Marathon 24-hour surgery held at JIPMER

PUDUCHERRY: Surgeons of the department of cardiothoracic vascular surgery, Jawaharlal Institute of Post Graduate Medical Education and Research (JIPMER), led by Dr K S V K Subba Rao, on December 8, set a mark in world surgical record by successfully performing a  marathon aortic operation in 24 hours and 30 minutes.The rare operation was performed on a 46-year-old man suffering from complete occlusion of entire abdominal aorta and visceral, renal, iliac arteries from the level of diaphragm to femoral region.  In this condition, the blood supply to the liver, spleen, intestines, pancreas, kidneys and both the legs were affected by the blockages in the aorta. The right kidney was not functioning while the left was functioning partially and the patient had been complaining of severe headache. These headaches were due to high blood pressure which in turn was being caused by the lack of blood supply to the kidneys and pain in the legs.Subba Rao said that the multiple visceral and left renal arterial bypass was done along with a right nephrectomy. The patient recovered uneventfully and was discharged;the surgery was done at one go because several vital parts were affected by the blockade.The marathon surgery was done under the guidance of Dr KSVK Subba Rao, head of the department, and was performed by B V Sai Chandran. Young residents, P Sudarsan Reddy,  Pleasant Sunny and E Elamaran were involved. Anaesthesiologists Satyen Parida and Basavaraj participated. They were assisted by nurses K P Yousaf, K Sembainathan, M Sumathy and Kuthukumaran.The entire procedure was done through abdominal approach without opening the chest. An artificial conduit graft was sutured to the abdominal aorta just below the diaphragm using a technique called complete medical visceral rotation. In this the aorta is reached after moving the liver, spleen, intestines to the right side.The suturing had to be performed swiftly as the time delay after 30 minutes of clamping aorta would damage the abdominal organs and the kidney. It had to be done meticulously as any leaks would result in further complications.From this graft, many grafts were attached by sutures and these were then individually attached to the blood vessels supplying liver, spleen, pancreas, left kidney and both legs. The non-functional right kidney was removed.The patient also had pseudoanaeurysm of the right brachial artery, which was repaired in the same sitting. The patient recovered without need for dialysis.