Tirunelveli: In a challenging surgical procedure, doctors at Kauvery Hospital, Tirunelveli, have successfully performed two major operations consecutively on a 75-year-old man, completing heart bypass surgery followed immediately by laparoscopic abdominal surgery without any interval between them.
The patient was diagnosed with triple-vessel coronary artery disease and a large 10-cm mesenteric cyst, which was causing severe abdominal pain. Given the urgency of his abdominal condition, the medical team decided that postponing the second operation could not be considered.
The first procedure involved an off-pump coronary artery bypass grafting (CABG), performed while the heart continued beating. Surgeons created three bypass grafts using an artery from the chest and veins from the leg to restore blood flow to the blocked coronary arteries.
Immediately after completing the cardiac procedure, the gastrointestinal surgical team proceeded with laparoscopic subtotal excision of the mesenteric cyst. The minimally invasive technique enabled the removal of the cyst through small abdominal incisions.
Such back-to-back procedures are rarely undertaken because performing major abdominal surgery immediately after a heart bypass carries considerable risks. These include excessive bleeding, changes in blood clotting, cardiovascular instability, anaesthesia-related complications and infection. Typically, doctors recommend allowing several weeks or months between the two operations to enable adequate recovery.
The decision to proceed with both surgeries in one session followed a careful assessment of the patient’s condition and the urgency of treating the cyst.
The multidisciplinary team was led by Dr. R. Arun Singh, Cardiothoracic Surgeon, who performed the bypass procedure, with support from Dr. M.S.L. Mahboobu Subuhani, Cardiologist. Dr. Karthikeyan, Gastrointestinal Surgeon, carried out the abdominal surgery, while anaesthesiologists Dr. Lakshmanan K and Dr. Selvi Mahalingam M provided anaesthesia and perioperative support.
Explaining the complexity of the case, Dr. Arun Singh said, “There are several risks involved.” He highlighted the additional challenges associated with blood-thinning medication, altered clotting mechanisms following bypass surgery and the impact of laparoscopic surgery on cardiac function.
Dr. Karthikeyan described the experience as particularly challenging, emphasising the need for close coordination between the cardiac, gastrointestinal and anaesthesia teams to safely complete the second operation immediately after the bypass.
The patient recovered well following both procedures and showed no signs of infection during subsequent follow-up.
The successful outcome highlights the importance of multidisciplinary expertise, advanced surgical capabilities and coordinated clinical decision-making in managing complex cases, particularly when patients require multiple major interventions within a limited timeframe.