• The 46-year-old patient got afflicted with elephantiasis 30 years ago and was bed ridden for the last 2 years
• No doctor was ready to take up his case due to sheer size of the swelling

Saidalavi, a 46-year-old man hailing from Kerala’s Thrissur district, was bedridden for the last two years because of a humungous swollen mass hanging from his left thighin a sac like structure that weighed a staggering 14 kg. He got afflicted with lymphatic filariasis (elephantiasis) three decades ago and underwent a couple of surgeries over the years, but to no avail – the swelling kept increasing.

The patient could move with great difficulty with the help of his aged mother and two brothers. His family members ran pillar to post, but no doctor was ready to take up his case due to the sheer size of the swelling which gave his leg a grotesque appearance. It was a race against time as his swollen legs had begun to get infected.

Saidalavi’s life changed radically for the better a few days ago when a team of five surgeons and three anesthetistsat Amrita Institute of Medical Sciences in Kochi removed the deformity in a surgery that lasted over five hours. Said Dr. Subramania Iyer, Head, Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi: “It was a complex surgery. Several complications could rise because of the patient being overweight and his inability to walk. First, we treated him for four weeks with intensive antibiotic therapy to control infection in his legs. Then, the challenge was to institute Comprehensive Decongestive Therapy (CDT) which plays a major role in preparing a lymphedema patient for surgical treatment.In Saidalavi’s case, this went on for a month and involved Manual Lymphatic Drainage (MLD) and a special method of bandaging to make the legs softer by pushing the accumulated fluid to other parts of the body. The size of his swollen legs and immobility made this very difficult and needed at least four therapists instead of the usualone.”

Dr. Subramania Iyer added: “Finally, his leg was ready for reduction. It was a challenge for anesthetists to manage the big excision in such an overweight patient. Saidalavi’s physical transfer to the operating table and correct positioning during surgery was also difficult and required meticulous planning. The surgery was successful and the swelling was removed. However, a massive leaking of fluid from the wound began, which would have prevented healing if sutured immediately. Therefore, we used the technique of vacuum-assisted dressing for the next seven days to suck out the fluid and reduce the size of the legs.Finally, a month after surgery, it was a delightful day for Saidalavi, his family and the lymphedema management team of Amrita Hospital to make him walk on his own without support. He will need further reduction surgery on both the legs after 6-9 months, and then he will be able to lead a normal life.”

Said the patient Saidalavi: “I thank the doctors of Amrita Hospital from the bottom of my heart for enabling me to lead a normal life. It is amazing feeling to stand on my own two feet without any support. I had given up all hope and was even worried that my legs would need to be amputated if the infection spread. I have now got my life back and look forward to taking up a job again.”

India has the highest number of lymphedema patients in the world, a crippling condition involving the collection of body fluid in any part of the body, leading to its abnormal enlargement and eventual disability. The incidence is high mostly due to lymphatic filariasis (elephantiasis), a tropical infection with the filarial worms transmitted through mosquito bites.

Said Dr. Mohit Sharma, Professor, Dept. of Plastic & Reconstructive Surgery, Amrita Institute of Medical Sciences, Kochi: “Lymphedema is a major health problem in India, next only to malaria. In fact, the country has the highest number of lymphedema patients in the world. Lymphatic filariasis (elephantiasis) is endemic in 250 districts in 20 states, putting 600 million people at risk. Kerala has about 6 to 7 lakh cases of this disease. The patients, mostly poor and marginalized, suffer mental, social and financial losses, leading to life-long stigma and poverty. To make matter worse, an increasing number of people are acquiring lymphedema as side-effect of breast cancer therapy.”

Last year, Amrita Institute of Medical Sciences opened India’s most comprehensive lymphedema treatment clinic.The state-of-the-art facility follows a multi-disciplinary approach, combining the traditional Manual Lymphatic Draining (MLD) technique and Complete Decongestive Therapy (CDT) with latest surgical advancements like connecting lymph nodes and vessels to blood vessels using micro surgery. This has the potential to cause significant reduction in oedema and the associated death rate.The new clinic at Kochi can treat the disease almost fully, giving a ray of hope to patients from across the country.Considering the deficiency of lymphedema therapists in India, it runs a training programme twice a year with the assistance of “Lymphedema Alliance of New York”.

Due to the prevalence of this disease in the coastal regions of Kerala, the Amrita Institute of Medical Sciences has started a community health programin the region, aimed at reducing morbidity in the victims.