The patient was diagnosed with triple-vessel coronary artery disease and a large 10-cm mesenteric cyst. Given the severity of his abdominal pain caused by the cyst, the multidisciplinary medical team decided that both major surgeries needed to be performed during the same surgical session rather than delaying the abdominal procedure until after recovery from the cardiac operation.
The first procedure was a beating-heart Coronary Artery Bypass Grafting (CABG). Surgeons created three bypass grafts, using one artery from inside the chest and two veins from the leg, to bypass three blocked coronary vessels.
Immediately after completing the bypass surgery, the gastrointestinal team performed a laparoscopic subtotal excision to remove the 10-cm cyst located in the mesentery, the tissue that supports the intestines. The abdominal procedure was carried out through small keyhole incisions.
The patient recovered well following both operations and continues to do well during follow-up, with no signs of infection.
Under normal circumstances, patients requiring both cardiac and major abdominal surgery undergo the procedures in separate stages. A gap of several weeks to months is generally allowed to give the heart and other organs sufficient time to recover and stabilise after the first major operation.
Performing two major surgeries in immediate succession is considered high-risk because of the additional stress placed on the heart and lungs. The associated concerns include blood loss, anaesthesia-related complications, postoperative complications and infection.
In this case, the patient's severe pain due to the abdominal cyst made it necessary to proceed without delay. To minimise the risk of bleeding, the cardiac team performed the bypass surgery on the beating heart. The gastrointestinal team then removed the cyst using the laparoscopic approach.
The procedures were performed by a multidisciplinary team led by Dr. R. Arun Singh, Cardiothoracic Surgeon, who conducted the bypass operation, with support from Dr. M.S.L. Mahboobu Subuhani, Cardiologist. Dr. Karthikeyan, Gastrointestinal Surgeon, performed the laparoscopic abdominal procedure. Dr. Lakshmanan K and Dr. Selvi Mahalingam M, Anaesthesiologists, provided anaesthesia and perioperative support for both operations.
Explaining the complexities involved, Dr. R. Arun Singh, Cardiothoracic Surgeon, Kauvery Hospital, Tirunelveli, said, “Performing bypass surgery and then proceeding immediately to a major abdominal surgery in the same session is not routinely undertaken anywhere, as the heart is particularly vulnerable in the period immediately following bypass. There are several risks involved. The blood-thinning medicines used during cardiac surgery, along with the body’s altered clotting tendency after bypass, can increase the risk of bleeding. Laparoscopic surgery itself can affect blood flow and heart function. Besides, performing two major procedures in succession places additional stress on the heart and lungs. There is also a risk of infection, including infection affecting the heart. However, in this situation, the patient was experiencing severe pain caused by the abdominal cyst and the procedure could not be delayed. We therefore carefully assessed and managed each of the associated risks to proceed with the abdominal surgery immediately after the bypass.”
Dr. Karthikeyan, Gastrointestinal Surgeon, Kauvery Hospital, Tirunelveli, described the operation as a challenging experience requiring considerable expertise and coordination between the surgical teams.
“This was the first time I performed a major abdominal surgery immediately following a cardiac bypass, and it was a challenging experience that required considerable expertise and close coordination with the cardiac and anaesthesia teams. The patient had to undergo the abdominal procedure because of the severe pain caused by the cyst, despite having just undergone a major cardiac surgery. We had to carefully balance the abdominal requirement with the patient’s cardiac condition and proceed with the laparoscopic surgery without any delay. I am very happy that we were able to complete the procedure successfully and that the patient is recovering well, with both his cardiac and abdominal conditions addressed,” he said.
Dr. Lakshmanan, Medical Administrator, Kauvery Hospital, Tirunelveli, said the achievement reflected the hospital's clinical expertise, preparedness and teamwork.
“We are extremely proud of this significant achievement, which demonstrates the clinical expertise, preparedness and teamwork of our medical teams. Performing two major procedures without an intervening gap required meticulous planning, close coordination and continuous monitoring. The seamless collaboration between our cardiac, gastrointestinal and anaesthesia teams enabled us to undertake this challenging sequence of procedures safely and successfully. This achievement reflects our commitment to providing advanced, multidisciplinary care for patients who present with complex and time-sensitive medical needs,” he said.
The successful completion of both operations in a single uninterrupted surgical session highlights the coordination required between cardiac, gastrointestinal and anaesthesia specialists when treating patients with complex conditions requiring immediate intervention.
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