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14 September 2010

Doctors performed 10 surgeries successfully in a single session on a person, an achievement that is being hailed as a medical miracle.

MEDICAL experts called it a miracle when doctors at Bangalore-based Manipal Hospital performed 10 surgeries on a one person in a single session last month.

Fifty-nine-year-old Nagamma underwent four major joint replacements besides six other surgeries. Not just did she survive, but two days later she was actually able to walk with the help of a support.

Bedridden with multiple aches and pains-in her hips for 15 years, right knee for eight and left knee for two-she had given up hope of ever feeling well or moving about normally. The doctors diagnosed her condition to be progressive flexion deformity which leads to bending of the hips and knees. Rheumatoid arthritis had also struck two years ago. The impact of two disabling diseases had rendered Nagamma immobile and she had to be carried around by her children.

The operative procedures began by placing her flat on her back first and correcting the deformities on the adductor muscles of her hips. After these surgeries, she was turned over and four hamstring release procedures were done on both knees to correct the knee deformities. Later, total hip replacement surgeries were done on both her hips before the replacement surgeries of both her knees. Doctors are flummoxed by how well Nagamma responded to the surgeries and the fact that she did not even require post-operative ICU care.

While the case highlights the advancement in technology and expertise we have gained in the field of medical surgeries, experts feel it was a rare procedure which could have been disastrous for the patient and is better not replicated.

DOCTORS generally perform multiple joint surgeries in a staged manner instead of doing it all in one go. "Multiple joint surgeries are usually performed in stages with a gap of 7-10 days. While surgeries involving two joints are common, it is better not to operate on more than three joints in one go. Not only the patient is in a better state to deal with the trauma of surgery, this also reduces the risk of dislocation. Also, the body replenishes itself with fresh blood during the rest period," says Dr I P S Oberoi, head of orthopaedic department, Artemis Health Institute.

Even the surgeons who performed the surgery were skeptical about whether they be able to go the whole way. "We had planned to do all the surgeries in one session but were not really optimistic. One of the reasons is that a patient usually loses around 2-3 litres of blood which can be fatal. Fortunately, Nagamma's blood loss was minimal which gave us a signal to go ahead with all the procedures. By the end of the session, she only lost 800 ml," says Dr R D Chakravarthy, head of orthopaedic department, Manipal Hospital, who operated upon Nagamma.

Besides blood loss, multiple joint surgeries can burden your body in several ways which can be fatal. "During joint surgeries like hip and knee replacements, we cut the bones and use special kind of cement as a filling with the implant. The use of this cement causes fall in blood pressure which needs to be monitored.

During multiple surgeries, it's obvious that more cement is used which causes a greater fall in blood pressure. When enough blood is not delivered to the body organs, they do not work properly and may be permanently damaged," says Dr Oberoi.

In addition, there is a threat of fat embolism. During a fracture or joint surgery, small fat particles escape from the bone marrow and enter the blood stream.

"These fatty particles travel through the circulation and eventually block the blood vessel. If it moves to the brain, the patient can get into coma. Performing multiple surgeries increases the magnitude of fat embolism and hence higher risk of complications," says Dr Oberoi.

THE risk of prolonged anaesthesia also can't be underestimated.

Nagamma was put on both general as well as local anaesthesia. "During general anaesthesia, all body functions are controlled by experts with the help of machines. Longer the duration of anaesthesia, greater is the risk of complications. The drugs used during anaesthesia have their own side effects," says Dr D K Gupta, senior consultant orthopaedician, Batra Hospital.

Dr Chakravarthy agrees Nagamma's case was rare. "I don't know how she came through without any complications. Her body was being regularly monitored and did not show any sign of decline. I don't know if we would be able to repeat the feat," he admits.

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