tension and things will settle. But meanwhile my vomiting continued daily. Meanwhile the doctors had said that will be on a tour for Christmas for a week and will not be available at Trivandrum.
• Since my condition was worsening daily with recurrent vomiting and having to take daily IV fluids to live, I (being a Radiologist myself) decided to take a CT scan 23/12/2011. The CT scan showed Severe narrowing of the stomach of about 90%. Thus it was proven that I am not vomiting due to tension(unlike what my treating doctors were arguing) but there is severe narrowing in the stomach.
• Due to lack of improvement in vomiting, was advised by Dr. Koshy to take repeat Inj.DEXA (steroid) 16 mg IV (high dose), with which there was relief for 2 days. But vomiting restarted after 1 day.
• As it was not possible to get across telephonically to Dr.Koshy’s mobile, we discussed with the junior surgeon Dr.Sudheer about the worsening condition and asked to contact Dr. Koshy.
• On discussion with Dr.Koshy, he said that on reviewing of my surgery video, he understood that the stitches in the pyloric region of stomach are tight and if that is relieved by another sugery, I will become alright.
• Believing in Dr.Koshy’s words I was readmitted at Meditrina hospital, Trivandrum on 29/12/2011.
• Gastrograffin study on 30/12/2011: Fundal dilatation with contrast showing severe obstruction beyond the fundus. No passage of the contrast into the lower stomach (pylorus) even on delayed films taken after 45 minutes.
• 31/12/2011: Relap, Omental suture release at prepyloric region. Bougie was not passing before suture release. But after suture removal Bougie was passed. Kept NPO for 2 days there after. Started Inj. DEXA (steroid) 8 mg IV BD (high dose) which was continued for 5 days.
• 03/01/2012: Gastrograffin study: Fundal dilatation with contrast showing severe obstruction beyond the fundus. No passage of the contrast into the lower stomach (pylorus) even on delayed films taken after 45 minutes. Residual contrast of previous study noted in transverse colon.
• By now even with the high dose steroids, there was no relief. And eventhough Dr.Koshy had said there will be improvement after removal of the tight sutures, my condition was gradually worsening day by day. If I swallow 25 ml liquid, it will go on regurgitating into my mouth atleast 5 to 10 times and finally eventhough I was taking anti-emetics also, I was vomiting.
• Since I was suffering a lot due to recurrent vomiting inspite of Dexa and antiemetics and there was no improvement as Dr.Koshy had promised we decided to shift our treatment to Amrita hospital, Kochi. After we said that, they Dr.Koshy and associates brought a Gastroenterologist (Dr.Jayakumar) from Neyyattinkara (NIMS Hospital). They were advising me to go NIMS hospital 25 kms away to get an endoscopy done for futher evaluation. Since my physical condition was very weak and we had lost trust in Dr.Koshy and team we requested a discharge and proceeded to Amrita hospital, Kochi for further treatment.
• By now my condition was very bad with giddiness developing soon if IV fluids are stopped, unable to get new IV lines on both my hands due to regular IV line insertions and all veins being already clotted, tongue with a white coating, regurgitation of even saliva and acid reflux, being unable to even walk few steps etc.
• After discharge from Meditrina hospital, Trivandrum on 05/01/2011, I was managed at St. Joseph’s hospital, Kothamangalam with IV line insertion, IV fluids and antiemetics till 09/01/2012.
• On 09/01/2012, I was admitted to Amrita hospital, Kochi.
• We requested Dr. Kosy to speak to Dr. Sudheer regarding the surgeries and what exactly is the problem. But he refused to speak to Dr. Sudheer as he was more worried about bad name.
• 10/01/2012: Gastrograffin Swallow performed: Severe narrowing of mid stomach with hold up of contrast.
• 10/01/2012: Upper GI Endoscopy performed: Narrowing of mid stomach.
• 11/01/2012: Endoscopy dialatation attempted: Narrowing of mid stomach. Scope negotiable with difficulty. Serial balloon dilatation from 7 mm to 15 mm tried. Ryle’s tube placed across stricture.
• On discussion with Dr.Sudheer O.V Mch, who reviewed the videos of both surgeries by Dr. Koshy at Trivandrum he said the following mistakes were commited in his surgery. 1st: The fundus of stomach which needs to be removed in this surgery (because Ghrelin the hormone causing appetite is produced there) was not removed. This was also confirmed in the CT scan and also by Dr. Mohammed Ismail at Perinthalmanna. 2nd: The unremoved fudus has become like a pouch collecting all fluids swallowed and not passing below. 3rd: Narrowing in the upper part of stomach due to misalignment of staples. 4th: He has not looked under the left hemidiaphragm.
• Meanwhile there was no relief in symptoms and vomting continued, even after the attempted endoscopic dilatation and Ryle’s tube placement. So Dr.Sudheer O.V Mch advised Roux-en-Y Gastric bypass as the surgical option for me. We also had discussions with Dr. Mohammed Ismail at Perinthalmanna, who is the famous Bariatric surgeon in India. After seeing my Gastrograffin Xray film, he said that there is severe narrowing in the upper stomach and this patient will not be able to drink even water in this condition. He also said that the fundus of stomach which needs to be removed in this surgery is not removed and the patient will not benefit from the surgery done as the patient will have a recurrence of diabetes soon.
• Thus after understanding that there was no other option for me to be able to swallow water again we decided to proceed with Roux-en-Y Gastric bypass. Thus the surgery was performed by Dr.Sudheer O.V Mch at Amritha hospital Kochi on 21/01/2012. The surgery took nearly 8 hours to complete.
• On 24/01/2012: Post Gastrograffin Swallow performed: No leak of contrast.
• On 24/01/2012: Oral sips of fluid was started. I was able to drink even little water without vomiting after about 40 days of vomiting.
• On 27/01/2012: Discharged from Amritha hospital Kochi. IV fluids were stopped on the day of discharge. Thus 41 days of continuous IV fluids and repeated canula injections which caused so much suffering to me due to repeated injections, clotting of veins and pain also ended. There was even an occasion when Dr. Harris, anaesthetist at Meditrina hospital, Trivandrum injected me 4 times with few minutes, trying to get an IV canula line, but failed. Then, due to the pain of repeated injections I requested a nurse at that hospital, who got the IV canula acess with just one injection.
• The sufferings caused by mistake in Dr. Koshy’s surgey is not only the pain, inability to drink water, vomiting, IV fluid injections, 2 repeated surgeries, financial burden, inability to go for work etc. My family was very anxiously following and helping me all these days when I was bed-ridden. What I had gone to Dr.Koshy was for sleeve gastrectomy (reducing the size of the stomach) but due to the surgical mistakes, at this young age of 36, I lost function of my stomach and I will have digestive problems, abdominal pains and have to live entire life on supplements of vitamins, iron, calcium, minerals etc.
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