In a rare surgery conducted for the first time in Goa, a team of doctors from Healthway Hospital operated on a 7-month-old child and removed a liver tumour weighing 1.8 kgs. The tumour being 18cm by 18cm by 17cm in size, in a child aged only 7 months and arising from the centre of the liver, made the surgery and subsequent care challenging, technically demanding and potentially associated with life-threatening complications.
In a 9-hour operation called Central Hepatectomy, a team of doctors from Healthway Hospitals successfully removed the tumor called Mesenchymal Hamartoma that had grown from the central part of the infant’s liver and filled most of her abdominal cavity pushing aside her intestines and other organs. The infant girl recovered well and was discharged from the hospital without complications.
The team of doctors involved in the life-changing surgery included Dr. Rahul Kakodkar (Hepatobiliary & Liver Transplant Surgeon), Dr. Vishal Sawant (Pediatric and neonatal surgeon), Dr. Jean Louis Menezes (Oncosurgeon), Dr. Bharati Sawant and Dr. Sandeep Pawar (Anaesthetists) and Dr. Sumant Prabhudessai (Pediatric Intensivist) ably supported by nurses Priti Ghadi and Anjali who assisted in the procedure along with the technicians and other staff of Healthway Hospital. The case was diagnosed and referred by Dr. Shivanand Gauns from Mapusa.
Dr Kakodkar pointed out the challenges of removing large central liver tumours from small infants such as this one which include meticulous dissection to reduce blood loss, preservation of blood supply to residual normal liver tissue on both sides of the tumour to prevent liver dysfunction after surgery. Another unique challenge was the anomalous blood supply of the liver in the infant arising from the superior mesenteric artery, something encountered in less than 5% persons. Apart from the surgical challenges, anaesthetising for such supra major and prolonged surgery was very challenging and risky. There was risk of sudden life threatening blood loss. Beat to beat monitoring with invasive lines in the major vein and artery, promptly replacing the blood and fluid loss, maintaining the vital parameters, body temperature and also providing adequate pain relief was very important. This was done with aplomb by Dr Bharati Sawant, Dr Sandeep Pawar, Dr Sumant Prabhudessai and their team.
Dr Vishal Sawant further explained “Sometimes the liver tumours may be very extensive wherein whole liver needs to be removed and liver transplant is the only hope in these children.
The post-surgery care and recovery was efficiently managed by Dr. Sumant and PICU team. Dr. Sawant added, “This was the first time such a big liver tumor was operated and extracted from the body of such a small child in Goa. This was a challenging surgery as the tumour was almost 22 percent of the baby’s weight.”
The Pediatric Surgery department at Healthway Hospitals aims to offer advanced surgical treatment for all complex surgical problems in children. With the availability of a qualified liver transplant and Hepatobiliary surgeons and with the renal transplant program already in place Healthway Hospital aims towards making liver transplant a reality in Goa in the near future.